CHRONIC KIDNEY DISEASE

Presented by,
Mariya Antony
3rd year BSc nursing
St.Thomas College Of Nursing
Chethipuzha
 Contents…..
• Introduction
• Definition
• Incidence
• Etiology and risk factors
• Stages
• Pathophysiology
• Clinical manifestations
• Diagnostic measures
• Medical management
• Nutritional therapy
• Nursing management
• Dialysis
Introduction
• Chronic kidney disease (CKD) OR Chronic Renal Failure (CRF) involves
progressive loss of kidney function. It can develop insidiously over many
years or it may result from an episode of ARF from which client has not
covered.

• Despite of all the technological advances in life sustaining treatment with

dialysis ,patients with ESRD have a high mortality rate.
Definition
• Chronic or irreversible renal failure is a progressive
reduction of functioning renal tissue such that the
remaining kidney mass can no longer maintain the
body’s internal environment.
-Joyce. M . Black
• Chronic kidney disease is defined as either the presence of kidney damage
or a decreased GFR less than 60ml/min/1.73metre sq for longer than 3
months.

-KDOQI of the National Kidney Foundation

March 10 ,2022
Incidence
• More than 1 in 7 that is 15% of US adults or 37 million people are
estimated to have CKD.
• SEEK –India cohort study , the prevalence of CKD was 16.4%
CKD Stage 1 was 8%
Stage 2 was 3.2%
Stage 3 was 3.3%
 Etiology and risk factors

❖ The causes of CRF are numerous:

❑ Diabetes – 1st leading cause

❑ Hypertension – 2nd leading cause
❖ Other causes include:
• Chronic glomerulonephritis
• Acute Renal Failure
• Polycystic kidney disease
• Obstruction
• Repeated episodes of
pyelonephritis
• nephrotoxins
❑ Systemic causes
• Lupus erythematosus
• Polyarteritis
• Sickle cell disease
• Amyloidosis
Risk factors
Diabetes mellitus
Hypertension
Age over 60 years
Cardiovascular disease
Family history of CKD
Exposure to nephrotoxic drugs
Stages of ckd
Description GFR(ml/min/1.73 meter sq) Clinical Action Plan

Stage 1 > Or = 90 • Diagnosis and treatment

Kidney damage with normal or • CVD risk reduction
increased GFR • Slow progression
Stage 2 60-89 Estimation of progression
Kidney damage with mild decrease in
GFR
Stage 3 a 45-59 Evaluation of treatment of
Moderate decrease in GFR complications

Stage 3b 30-44 More aggressive treatment of

Moderate decrease in GFR complications
Stage 4 15-29 Preparation for renal replacement
Severe decrease in GFR therapy(dialysis, kidney transplant)

Stage 5 <15 OR Dialysis Renal replacement threrapy

Kidney failure
Pathophysiology
Clinical manifestations
1. Uremia (GFR =10 ml/ 2. Urinary system: Polyuria
min or less)
 3. Metabolic disturbances
• Waste production accumulation
As GFR decreases , the BUN and
S.creatinine increase
.
• Altered carbohydrate metabolism:
Cellular insensitivity to normal
action of insulin
Impaired glucose metabolism
Defective carbohydrate
metabolism
• Elevated triglyceride:
hyperinsulinemia

hepatic production of TGl

• dyslipidemia
 4. Electrolyte and acid- base balance
• Hyperkalemia • Metabolic acidosis

• Hypernatremia

• Hypocalcemia

• Hyperphosphatemia

• Hypermagnesemia
5. Hematologic system

• Anemia( normocytic , • Bleeding tendencies

normochromic) • Infection
6.Cardiovascular system
• 7.Respiratory system • 8. GI System
• Kussmaul breathing • Stomatitis
• dyspnea • Anorexia, nausea, vomiting
• Weight loss
• Malnutrition
• GI bleeding
• Constipation
 9.Neurologic system

• Lethargy
• Apathy
• Decreased ability to concentrate
• Fatigue
• Irritability
• Altered mental ability
• Seizures
• Coma
10. Musculoskeletal
• Ckd mineral bone disorder
 11.Integumentary

• Pruritis
• Dry skin
• Sensory neuropathy
• Uremic frost
• 12.Reproductive 13.Psychologic changes
• Decreased libido • Depression
• Infertility • Withdrawal
• Personality and behavioural change
• Emotional lability
 Diagnostic measures..
• History and physical examination
• Renal ultrasound
• Renal scan
• Ct scan
• Renal biopsy
• Bun, s. creatinine
• Serum electrolytes
• Lipid profile
• Protein to creatinine ratio
• Urinalysis
• Hct and Hb level
 1.History collection
• Family history
• Any drugs
• Dm
• Hypertension
• LBW babies
• Older age
2.Physical examination
Abdominal findings Bruit (atherosclerotic renal stenosis, fibromuscular dysplasia,
distended bladder, flank pain )

Cardiovascular HF, ventricular hypertrophy

Carotid bruit CAD

Decreased peripheral pulses Peripheral Vascular Disease

Increased BP and weight Hypertension

Weight obesity

Musculoskeletal findings Arthritis

synovitis

Ophthalmoscopic findings Hypertensive or diabetic renal disease

Skin changes Rash and Skin changes, dry pale or earthy hue, Hemorrahage
Petechiae, Ecchymosis, Pruritis
• Renal ultrasound • Renal biopsy
• GFR and s. creatinine • urinalysis
ESTIMATION OF GFR 76 YR OLD WOMEN 28 YR OLD MAN
(56KG) (74 KG)

Serum creatinine 1.4 mg/dl 1.4mg/dl

GFR estimated by Cockcroft Gault 30.2ml/min 82.2ml/min

Formula

GFR estimated by MDRD equation 47ml/min/1.73msq 67ml/min/1.73msq

Management
 1. Medical management

a) Pharmacological therapy
❑ a)hyperkalemia
✔ IV glucose and insulin
✔ IV calcium gluconate
✔ Dialysis

b) hypertension
Target BP= less than 130/80
Weight loss
Therapeutic lifestyle
(exercise ,alcohol , smoking)
Diet recommendations : DASH diet
 Antihypertensive medications
Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blocker agents
 c) CKD- MBD
• Administer potassium binder
• Supplementing vit D
• Control hyperparathyroidism
• Cinacalcet, calcimimetic agent-control sec hyperparathyroidism
 d)Anemia

• Exogenous erythropoietin (EPO)

• Dose – as ordered
• Route: IV or Subcutaneous
• Frequency: 2 or 3 times per week
• Darbopoietin Alfa – longer acting
• Administerly weekly or biweekly
• Significant increase in Hct and hb level is usually not seen for 2-3weeks
• IV iron sucrose –For HD patients
e) Dyslipidemia
• Atorvastatin –to lower cholesterol
• Fibrates such as gemfibrozil used to lower Tgl levels
diet
 Nutritional therapy
• A) Protein restriction

• PEM malnutrition
• Evaluate nutritional status:
❑ S .albumin
❑ Pre albumin
❑ Ferritin
❑ Anthropometric measurement
Recommended protein intake 1.2g/kg of IBW Per day
B) Water restriction

C) Sodium and potassium restriction

• Sodium restricted diets:2-4g/kg
• Dietary potassium : 2-3g
Nursing management
• Nursing assessment
Nursing diagnosis

• Excess fluid volume related to impaired kidney function

• Risk for electrolyte imbalance related to impaired kidney function resulting
in hyperkalemia, hypocalcemia , hyperphosphatemia and altered vitamin d
metabolism
• Imbalanced nutrition less than body requirement related to restricted
intake of nutrients ,nausea , vomiting , anorexia and stomatitis
 Dialysis
• Hemodialysis
• Peritoneal dialysis
• CRRT
• KIDNEY TRANSPLANTATION
Round 1:

tyk
 Qn 1:Team 1

1.Modifiable risk factors for CKD include:

• a. Diabetes
• b. Hypertension
• c. History of AKI
• d. Frequent NSAID use
• e. All of the above
E. All of the above

Rationale: Diabetes, hypertension, history of AKI, and

frequent NSAID use can all damage the kidneys and are
risk factors for CKD
 Qn 2: Team 2
2. World kidney day is celebrated on:
• A)May 10
• B)June 12
• C)March 10
• D)October 10

• Answer: March 10
 Qn 3: Team 3
3. GFR (ml/mt/1.73sq) rate for stage 3a CKD:
• A)39-45
• B)30-44
• C)40-59
• D)15-29

• C) 40-59
 Qn 4: Team 4
4. The most important nutrition goal/s for patients with CKD
include:
• a. Limit Na, decrease HTN
• b. Reduce Protein
• c. Glycemic Control/Weight
• d. All of the above
D. All of the above

Rationale: There are several important nutrition goals for patients

with CKD, including limiting Sodium, decreasing hypertension (if
elevated), reduce protein intake, and maintaining a proper weight.
 Qn 5 Team 5
5. A patient with CKD has a low erythropoietin (EPO)
level. The patient is at risk for?*
• A)Hypercalcemia
• B)Anemia
• C)Blood clots
• D)Hyperkalemia

• Answer: Anemia
Round 2:

Round 2:

Rapid fire
Complete the abbrevations :
• ESRD
End Stage Renal Disease
• ARDS
Acute Respiratory Distress Syndrome
• CAPD
Continuous Ambulatory Peritoneal Dialysis
• ECMO
Extra Coporeal Membrane Oxygenation
• IVP
Intravenous Pyelogram
Conclusion
Reference
• Joyce .M .Black

• Lewis Medical Surgical

• www.medline.in