Chronic Kidney Disease Management and care

Mr. Sachin Dwivedi
College of Nursing, AIIMS Rishikesh

Chronic kidney disease
(CKD)
 Chronic kidney disease (CKD) consists of a
spectrum of different pathophysiologic
processes associated with abnormal kidney
function, and a progressive decline in
glomerular filtration rate (GFR).

Acc. To National kidney foundation,
It is defined as……….
1.Kidney damage for ≥3 months, as defined by
structural or functional abnormalities of the
kidney, with or without decreased GFR,
manifest by either:
 Pathological abnormalities or
 Markers of kidney damage
2. GFR <60ml/min/ for ≥3mths, with or
without kidney damage.

Epidemiology
 CKD has a high global prevalence with a
consistent estimated global CKD prevalence of
between 9.1 to 13% with the majority stage 3.
(2022)
 4 to 20% prevalence of CKD in India. (2023)
 Common cause of CKD in India-Diabetic
nephropathy.

Risk factors
 Older age,
 A family history of renal disease,
 A previous episode of acute renal
failure,
 Diabetes mellitus,
 Hypertension,
 Autoimmune disease,
 Structural abnormalities of the
urinary tract.

Causes of chronic kidney
disease
Primary glomerular diseases:
Glomerulonephritis, IgA nephritis.
Systemic disease:
diabetes mellitus, hypertension, SLE,
Hereditary nephropathies:
 Hereditary nephritis.

Cont…
Vascular causes:
 Large vessel disease such as bilateral renal artery
stenosis
 Small vessel disease such as ischemic
nephropathy and vasculitis.
Obstructive causes: such as
 bilateral kidney stones and
 Diseases of the prostate,
 urinary system tumors,

Compensatory
hypertrophy of
surviving nephrons
adaptive hyper filtration
& hypertrophy.
Loss of
excretory
function
Loss of non-
excretory renal
function.
sclerosis of remaining
nephrons, & total
function loss.
Decreased ph, k+,
nitrogenous waste
excretion.
Like failure to
produce
erythropoietin &
to convert
inactive form of
calcium
Pathophysiology

Classification of Chronic Kidney
Disease (CKD)
Stage Description GFR, ml/min
0 With risk factors. >90,
1 Kidney Damage
with normal GFR.
≥90,
2 Kidney Damage
with mild ↓ in GFR.
60-89
3 Moderate ↓ in GFR. 30-59
4 Severe ↓in GFR. 15-29
5 End stage Renal
Disease.
<15
http://www.kidney.org/

Stage 5 CKD is also called established chronic
kidney disease and is synonymous with the now
outdated terms
 end-stage renal disease (ESRD),
 chronic kidney failure (CKF) or
 chronic renal failure (CRF).

End-stage renal disease
 The term represents a stage of CKD where the
accumulation of toxins, fluid, and electrolytes normally
excreted by the kidneys results in the Uremic
syndrome.
 No more compensation; all other organ systems will end
up with some kind of dysfunction.
 This syndrome leads to death unless the toxins are
removed by renal replacement therapy, using dialysis or
kidney transplantation.

Clinical manifestations
Neurological –
Central:
 Slurred speech
 Asterixis and myoclonus
 Seizures
 Disorientation and confusion
 Increased muscle fatigability

Clinical manifestations
 Failure of kidneys to remove excess fluid
may cause:
 Edema of the legs, ankles, feet, face and/or
hands
 Shortness of breath due to extra fluid on the
lungs (may also be caused by anemia)
 hypertension and/or congestive heart failure

Metabolic changes
1.An increase in serum creatinine or BUN.
High levels of urea in the blood, which can
result in:
 Vomiting and/or diarrhea, which may lead
to dehydration.
 Weight loss
 Nocturnal urination.
 Azotemia and ultimately uremia.

Metabolic changes
1.Metabolic acidosis
2.Proteinuria
3.Hyperphosphatemia
4. Hyperkalemia
may cause:
 Abnormal heart rhythms

Hematological changes
 Erythropoietin synthesis is decreased leading to
anemia, which causes:
 Feeling tired and/or weak
 Memory problems
 Difficulty concentrating
 Dizziness

GIT changes
 Appetite loss, a bitter, metallic or salty taste in
the mouth
 Fishy or ammonia-like smell in breath
 Difficulty sleeping
 constipation

Cardiovascular changes
 50%-65% deaths occur due to cardiac
complications of CKD.
 Hypertention
 Left ventricular hypertrophy
 Electrolyte imbalance

Respiratory changes
 Pulmonary edema
 Pleuritis
 Tachypnea

DIAGNOSTIC MEASURES
1.Urine tests:
a) Urinalysis: dipstick test, urine albumin
& creatinine.
b) Twenty-four-hour urine tests: The
urine may be analyzed for protein and
waste products
c) Glomerular filtration rate: As kidney
disease progresses, GFR fall

DIAGNOSTIC MEASURES
2. Blood tests:
 Creatinine and urea (BUN) in the blood
 Electrolyte levels and acid-base balance
 Blood cell counts
 Erythropoietin
3. Other tests:
a) Abdominal ultrasound :Kidneys with CKD are
usually smaller (< 9 cm) than normal kidneys.
b) Renal Biopsy
c) Abdominal CT scan
d) Abdominal MRI
e) Renal scan

MANAGEMENT
Goals of treatment:
1. To preserve renal function
2. To delay the need for dialysis or transplantation as
long as feasible.
3. To alleviate extra renal manifestations as much as
possible.
4. To improve body chemistry values.
5. To provide an optimal quality of life for the client &
significant others.

Preserve renal function & delay dialysis:
PHARMACOLOGICAL THERAPY:
 Antihypertensive: goal is to keep blood pressure at or
below 130/80 mmHg. ACE inhibitors or angiotensin
receptor blockers (ARB) are usually prescribed.
 Cardiovascular agents: diuretics, ianotropic agents.
 Antacids: phosphorus binding antacids (Fosrenol)
 Metabolic acidosis: sodium bicarbonate, dialysis.
 Anemia: Erythropoietin
 Control of blood glucose levels.

Alleviate extra renal manifestations:
 Seizures :Antiseizure agents, safety
measures to protect patient.

Improve body chemistry:
Medications
 Diet management
 Renal replacement therapy:
dialysis , renal transplantation.

Dietary management:
General dietary guidelines:
 Protein restriction: Decreasing protein
intake may slow the progression of
chronic kidney disease.
 Salt restriction: Limit to 2 grams a day to
avoid fluid retention and help control
high blood pressure.
 Restrict Fluid intake

Dietary management:
 Potassium restriction: High levels of potassium can
cause abnormal 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.
 High calorie diet
 Vitamin supplements

Nursing management
Assessment:
1. Complete history taking:
 Past & present history regarding illness, any
medication, diet, wt. changes, patterns of urination etc.
2. Assess pt for the multiple effects of
CRF on all body systems.
3. Assess the pt’s understanding of CRF, the
diagnostic tests,& the treatment regimens.
4. Assess the pt’s need for dialysis.
5. Assess the significant other’s understanding of the
treatment regimen.

Nursing diagnosis.
1. Excess fluid volume related to Decline GFR.
2. Imbalanced nutrition: less than body requirements.
3. Activity intolerance related to fatigue, anemia,
retention of waste products, dialysis.
4. Risk for impaired skin integrity.

Nursing diagnosis.
5. Risk for infection.
6. Risk for injury.
7. Disturbed self- esteem related to dependency, role, change
in body image.

REFERENCES
 Brunner & Suddarth’s, Textbook of Medical Surgical
Nursing.10th ed. Lippincott.
 Black M. Joyce, Hawks Hokanson Jane, Medical
Surgical nursing.7th ed.2005, Saunders
 http://www.emedicinehealth.com/

Chronic Kidney Disease Management and care

Chronic Kidney Disease Management and care

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