Chronic Kidney Disease
Chronic Kidney Disease could be known if the following criteria has met:
- Kidney damage for equal or more than 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR
- GFR <60 mL/min/1.73m2 for greater than or equal 3 months, with or without kidney damage
Stages of Chronic Kidney Disease
This is according to National Kidney Foundation
| Stage | Description | GFR (mL/min/1.73m2 ) |
| 1 | Kidney damage with normal or increased GFR | Greater than or equal 90 |
| 2 | Kidney damage with mild decrease of GFR | 60-89 |
| 3 | Moderate decrease of GFR | 30-59 |
| 4 | Severe decrease of GFR | 15-29 |
| 5 | Kidney Failure | Less than 15 (dialysis) |
Risk Factors
- Diabetes – most common cause of chronic kidney disease worldwide; obesity is an additional factor for diabetes
- Hypertension – systolic hypertension is of particular concern. Beginning at around age 50, systolic blood pressure rises and continues to rise with age.
- Autoimmune disease
- Systemic infection
- Urinary stones or lower urinary tract obstruction
- Exposure to certain toxic drugs – cyclosporins and othe immunosuppressive agents and corticosteriods
Diagnostic Evaluation:
- Urinalysis reveal that casts found in urine are helpful in determining the type of kidney disease
- Blood analyses may include levels of createnine, blood urea nitrogen, serum electrolytes and pH
- Ultrasonography can detect a tumor or hydronephrosis
- Computed tomography and magnetic resonance imaging demonstrate vessel disorders
- Kidney arteriography and venography can show damage to kidney vasculature
- Proteinuria screening – persistent proteinuria is usually the first indicator of kidney damage.
Signs and symptoms:
- swelling, usually of the lower extremities
- fatigue
- weight loss
- loss of appetite
- nausea or vomiting
- a change in urination (change in volume and frequency)
- change is sleep pattern
- headaches
- itching
- difficulties in memory and concentration
Complications:
- Cardiovascular disease – hypertension may also contribute to the development and increase the risk of stroke
- Anemia – when kidneys are damaged there is a decrease in erythropoietine, a hormone that stimulates production of red blood cells
- Bone disease – disorders of calcium and phosphorus metabolism may develop early
- Malnutrition – alteration of the body’s response to insulin as well as other metabolic functions (such as erythropoietin formation and vitamin D matebolism)
- Decreased functional status and well-being – includes complex regimen, adverse effects and the possible or actual loss of job and income
Medical Management:
- Peritoneal dialysis
- Hemodialysis
- Kidney Transplantation
Nursing Management:
- Proper assessment for risk factors that might cause a rapid decline
- Encourage self-management such a blood pressure monitoring and glucose monitoring
- Administer prescribe medications ( ion exchange resin, alkalizing agents, antibiotics, erythropoietin, folic acid supplements)
- Maintain strict fluid control
- Encourage intake of high biologic value protein (eggs, dairy products and meats)
- Encourage adequate rest
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
