CASE PRESENTATION

•JELYN CASONGSONG JAKE DIZON

•RHEALYN VELASQUEZ DIANE CARINO
•LUCY ISON EURIKA CLAVERIA
•DIVINE PARAGAS LESTER DANAN
•MILLEN BASTILO FRED MARRA
•BON BAUTISTA EMILYN ESPINO
•MJ SORIANO AHMED BA ELAIAN
INTRODUCTION
Jelyn Casongsong
• Chronic kidney disease means your kidneys
are damaged and can't filter blood the way
they should. The disease is called “chronic”
because the damage to your kidneys happens
slowly over a long period of time. This
damage can cause wastes to build up in your
body. CKD can also cause other health
problems.
Health History
Lester Danan
 Past Health History
• The patient stated that around May 2013 he noticed some symptoms but did
not knew that it was CKD already. The patient also stated that during a
basketball league, his knees started to feel weak while he was running and
noticed that he was not that agile anymore. After a few days the patient
went for a checkup and noticed on his laboratory results that his hemoglobin
level is low and was advised to have two bags of blood transfusion, the
patient stated that it went well and his condition gets better for quite some
time. But after a few days the patient eventually felt weak again and stated
that he experienced chills and fever that lasts about two to three days.
 Present Health History
• The patient was rushed to the hospital with symptoms of
weakness, chills, and fever. He appears to be in distress, exhibit
malaise and generalized weakness. Upon several diagnostic
procedures and laboratory test the result of the creatinine level of
the patient is high and was ordered to have an emergency dialysis.
He was diagnosed to have Stage 5 Chronic Kidney Disease.
Assessment
Emilyn Espino
VITAL SIGNS
 HR - 110 bpm

 BP - 140/80 mmHg

 RR - 24 breaths/min

GENERAL APPEARANCE
 The patient appears to be in distress. Exhibit malaise and generalized weakness

SKIN
 The patient was pale-looking has dry and itchy skin. Uremic frost was noted

HEENT
 Head- The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions,
or scarring.
 Eyes- xerostomia (dry mucus membranes) was noted

 Ears- Non-tender. Hearing is weak on the left ear. 

 Nose- The nasal septum is midline. Nares are patent bilaterally.

 Throat/mouth- Dry mouth was noted.

PULMONARY
 Posterior thorax is symmetric, have no tenderness and masses. Shortness of breath, kussmaul breathing and
crackles are present

UPPER EXTREMITIES
 Both extremities are equal in size, have the same contour with prominences of joints color is even, has difficulty in
performing complete range of motion, crepitus noted on joints 

GASTROINTESTINAL

 The patient’s abdomen skin color is uniform, rounded, distended, no tenderness noted, and has no muscle
guarding. Nausea was noted.

LOWER EXTREMITIES
 Bilateral legs with +2 pitting edema, observed weakness of the legs.

MUSCULOSKELETAL
 Has contractures and tremors, muscle and bone weakness are present.

NEUROLOGIC
 Presence of asterixis and disorientation
Medical Diagnosis
Lucy Ison
• Patient is diagnosed with stage 5 chronic kidney disease.
Stage 5 CKD mean that the patient have an estimated
glomerular filtration rate or eGFR of less than 15.
Meaning, the kidneys are getting very close to failure or
have completely failed. This disease does not have a cure
but to do a lifetime dialysis based on his doctor's
judgement.
Anatomy and Physiology
Bon Mark Bautista
Urinary System
Urinary system anatomy
Kidneys
• Paired structures
• Main functions: regulate volume, composition, and pH of body fluids

• Removes metabolic wastes from blood, excretes to outside of body

Kidney anatomy
Nephron functioning

• Four processes:
• Filtration- movement of substances from blood to nephron
• Reabsorption- moving substances back into blood
• Secretion- removing select molecules from blood to tubule
• Excretion- filtrate into the bladder
Nephrons
• Each kidney contains about 1 million

• Composed of two parts

1. Renal corpuscle (glomerulus, Bowman’s (glomerular) capsule)
2. Renal tubules (from Bowman’s to collecting duct)

• Distal tubules of several nephrons empty into one collecting duct, many
collecting ducts merge
Renal corpuscle

- Capsule
- Glomerulus
Glomerular filtration

• Blood from afferent arteriole into glomerular capillaries

• Capillaries are very permeable

• Large volume of water, ions, sugars are filtered out of the blood stream
and into the renal tubule
Glomerular filtration

• Only 20% filters through, 19% reabsorbed

Capillary pressure

• Drives filtration from capillary to glomerulus

• Primarily due to blood pressure
Reabsorption
• Concentration gradients
• Along Loop of Henle

• Descending loop- permeable to water, as solute

concentration increases in medulla, water moves
to try to equalize
• Ascending loop- permeable to solutes, as solute
concentration decreases, solutes move

• Allows for reabsorption of water and solutes as

needed
Secretion

• If a substance isn’t caught during filtration, capillaries can secrete into

nephron
• Usually an active transport process
• Organic compounds and foreign materials
Urethra

• Tube through which urine leaves body

Urine

• 95% water
• Urea, chloride, sodium, other organic and inorganic substances
PATHOPHYSIOLOGY OF CHRONIC
KIDNEY DISEASE
EURIKA CLAVERIA
 PATHOPHYSIOLOGY

CHRONIC KIDNEY DISEASE

HYPERTENSION DIABETES

OTHERS: LUPUS, NICOTINE, NSAIDS

 PATHOPHYSIOLOGY

HYPERTENSION

RENAL ARTERY TRANSFORMING

NARROW LUMEN ISCHEMIC INJURY
THICKENS GROWTH FACTOR BETA 1

MESANGIAL CELLS
REGRESSION TO GLOMERULOSCLEROSIS CKD
MESANGIOBLASTS
 PATHOPHYSIOLOGY

DIABETES

INCREASE
NON-ENZYMATIC HYALINE
PRESSURE IN HYPERFILTRATION
GLYCATION ARTERIOSCLEROSIS
GLOMERULUS

SECRETION OF MORE
GLOMERULOSCLEROSIS CKD
STRUCTURAL MATRIX
 PATHOPHYSIOLOGY

OTHER CAUSES

LUPUS NSAIDS

NICOTINE
 PATHOPHYSIOLOGY

CHRONIC KIDNEY
DISEASE

DECREASED GFR
1 7
HIGH UREA LEVES,
HYPERNATREMIA
AZOTEMIA 3 5
HYPERVOLEMIA
HYPERKALEMIA
EDEMA
2 6
HIGH CREATININE
4 HYPERMAGNESEMIA
LEVELS
OLIGURIA
 PATHOPHYSIOLOGY

CHRONIC KIDNEY
DISEASE

DECREASED GFR
8 14
HYPERPHOSPHATEMI
HIGH BP
A 10 12
RENAL
HEMATURIA
OSTEODYSTHROPHY
9 13

HYPOCALCEMIA 11 ANEMIA

PROTEINURIA
Diagnostic
AHMED BA ELAIAN
•Blood test for glomerular filtration rate or GFR: tell how well your
kidneys are working to remove wastes from your blood

•Blood tests. A sample of your blood may reveal rapidly rising levels of urea
and creatinine — two substances used to measure kidney function, also
serum electrolyte test to measure the electrolytes level.

•Urine output measurements. Measuring how much you urinate in 24

hours may help your doctor determine the cause of your kidney failure.

•Urine tests. Analyzing a sample of your urine (urinalysis) and for albumin

(albuminuria), may reveal abnormalities that suggest kidney failure.

•Imaging tests. Imaging tests such as ultrasound and computerized

tomography (CT scan) may be used to help your doctor see your kidneys.

•kidney biopsy.  a kidney biopsy to remove a small sample of kidney tissue

for lab testing. Your doctor inserts a needle through your skin and into your
kidney to remove the sample to look at glomerulosclerosis.
Medical Management

Mj Soriano
•Pharmacologic therapy
o Azathioprine
o Prednisolone
o Cyclophosphamide
o Pt. is having Dialysis 2-3 times a week sometimes once a week
SURGICAL MANAGEMENT:

Diane Carino
Kidney transplant
 A kidney transplant involves surgically placing a healthy kidney from a donor into
your body.
 Kidney transplantation has become the treatment of choice for most patients with
ESKD.
 In addition, the cost of maintaining a successful transplantation is one third the
cost of dialysis treatment.
 Kidney transplantation is an elective procedure, not an emergency lifesaving
procedure.
 Transplanted kidneys can come from deceased or living donors.
•Preoperative management goals
 Bringing the patient's metabolic state to a level as close to normal as possible through diet,
possibly dialysis and medical management, making sure that the patient is free of infection,
and preparing the patient for surgery and the postoperative course.
Medical Management
 A complete physical examination is performed on the donor and the recipient
 Tissue typing, blood typing, and antibody screening are performed
 Other diagnostic tests must be completed to identify conditions requiring treatment before transplantation for
either individual.
 The lower urinary tract is studied to assess bladder neck function and to detect ureteral reflux.
 After surgery, medications to prevent transplant rejection will be prescribed to the transplant recipient.
 A psychosocial evaluation is conducted
 A psychosocial evaluation is also conducted to assess the organ donor's motive for giving the organ.
 If a dialysis routine has been established, hemodialysis is often performed the day before the scheduled
transplantation procedure
NURSING MANAGEMENT:
 Preoperative education can be conducted in a variety of settings, including the outpatient preadmission area,
the hospital, or the transplantation clinic during the preliminary workup phase.
 Assess the knowledge and feelings about the procedure
 The overall goal is to preserve the function of the organs through maintaining hemodynamic stability,
decreasing the risk for infection, and monitoring laboratory values while providing dignified care to the donor
and family members
Postoperative Management
•The goal of postoperative care is to maintain homeostasis until the transplanted kidney is functioning
well. The patient whose kidney functions immediately has a more favorable prognosis than the patient whose
kidney does not.

Medical Management:
 After a kidney transplantation, rejection and failure can occur within 24 hours (hyperacute), within 3 to 14
days (acute), or after many years.
 A hyperacute rejection is caused by an immediate antibody-mediated reaction that leads to generalized
glomerular capillary thrombosis and necrosis. It requires immediate removal of the transplanted organ
 An acute rejection typically occurs within a few days to weeks of the transplant surgery, and the patient
experiences tenderness at the transplant site, a decrease in serum creatinine values, fever, malaise, and it
requires early recognition and treatment with immunosuppressant therapy.
 The long-term survival of a transplanted kidney depends on how well it matches the recipient and how well
the body's immune response is controlled.
 Combinations of corticosteroids and medications specifically developed
•NURSING MANAGEMENT:
 Measure urine output every 30 to 60 minutes initially
 Monitor serum electrolytes and renal function test
 Assessing the patient for transplant rejections
 Preventing infection
 Addressing psychological concerns
 Monitoring and managing potential complications
 Discharge Planning
• Velasquez, Rhealyn B
 Instruct the patient to take his medication
exactly as prescribed.
 Educate the patient to drink plenty of water.
 Educate the patient to maintain a normal blood
pressure.
 Advice the patient to maintain a healthy weight.
 Advice the patient to limit sodium (salt) and pain
medications.
 Advice the patient to avoid alcohol intake and do
not smoke.
 Encourage to create an exercise and healthy
eating plan.
 NURSING CARE PLAN
DIVINE PARAGAS

FRED MARRA
THANK
YOU