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1. Chronic Kidney
Disease

2.  Chronic kidney disease: is a condition characterized by the
gradual, irreversible loss of kidney function resulting from long-term
disease or injury; also called chronic renal failure.
 Chronic kidney disease typically progresses over many years
without causing symptoms.
 Patients are often diagnosed late in the course of illness, after most
kidney function has been lost.
 The most common causes of chronic kidney disease are diabetes
mellitus and hypertension, which are estimated to cause 45 and 27
percent of cases, respectively.
 Other conditions that lead to chronic kidney disease include
inflammatory (swelling of body), immunological, and hereditary
diseases that directly involve the kidneys.

3. Consequences of Chronic Kidney
Disease
 In the early stages of chronic kidney disease, the functional
nephrons compensate for those that are lost or damaged: they
enlarge and filter blood more rapidly so that they are able to
handle the extra workload.
 The overburdened nephrons continue to degenerate until
eventually the kidneys are unable to function adequately,
resulting in kidney failure, condition called End-stage Renal
Disease.
 End-stage Renal Disease refers to an advanced stage of
chronic kidney disease in which dialysis or a kidney transplant is
necessary to sustain life.

4.  Chronic kidney disease is evaluated based on;
1. Glomerular Filtration Rate (GFR); the rate at which filtrate is
formed within the kidneys, normally about 125 mL/min in
healthy young adults.
2. The Degree Of Albuminuria; the amount of albumin lost in
urine daily.
 GFR is considered the best index of overall kidney function,
whereas albuminuria reflects the extent of kidney damage.

6. There are three consequences of chronic kidney
disease and these are;
 Altered Electrolytes and Hormones
 Uremic Syndrome
 Malnutrition

7. Altered Electrolytes and Hormones
 As the GFR falls, the increased activity of the remaining nephrons is
often sufficient to maintain electrolyte excretion; thus, fluid and
electrolyte imbalances may not develop until the fourth or fifth stage
of chronic kidney disease when all the nephrons are damaged.
 A number of hormonal adaptations also help to regulate electrolyte
levels, but these changes may cause complications of their own.
 The increased secretion of aldosterone (hormone secreted by
adrenal gland) helps to prevent increases in serum potassium but
promotes sodium and thus water retention, may contributes to fluid
overload and the development of hypertension.

8.  Increased secretion of parathyroid hormone (secreted by
parathyroid gland to regulate concentration of serum calcium
and phosphate) may result into bone loss a condition termed as
Renal Osteodystrophy.
 Renal Osteodystrophy: is a bone disorder that develops in
patients with chronic kidney disease as a result of increased
secretion of parathyroid hormone.
 Because the kidneys are responsible for maintaining acid–base
balance, acidosis may develop at later stages of chronic kidney
disease.
 The acidosis exacerbates Renal Osteodystrophy because
compounds in bone (for example, protein and phosphates) are
released to buffer the acid in blood.

9. Uremic Syndrome
 Uremia (increased blood levels of urea and thus
nitrogenous waste) may develop during the final stages
of chronic kidney disease, when the GFR falls below
about 15 milliliters per minute.
 The many complications that result from uremia are
collectively known as the uremic syndrome.
 These include; Neuromuscular disturbances, Altered
heart function/increased heart disease risk, etc.

10. Malnutrition
 The problems caused by chronic kidney disease contribute to
protein-energy wasting, a syndrome characterized by losses of
muscle mass and energy reserves.
 The wasting occurs as a result of the breakdown of body
proteins and negative nitrogen balance (nitrogen input less
than nitrogen output, seen in children with kwashiorkor).
 In addition, patients with chronic kidney disease often eat
poorly because of anorexia (loss of appetite to food), dietary
restrictions, depression, and the dietary challenges of other
diseases.
 Nutrient losses contribute to malnutrition

11. Treatment of Chronic Kidney
Disease
 Dialysis; this replaces kidney function by removing excess fluid and wastes
from the blood using a dialyzer (artificial kidney).
 Energy; patients are advised to consume enough energy to maintain a
healthy body weight.
 Protein; A moderate protein restriction may be prescribed to slow disease
progression and reduce nitrogenous wastes.
 Lipids; patients should limit the intake of saturated and trans fats to control
elevated blood lipid levels.
 Sodium and Fluids; Recommendations depend on the total urine output,
changes in body weight and blood pressure, and serum sodium levels. A
rise in body weight and blood pressure suggests that the person is retaining
sodium and fluid;

12.  Phosphorus, Calcium, and Vitamin D; To minimize
the risk of bone disease, serum phosphate and
calcium levels are monitored in renal patients, and
laboratory values help to guide recommendations.
 Potassium; Most patients can handle typical intakes
of potassium during stages 1 through 4 of illness.
Restrictions are generally advised for patients who
develop hyperkalemia (high serum potassium levels)