Chronic kidney disease Chronic kidney disease occurs when one suffers from gradual and usually permanent

loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency. With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease. Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive. Risk Factors 1. Diabetes most common cause of chronic kidney disease worldwide; obesity is an additional factor for diabetes 2. Hypertension systolic hypertension is of particular concern. Beginning at around age 50, systolic blood pressure rises and continues to rise with age. 3. Autoimmune disease 4. Systemic infection 5. Urinary stones or lower urinary tract obstruction 6. Exposure to certain toxic drugs cyclosporins and othe immunosuppressive agents and corticosteriods Pathophysiology
Kidney damage with normal or increased GFR of >90 mL/min Blood flow through the kidney increases (hyperfiltration) and the kidneys increase in size Usually no outward signs are present Kidney damage with a mild decrease in GFR of 60-89 mL/min Albuminuria <30 mg/d Normal blood pressure Kidney damage with a moderate decrease in GFR of 30-59 mL/min Microalbuminuria becomes constant Losses increase to 30-300 mg/d Advanced kidney damage with GFR 15-29 mL/min Nephropathy Large amounts of protein in the urine Blood pressure increases New symptoms: nausea, taste changes, uremic breath, anorexia, difficulty concentrating, and numbness in fingers and toes End-stage renal disease (ESRD) with a GFR <15 mL/min Kidneys fail so toxins build up in the blood, causing an overall ill feeling New symptoms: anorexia, nausea or vomiting, headaches, fatigue, anuria, swelling around eyes and ankles, muscle cramps, tingling in hands or feet, and changing skin color and pigmentation

Symptoms may include: General ill feeling and fatigue Generalized itching (pruritus) and dry skin Headaches Weight loss without trying to lose weight Appetite loss Nausea Other symptoms that may develop, especially when kidney function has worsened: Abnormally dark or light skin Bone pain Brain and nervous system symptoms o Drowsiness and confusion o Problems concentrating or thinking o Numbness in the hands, feet, or other areas o Muscle twitching or cramps Breath odor Easy bruising, bleeding, or blood in the stool Excessive thirst Frequent hiccups Low level of sexual interest and impotence Menstrual periods stop (amenorrhea) Sleep problems, such as insomnia, restless leg syndrome, and obstructive sleep apnea Swelling of the feet and hands (edema) Vomiting, typically in the morning Fluid volume overload - symptoms may range from mild edema to lifethreatening pulmonary edema Complications Anemia Bleeding from the stomach or intestines Bone, joint, and muscle pain Changes in blood sugar Damage to nerves of the legs and arms (peripheral neuropathy) Dementia Fluid buildup around the lungs (pleural effusion) Heart and blood vessel complications o Congestive heart failure o Coronary artery disease o High blood pressure o Pericarditis o Stroke High phosphorous levels High potassium levels Hyperparathyroidism

Increased risk of infections Liver damage or failure Malnutrition Miscarriages and infertility Seizures Weakening of the bones and increased risk of fractures

Diagnostic Evaluation: 1. Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease 2. Blood analyses may include levels of createnine, blood urea nitrogen, serum electrolytes and pH 3. Ultrasonography can detect a tumor or hydronephrosis 4. Computed tomography and magnetic resonance imaging demonstrate vessel disorders 5. Kidney arteriography and venography can show damage to kidney vasculature 6. Proteinuria screening persistent proteinuria is usually the first indicator of kidney damage. Treatment Medical Treatment There is no cure for chronic kidney disease. The four goals of therapy are to: 1. slow the progression of disease; 2. treat underlying causes and contributing factors; 3. treat complications of disease; and 4. replace lost kidney function. Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following: Control of blood glucose Control of high blood pressure Protein restriction: Decreasing protein intake may slow the progression of chronic kidney disease. A dietitian can help you determine the appropriate amount of protein for you. Salt restriction: Limit to 4-6 grams a day to avoid fluid retention and help control high blood pressure. Fluid intake: Excessive water intake does not help prevent kidney disease. In fact, your doctor may recommend restriction of water intake. Potassium restriction: This is necessary in advanced kidney disease because the kidneys are unable to remove potassium. High levels of potassium can causeabnormal heart rhythms. Examples of foods high in potassium include bananas, oranges, nuts, and potatoes. Phosphorus restriction: Decreasing phosphorus intake is recommended to protect bones. Eggs, beans, cola drinks, and dairy products are examples of foods high in phosphorus. Other important measures that you can take include: carefully follow prescribed regimens to control your blood pressure and/or diabetes; stop smoking; and lose excess weight.

In chronic kidney disease, several medications can be toxic to the kidneys and may need to be avoided or given in adjusted doses. Among over-the-counter medications, the following need to be avoided or used with caution: Certain analgesics: Aspirin; nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen [Motrin, for example]) Fleets or phosphosoda enemas because of their high content of phosphorus Hemodialysis Peritoneal dialysis Surgical Treatment Kidney transplant Nursing management 1. Proper assessment for risk factors that might cause a rapid decline 2. Encourage self-management such a blood pressure monitoring and glucose monitoring 3. Administer prescribe medications ( ion exchange resin, alkalizing agents, antibiotics, erythropoietin, folic acid supplements) 4. Maintain strict fluid control 5. Encourage adequate rest

Wesleyan University- Philippines College of Nursing

Case Study
(Chronic Kidney Disease)
Submitted by:

Christiane Faye R. Pelayo

BSN III- BLK II Group 3

Submitted to: Maam Jocelle Lucena Clinical instructor