Chronic Kidney Disease

Chronic Kidney Disease could be known if the following criteria has met:

  1. Kidney damage for equal or more than 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased GFR
  2. 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

  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

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.

Signs and symptoms:

  1. swelling, usually of the lower extremities
  2. fatigue
  3. weight loss
  4. loss of appetite
  5. nausea or vomiting
  6. a change in urination (change in volume and frequency)
  7. change is sleep pattern
  8. headaches
  9. itching
  10. difficulties in memory and concentration

Complications:

  1. Cardiovascular disease – hypertension may also contribute to the development and increase the risk of stroke
  2. Anemia – when kidneys are damaged there is a decrease in erythropoietine, a hormone that stimulates production of red blood cells
  3. Bone disease – disorders of calcium and phosphorus metabolism may develop early
  4. Malnutrition – alteration of the body’s response to insulin as well as other metabolic functions (such as erythropoietin formation and vitamin D matebolism)
  5. Decreased functional status and well-being – includes complex regimen, adverse effects and the possible or actual loss of job and income

Medical Management:

  1. Peritoneal dialysis
  2. Hemodialysis
  3. Kidney Transplantation

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 intake of high biologic value protein (eggs, dairy products and meats)
  6. 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.

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