MEDICAL SURGICAL NURSING

SEMINAR ON

CHRONIC KIDNEY
DISEASE

SUBMITTED TO: SUBMITTED BY:

MS.ANJALI C GARGI M P

NURSING TUTOR 1ST YEAR MSC NURSING

AL-SHIFA COLLEGE OF NURSING AL-SHIFA COLLEGE OF

NURSING

SUBMITTED ON:
CENTRAL OBJECTIVE

At the end of class group will get adequate knowledge about “CHRONIC KIDNEY
DISEASE”

SPECIFIC OBJECTIVE

At the end of class group will be able to:

 describe about the chronic kidney disease.

 list down the risk factors of chronic kidney disease.
 briefly describe about pathophysiology of chronic kidney disease
 discuss the management of chronic kidney disease
 describe nursing care of a client with chronic kidney disease.
 CHRONIC KIDNEY DISEASE

Subject : MEDICAL SURGICAL NURSING Group :

Topic : CHRONIC KIDNEY DISEASE Place :

Method of teaching : Lecture-cum-discussion Date :

Teaching AV aid : Time :

Name of student teacher: GARGI M P Duration:

Name of the evaluator : MS.ANJALI C

 INTRODUCTION

Kidneys are small bean-shaped organs which are located behind the belly and under the ribs.
There are two kidneys and each one is located on either side of the spine. The size of each
kidney varies from 4 to 5 inches which are roughly the size of a fist. The kidneys consist of
many small filters called nephrons and its purpose is to purify the blood by extracting waste
out of the blood and the waste is converted into urine. This urine is accumulated in the
kidney's pelvis and then passed through a tube called the ureter and the bladder. This helps in
balancing body fluids and levels of electrolytes in the body. This process continues several
times a day. Kidneys are vital organs which help in maintaining healthy salt, pH, phosphorus
and potassium levels in the body. They also generate enzymes called renin which adjusts
blood pressure levels. It monitors the production of red blood cells by making a chemical
called erythropoietin and helps in absorbing calcium for healthy bones and teeth.

Once the kidney is damaged the filtering of blood is halted which leads to piling up of fluids
and waste in the body and this shows out symptoms such as poor sleep, nausea, shortness of
breath, weakness and swelling in the ankles. Kidney needs to be treated to prevent further
damage, if ignored it can lead to serious health issues and even death.
CHRONIC KIDNEY DISEASES

When the kidneys stop functioning for a longer period like 3 months or more it is called
chronic kidney disease. This is generally caused due to high blood pressure in the body.
Maintaining blood pressure levels in the body is very important as increased blood pressure
damages glomeruli in the kidneys which leads to kidney failure. The tiny blood vessels that
clean blood in the kidneys are called glomeruli. Chronic kidney disease can also be caused
due to diabetes. High sugar levels cause severe damage to blood vessels in the kidneys. Once
the condition is diagnosed the patient is advised to undergo dialysis. Dialysis is a process that
helps in extracting extra waste and fluids from the blood. This process can help kidneys to
perform better but it cannot cure the disease.

DEFINITION

Chronic kidney disease (CKD) is a type of kidney disease in which there is gradual loss of
kidney function over a period of months to years

INCIDENCE

 CKD, with its high prevalence, morbidity and mortality, is an important

public health problem.
 With <3% of land mass, India hosts 17% of the Earth’s population.
 Large numbers of patients below the poverty line, low gross domestic
product, and low monetary allocations for health care have led to
suboptimal outcomes.
 Moreover, CKD and other non communicable diseases have often been
ignored in the face of persistent challenges from and competition for
resources for communicable diseases and high infant and maternal
mortality
 Several issues contribute to high prevalence of CKD in India.
 United Nations Children’s Emergency Fund data show that 28% of
children are <2.5 kg at birth. Hypovitaminosis A and other nutritional
issues during pregnancy may cause smaller kidney volume at birth and a
lower eGFR.
 Consanguinity and genetic inbreeding increase risk of congenital
anomalies of the kidney and urinary tract and obstructive or reflux
nephropathy.
 Poverty, poor sanitation, pollutants, water contamination, overcrowding,
and known and unknown nephron toxins (including heavy metals and
plant toxins in indigenous remedies) may lead to glomerular and
interstitial kidney diseases.
 Added to these exposures are the growing burden of hypertension and
diabetes mellitus.
 By 2030, India is expected to have the world’s largest population of
patients with diabetes.
 Because of challenges in access to care, over 50% of patients with
advanced CKD are first seen when the eGFR is <15 ml/min per 1.73 m2.
 This sobering number highlights the need for robust screening programs
for those at risk for CKD.
 The reported prevalence of CKD in different regions ranges from <1% to
13%, and recently, data from the International Society of Nephrology’s
Kidney Disease Data Center Study reported a prevalence of 17%
 The etiology of CKD varies considerably throughout India.
 Parts of the states of Andhra Pradesh, Odisha, and Goa have high levels
of CKD of unknown etiology (CKDu), which is a chronic interstitial
nephropathy with insidious onset and slow progression .
  Compounding these issues is the sobering fact that 1.3 billion people are
served by 1850 nephrologists who are unequally distributed but mostly
concentrated in urban centers.
 Nephrology training positions are inadequate to grow the workforce, and
the situation is worsened by “brain drain” to developed countries..

CAUSES AND RISK FACTORS OF CHRONIC KIDNEY DISEASE

1. DIABETES
 Diabetes and CKD are very closely linked. According to the National
Kidney Foundation, diabetes is the leading cause of CKD.
 Chronic high blood sugar levels, and the high blood pressure that may
be associated with the development and progression of CKD, can
damage the kidney’s small blood vessel filtering system and contribute
to kidney failure
 Most of the risk factors for kidney disease in patients with diabetes
can be modified. We can treat and manage them.
 However, like many other chronic diseases, kidney disease has very
few early symptoms.
 For instance, a patient may have albuminuria, which is the earliest sign
of kidney disease.
 It means that there is too much of the protein albumin in the urine, but
a patient may not have any symptoms specific to the albuminuria.
 The prevalence of kidney disease in the United States is about 15
percent, yet awareness of kidney disease is very low.
 Patients can have kidney disease for a long time without having
symptoms or knowing that they have the disease.
  We found that many transplant patients and new dialysis patients had
little awareness of their kidney disease and did not know what they
could have done
 It is especially important to talk to patients with diabetes about kidney
disease risk factors because they are more than twice as likely to
develop kidney disease than those without diabetes.
 By talking with patients who have diabetes about kidney disease, the
disease may be diagnosed early, and patients can take steps to help
slow its progression.
2. HYPERTENSION
 More than half the people with chronic kidney disease (CKD) have
high blood pressure.
 High blood pressure increases the chance that kidney disease will get
worse.
 High blood pressure makes you more likely to develop heart disease.
 Following your treatment plan carefully and keeping your blood
pressure under control can help to prevent these complications.
 Treatment for high blood pressure and CKD includes following
healthy diet, exercising and taking medications. Blood pressure should
be controlled to less than 130/80 if you have CKD.
 High blood pressure can damage blood vessels by causing scaring and
weaken the vessel wall.
 It decrease the GFR thus causing damage to kidney cells.
3. Age and race
4. Cardio vascular disease
5. Obesity
6. Metabolic syndrome
7. Acute kidney injury
8. Malignancy
 9. Family history
10.Kidney stones
11.Infections
12.Hepatitis B and C
13.Auto immune diseases
14.Nephrotoxics like NSAIDS.

PATHOPHYSIOLOGY OF CKD

Compensatory hypertrophy of surviving nephrons

Adaptive hyper filtration and hypertrophy

Loss of excretory function Decreased ph,K+, nitrogenous waste excretion

Loss of non-excretory renal function -- Failure of erythropoietin formation

Sclerosis of remaining nephrons and total functional loss

CLINICAL MANIFESTATIONS

 Uremia: Syndrome that incorporates all signs and symptoms seen in

various systems throughout the body
 Urinary system
 Polyuria
Results from inability of kidneys to concentrate urine
Occurs most often at night
Specific gravity fixed around 1.010
 Oliguria
Occurs as CKD worsens
 Anuria
Urine output <40 ml per 24 hours
 Metabolic disturbances
 Waste product accumulation
 As GFR ↓, BUN ↑ and serum creatinine levels ↑
 BUN ↑
 Not only by kidney failure but by protein intake, fever,
corticosteroids, and catabolism
 N/V, lethargy, fatigue, impaired thought processes, and headaches
occur
 Electrolyte/acid–base imbalances
 Sodium -May be normal or low
  Because of impaired excretion, sodium is retained
 Water is retained
 Edema
 Hypertension
 CHF
 Potassium -Hyperkalemia
 Most serious electrolyte disorder in kidney disease
 Fatal dysrhythmias
 Calcium and phosphate alterations
 Magnesium alterations
 Metabolic acidosis
 Results from
 Inability of kidneys to excrete acid load (primary ammonia)
 Hematologic system
 Anemia
 Due to ↓ production of erythropoietin
 From ↓ of functioning renal tubular cells
 Bleeding tendencies
 Defect in platelet function
 Infection
 Changes in leukocyte function
 Altered immune response and function
 Diminished inflammatory response
 Cardiovascular system
 Hypertension
 Heart failure
 Left ventricular hypertrophy
  Peripheral edema
 Dysrhythmias
 Uremic pericarditis
 Respiratory system
 Kussmaul respiration
 Dyspnea
 Pulmonary edema
 Uremic pleuritis
 Pleural effusion
 Predisposition to respiratory infections
 Depressed cough reflex
 “Uremic lung”
 Gastrointestinal system
 Every part of GI is affected
 Due to excessive urea
 Mucosal ulcerations
 Stomatitis
 Uremic fetor (urinous odor of the breath)
 GI bleeding
 Anorexia
 N/V
 Neurologic system
 Expected as renal failure progresses
 Attributed to
 Increased nitrogenous waste products
 Electrolyte imbalances
 Metabolic acidosis
  Demyelination of nerve fibers
 Altered mental ability
 Seizures and Coma
 Dialysis encephalopathy
 Peripheral neuropathy
 Restless leg syndrome
 Muscle twitching
 Irritability
 Decreased ability to concentrate
 Reproductive system Infertility
 Experienced by both sexes
 Decreased libido
 Low sperm counts
 Sexual dysfunction
 Musculoskeletal system
 Renal osteodystrophy
 Syndrome of skeletal changes
 Result of alterations in calcium and phosphate metabolism
 Weaken bones, increase fracture risk
 Two types associated with ESRD
 Osteomalacia
 Osteitis fibrosa
 Integumentary system
 Most noticeable change
 Yellow-gray discoloration of the skin
 Due to absorption/retention of urinary pigments
 Pruritus
  Uremic frost
 Dry, pale skin
 Dry, brittle hair
 Thin nails
 Petechiae
 Ecchymoses

CLASSICATION OF CKD

Stage Description GFR ml/min

0 With risk factors >90
1 Kidney damage with risk factors > 90
2 Kidney damage with mild decrease in 60- 89
GFR
3 Moderate decrease in GFR 30-59
4 Severe decrease in GFR 15-29
5 Kidney failure < 15

DIAGNOSIS

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 (urea, nitrogen, and creatinine).

c) Glomerular filtration rate: As kidney disease progresses, GFR fall

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