Английский для нефрологической сестринской помощи: ключевые термины

"chronic kidney disease"

A long-term, progressive condition in which the kidneys gradually lose their ability to filter waste products and excess fluid from the blood, classified into five stages based on glomerular filtration rate

"The patient was diagnosed with stage 3b chronic kidney disease and referred to the renal nurse specialist for education on dietary modification and medication review."

"acute kidney injury"

A sudden, rapid deterioration in kidney function occurring over hours to days, characterised by a rise in serum creatinine or fall in urine output, and potentially reversible if identified and treated early

"Post-operative acute kidney injury was suspected when the patient's urine output dropped below 0.5 mL per kilogram per hour for six consecutive hours following major abdominal surgery."

"glomerular filtration rate"

A measure of how well the kidneys filter waste from the blood, expressed in millilitres per minute per 1.73 m² of body surface area; the primary index used to stage chronic kidney disease

"The repeat blood test revealed an estimated glomerular filtration rate of 28 mL/min/1.73 m², indicating disease progression from stage 3 to stage 4 CKD."

"serum creatinine"

A waste product of muscle metabolism filtered by the kidneys; a rising serum creatinine level indicates impaired kidney function and is a key diagnostic marker for both AKI and CKD

"Serum creatinine had doubled from baseline within 48 hours, meeting the KDIGO criteria for stage 2 acute kidney injury and prompting urgent nephrology review."

"proteinuria"

The presence of excess protein, particularly albumin, in the urine; a marker of glomerular damage and an independent risk factor for progression of kidney disease and cardiovascular events

"A urine albumin-to-creatinine ratio of 320 mg/g confirmed significant proteinuria, and the patient was started on an ACE inhibitor to slow renal progression."

"nephrotoxic drug"

Any medication or substance capable of causing direct damage to the renal tubular cells or impairing kidney perfusion, including NSAIDs, aminoglycoside antibiotics, contrast agents, and certain chemotherapy agents

"The renal nurse identified that the patient had been self-medicating with ibuprofen daily and explained that the nephrotoxic drug was likely contributing to her deteriorating kidney function."

"oliguria"

Urine output of less than 0.5 mL per kilogram per hour in adults or less than 400 mL per 24 hours, indicating insufficient renal filtration and a potential sign of acute kidney injury or haemodynamic compromise

"The nurse escalated to the medical registrar when oliguria persisted despite adequate fluid resuscitation, raising concern for intrinsic renal injury rather than a pre-renal cause."

"renal biopsy"

A percutaneous procedure in which a small sample of kidney tissue is extracted using a needle under ultrasound guidance to obtain a histological diagnosis of glomerular or tubulointerstitial kidney disease

"The patient was consented for a renal biopsy after presenting with nephrotic syndrome, and the renal nurse provided post-procedure monitoring instructions including observation for haematuria and flank pain."

"arteriovenous fistula"

A surgically created connection between an artery and a vein, usually in the forearm, that causes the vein to enlarge and develop a strong blood flow, providing reliable long-term access for haemodialysis needling

"The renal nurse assessed the arteriovenous fistula for a thrill and bruit before each dialysis session to confirm patency and detect early signs of stenosis or thrombosis."

"tunnelled central venous catheter"

A long-term dialysis catheter inserted into a central vein and tunnelled under the skin to reduce infection risk, used when arteriovenous access is not yet mature or has failed

"Strict aseptic technique was used during tunnelled central venous catheter care, including hub disinfection and dressing changes, to minimise the risk of catheter-related bloodstream infection."

"dialysis adequacy"

A measure of how effectively haemodialysis removes uraemic toxins from the blood, commonly expressed as the Kt/V ratio, which should reach at least 1.2 per session to meet clinical targets

"Monthly Kt/V measurements confirmed dialysis adequacy was being achieved consistently, but the nurse noted the patient had been cutting short sessions, reducing delivered dose."

"intradialytic hypotension"

A fall in blood pressure during a haemodialysis session, typically defined as a drop in systolic pressure of 20 mmHg or more, often caused by excessive ultrafiltration, antihypertensive medication timing, or poor cardiac reserve

"The patient experienced intradialytic hypotension during the final hour of dialysis and was placed in the Trendelenburg position while the ultrafiltration rate was reduced and a saline bolus administered."

"ultrafiltration"

The process by which excess fluid is removed from the blood during haemodialysis by applying hydrostatic pressure across the dialysis membrane, with the rate calibrated to achieve the patient's dry weight

"The dialysis nurse programmed an ultrafiltration rate of 800 mL per hour to remove the 2.4 kg of interdialytic weight gain over the three-hour session."

"dry weight"

The target post-dialysis body weight at which a patient is free of clinically detectable fluid overload and significant fluid depletion, reassessed regularly as clinical status changes

"The nephrologist lowered the patient's dry weight by 1 kg after the echocardiogram showed persistent mild pericardial effusion and residual signs of fluid overload at the end of each session."

"heparin anticoagulation"

The use of heparin administered into the extracorporeal circuit during haemodialysis to prevent blood clotting in the dialyser and bloodlines without causing systemic anticoagulation in most patients

"The dialysis nurse initiated heparin anticoagulation by programming an initial bolus followed by an hourly infusion into the arterial limb of the circuit to maintain circuit patency throughout the four-hour session."

"muscle cramps"

Painful involuntary muscle contractions occurring during or immediately after haemodialysis, commonly caused by excessive or rapid fluid removal, electrolyte shifts, or low blood pressure

"The patient reported severe muscle cramps in both legs during the final 30 minutes of dialysis; the nurse administered hypertonic saline and reduced the ultrafiltration rate, providing rapid relief."

"continuous ambulatory peritoneal dialysis"

A form of peritoneal dialysis performed manually by the patient four to five times daily, with each exchange consisting of draining used dialysate and infusing fresh solution via a permanent abdominal catheter

"The renal nurse taught the patient continuous ambulatory peritoneal dialysis technique over four days, emphasising aseptic connection and disconnection to prevent peritonitis."

"automated peritoneal dialysis"

A peritoneal dialysis modality using a cycler machine to perform multiple automated exchanges overnight while the patient sleeps, offering greater lifestyle flexibility than manual exchanges

"After struggling with four manual exchanges daily, the patient was converted to automated peritoneal dialysis and reported significantly improved quality of life and sleep."

"peritonitis"

An infection of the peritoneal membrane, the most serious complication of peritoneal dialysis, characterised by cloudy dialysate effluent, abdominal pain, and fever, requiring prompt antibiotic therapy

"The dialysis nurse identified peritonitis when the patient reported abdominal pain and brought in a cloudy dialysate bag; effluent was sent for cell count and culture, and intraperitoneal antibiotics were started empirically."

"exit site infection"

A localised bacterial infection at the point where the peritoneal dialysis catheter exits the skin, presenting as erythema, crusting, or purulent discharge, which can progress to tunnel infection and peritonitis if untreated

"The patient attended the renal unit with an exit site infection showing purulent discharge and surrounding erythema; a swab was taken and oral antibiotics prescribed after reviewing local sensitivity patterns."

"dialysate glucose concentration"

The concentration of glucose in the peritoneal dialysis solution, available in 1.36%, 2.27%, and 3.86% strengths, which determines osmotic pressure and thus the amount of fluid removed during each exchange

"The nurse increased the dialysate glucose concentration from 1.36% to 2.27% to achieve additional ultrafiltration in a patient with signs of fluid retention between visits."

"residual renal function"

The remaining urine-producing capacity of the native kidneys in dialysis patients, which contributes to overall solute clearance, fluid balance, and phosphate control and is associated with improved survival

"The renal team emphasised the importance of avoiding nephrotoxic drugs and maintaining adequate hydration to preserve residual renal function, noting that even 200 mL of daily urine output had significant clinical benefits."

"PD catheter"

A soft silicone tube surgically inserted through the abdominal wall into the peritoneal cavity to allow repeated infusion and drainage of dialysate; requires careful skin care and aseptic handling to prevent infection

"During the pre-dialysis assessment, the renal nurse inspected the PD catheter exit site for signs of infection and reinforced correct catheter immobilisation technique to prevent mechanical trauma."

"membrane transport status"

A classification of peritoneal membrane permeability based on the peritoneal equilibration test, categorised as high, high average, low average, or low transporter, which guides choice of dialysis solution and dwell time

"The peritoneal equilibration test revealed high transporter membrane status, prompting the team to recommend automated peritoneal dialysis with short dwell times to optimise solute clearance and ultrafiltration."

"hyperkalaemia"

An abnormally high serum potassium level, typically above 5.5 mmol/L, which in renal failure can reach life-threatening levels causing dangerous cardiac arrhythmias and muscle weakness

"The nurse immediately informed the renal registrar when the potassium result returned at 6.8 mmol/L, and the patient was placed on continuous cardiac monitoring while intravenous calcium gluconate and insulin-dextrose were prepared."

"fluid balance chart"

A nursing document that records all fluid inputs and outputs over a defined period, including oral fluids, intravenous infusions, urine, drain output, and insensible losses, to calculate net fluid balance

"Accurate completion of the fluid balance chart was essential for the dialysis nurse to calculate interdialytic weight gain and adjust the ultrafiltration target for the following session."

"fluid restriction"

A prescribed limit on total daily fluid intake, commonly 750–1500 mL per day in dialysis patients, implemented to prevent dangerous fluid overload between dialysis sessions

"The dietitian and renal nurse jointly educated the patient on fluid restriction, explaining that all liquids including soups, ice cream, and fluid medications counted toward the 1000 mL daily allowance."

"metabolic acidosis"

A disturbance of acid-base balance characterised by a low blood pH and reduced bicarbonate level, commonly caused by impaired acid excretion by the failing kidneys

"The venous blood gas confirmed metabolic acidosis with a bicarbonate of 14 mmol/L, and the patient was commenced on oral sodium bicarbonate supplementation to reduce the chronic acid load."

"hyperphosphataemia"

Elevated serum phosphate levels above 1.5 mmol/L in dialysis patients, resulting from impaired renal phosphate excretion and associated with vascular calcification, itching, and secondary hyperparathyroidism

"The renal dietitian reviewed the patient's diet following a phosphate of 2.3 mmol/L and reinforced the need to take phosphate binders with every meal to reduce gastrointestinal phosphate absorption."

"phosphate binder"

An oral medication taken with food to bind dietary phosphate in the gastrointestinal tract and prevent its absorption, used to manage hyperphosphataemia in CKD and dialysis patients

"The nurse noted that the patient was taking his phosphate binder after meals rather than with the first bite of food, a timing error that significantly reduced the drug's efficacy."

"oedema assessment"

The clinical evaluation of fluid accumulation in body tissues, graded by degree of pitting, location, and extent, using examination of the ankles, sacrum, and lungs to guide fluid removal decisions

"The renal nurse documented pitting oedema extending to the mid-shin bilaterally, graded as 2+, and a weight gain of 3.5 kg since the last dialysis session, informing the ultrafiltration prescription."

"hyponatraemia"

A serum sodium level below 135 mmol/L, which in renal patients can result from excessive fluid intake relative to sodium intake or impaired water excretion, causing symptoms from mild confusion to seizures in severe cases

"The CKD patient presented with confusion and a sodium of 126 mmol/L; the renal nurse assisted with fluid restriction and reviewed the medication list for drugs known to cause hyponatraemia, including diuretics and antidepressants."

"immunosuppression"

The pharmacological suppression of the immune system using drugs such as tacrolimus, mycophenolate, and prednisolone to prevent the recipient's immune cells from recognising and attacking the transplanted kidney

"The transplant nurse counselled the patient on the importance of strict immunosuppression adherence, explaining that even one missed dose of tacrolimus could increase the risk of acute rejection."

"acute rejection"

An immune response against transplanted kidney tissue occurring days to months after transplantation, characterised by a rise in creatinine and confirmed by biopsy, typically treated with high-dose intravenous corticosteroids

"Acute rejection was suspected when serum creatinine rose 30% above baseline at three weeks post-transplant; the patient was admitted for renal biopsy and commenced on methylprednisolone pulse therapy."

"calcineurin inhibitor"

A class of immunosuppressive drugs including tacrolimus and ciclosporin that prevent T-lymphocyte activation by inhibiting calcineurin, forming the cornerstone of most renal transplant immunosuppression regimens

"The transplant nurse ensured tacrolimus trough levels were drawn before the morning dose, explaining that consistent sampling time was essential for interpreting calcineurin inhibitor levels and adjusting the dose safely."

"delayed graft function"

The need for dialysis in the first week after kidney transplantation due to ischaemia-reperfusion injury to the donor organ, requiring the patient to remain on temporary dialysis until the transplanted kidney recovers

"Delayed graft function was diagnosed when the patient's urine output remained below 200 mL per day and creatinine failed to fall in the first 48 hours post-transplant; haemodialysis was continued via the temporary catheter."

"graft function monitoring"

The regular assessment of transplanted kidney performance through serial serum creatinine measurements, urine output recording, and periodic protocol biopsies to detect subclinical rejection early

"The transplant coordinator scheduled twice-weekly graft function monitoring for the first month, then reduced to weekly as the patient's creatinine stabilised within the target range."

"opportunistic infection"

An infection caused by pathogens that rarely cause disease in immunocompetent individuals but become problematic in transplant recipients whose immune defences are suppressed, including CMV, BK virus, and Pneumocystis jirovecii

"The transplant nurse educated the new recipient about opportunistic infection prophylaxis, explaining that trimethoprim-sulfamethoxazole for Pneumocystis and valganciclovir for CMV were essential medications for the first six months."

"crossmatch"

A pre-transplant compatibility test in which donor cells are mixed with recipient serum to detect pre-formed antibodies that would cause immediate rejection of the graft, with a positive crossmatch generally contraindicating transplantation

"A negative crossmatch was confirmed the evening before the scheduled operation, allowing the transplant team to proceed with organ acceptance and notify the recipient to attend for surgery."

"biopsy-proven rejection"

Transplant rejection confirmed by histopathological examination of a kidney biopsy specimen, classified according to the Banff criteria into T-cell-mediated or antibody-mediated rejection to guide specific treatment

"The histology report described changes consistent with Banff 1A acute T-cell-mediated rejection, and the multidisciplinary team commenced three days of methylprednisolone followed by optimisation of the maintenance immunosuppression."

"erythropoiesis-stimulating agent"

A class of drugs including epoetin and darbepoetin that stimulate the bone marrow to produce red blood cells, used to treat the anaemia of chronic kidney disease caused by insufficient erythropoietin production by the kidneys

"The renal nurse administered the monthly subcutaneous injection of darbepoetin as part of the patient's erythropoiesis-stimulating agent regimen and documented the haemoglobin trend to assess treatment response."

"transferrin saturation"

A measure of the amount of iron bound to transferrin relative to the total iron-binding capacity, used alongside serum ferritin to assess iron stores and guide intravenous iron therapy in renal anaemia management

"A transferrin saturation of 16% below the target of 20% indicated functional iron deficiency, and the renal nurse arranged intravenous iron infusion prior to the next erythropoiesis-stimulating agent dose adjustment."

"secondary hyperparathyroidism"

An increase in parathyroid hormone secretion occurring in CKD in response to low calcium, high phosphate, and reduced vitamin D activation by the kidneys, leading to renal osteodystrophy and vascular calcification

"The patient's intact PTH was 620 pg/mL, well above the target range for dialysis patients; the renal nurse reinforced adherence to phosphate binders and reviewed the cinacalcet dose with the prescribing pharmacist."

"renal osteodystrophy"

A complex bone disease caused by abnormal calcium, phosphate, and parathyroid hormone metabolism in CKD, leading to weakened bones, fracture risk, and skeletal deformity

"Bone densitometry revealed significant loss at the femoral neck consistent with renal osteodystrophy, prompting a referral to the specialist metabolic bone service and a review of the patient's active vitamin D therapy."

"vascular calcification"

The abnormal deposition of calcium phosphate crystals in the walls of blood vessels, highly prevalent in CKD and dialysis patients, contributing to cardiovascular mortality and stiffness of the arterial wall

"Plain X-ray of the pelvis demonstrated extensive vascular calcification of the iliac vessels, a finding that influenced the vascular surgeon's recommendation against arteriovenous fistula creation in that limb."

"uraemia"

A clinical syndrome resulting from the accumulation of urea and other nitrogenous waste products in the blood due to severely impaired kidney function, causing symptoms including nausea, vomiting, pruritus, confusion, and pericarditis

"The patient presented with uraemic pericarditis and uremic frost visible on the skin, indicating an urgent need to initiate renal replacement therapy; the renal nurse co-ordinated emergency haemodialysis access."

"renal pruritus"

Generalised or localised itching caused by uraemia, calcium-phosphate product deposition in the skin, or secondary hyperparathyroidism in CKD and dialysis patients, significantly impairing quality of life

"The patient described severe renal pruritus that was disrupting sleep; the renal nurse reviewed phosphate and PTH levels, adjusted the phosphate binder regimen, and initiated a trial of topical emollient to reduce skin dryness."

"cardio-renal syndrome"

A clinical condition in which dysfunction of the heart and kidneys occur together, with each organ's failure exacerbating the other through haemodynamic, neurohormonal, and inflammatory pathways

"The patient admitted with acute decompensated heart failure developed worsening creatinine consistent with type 1 cardio-renal syndrome; the renal and cardiology nurses collaborated closely to balance diuresis against renal perfusion."