CHRONIC KIDNEY DISEASE CHRONIC RENAL FAILURE CHRONIC KIDNEY INJURY END STAGE RENAL DISEASE

1. CHRONIC KIDNEY DISEASE
Presented by,
Mariya Antony
3rd year BSc nursing
St.Thomas College Of Nursing
Chethipuzha

2. Contents…..
• Introduction
• Definition
• Incidence
• Etiology and risk factors
• Stages
• Pathophysiology
• Clinical manifestations
• Diagnostic measures
• Medical management
• Nutritional therapy
• Nursing management
• Dialysis

3. Introduction
• Chronic kidney disease (CKD) OR Chronic Renal Failure (CRF) involves
progressive loss of kidney function. It can develop insidiously over
many years or it may result from an episode of ARF from which client
has not covered.
• Despite of all the technological advances in life sustaining treatment
with dialysis ,patients with ESRD have a high mortality rate.

4. Definition
• Chronic or irreversible renal failure is a progressive
reduction of functioning renal tissue such that the
remaining kidney mass can no longer maintain the
body’s internal environment.
-Joyce. M . Black
• Chronic kidney disease is defined as either the presence of kidney
damage or a decreased GFR less than 60ml/min/1.73metre sq for
longer than 3 months.
-KDOQI of the National Kidney Foundation

5. March 10 ,2022

6. Incidence
• More than 1 in 7 that is 15% of US adults or 37 million people are
estimated to have CKD.
• SEEK –India cohort study , the prevalence of CKD was 16.4%
CKD Stage 1 was 8%
Stage 2 was 3.2%
Stage 3 was 3.3%

7. Etiology and risk factors
The causes of CRF are numerous:
 Diabetes – 1st leading cause
 Hypertension – 2nd leading cause

8. Other causes include:
• Chronic glomerulonephritis
• Acute Renal Failure
• Polycystic kidney disease
• Obstruction
• Repeated episodes of
pyelonephritis
• nephrotoxins
Systemic causes
• Lupus erythematosus
• Polyarteritis
• Sickle cell disease
• Amyloidosis

9. Risk factors
Diabetes mellitus
Hypertension
Age over 60 years
Cardiovascular disease
Family history of CKD
Exposure to nephrotoxic drugs

10. Stages of ckd

11. Description GFR(ml/min/1.73 meter sq) Clinical Action Plan
Stage 1
Kidney damage with normal or
increased GFR
> Or = 90 • Diagnosis and treatment
• CVD risk reduction
• Slow progression
Stage 2
Kidney damage with mild decrease
in GFR
60-89 Estimation of progression
Stage 3 a
Moderate decrease in GFR
Stage 3b
Moderate decrease in GFR
45-59
30-44
Evaluation of treatment of
complications
More aggressive treatment of
complications
Stage 4
Severe decrease in GFR
15-29 Preparation for renal replacement
therapy(dialysis, kidney transplant)
Stage 5
Kidney failure
<15 OR Dialysis Renal replacement threrapy

13. Pathophysiology

15. Clinical manifestations

16. 1. Uremia (GFR =10 ml/min
or less)
2. Urinary system: Polyuria

17. 3. Metabolic disturbances
• Waste production accumulation
As GFR decreases , the BUN
and S.creatinine increase
.
• Altered carbohydrate metabolism:
Cellular insensitivity to normal
action of insulin
Impaired glucose metabolism
Defective carbohydrate
metabolism

18. • Elevated triglyceride:
hyperinsulinemia
hepatic production of TGl
• dyslipidemia

19. 4. Electrolyte and acid- base balance
• Hyperkalemia
• Hypernatremia
• Hypocalcemia
• Hyperphosphatemia
• Hypermagnesemia
• Metabolic acidosis

20. 5. Hematologic system
• Anemia( normocytic
,normochromic)
• Bleeding tendencies
• Infection

21. 6.Cardiovascular system

22. • 7.Respiratory system
• Kussmaul breathing
• dyspnea
• 8. GI System
• Stomatitis
• Anorexia, nausea, vomiting
• Weight loss
• Malnutrition
• GI bleeding
• Constipation

23. 9.Neurologic system
• Lethargy
• Apathy
• Decreased ability to concentrate
• Fatigue
• Irritability
• Altered mental ability
• Seizures
• Coma

24. 10. Musculoskeletal
• Ckd mineral bone disorder

25. 11.Integumentary
• Pruritis
• Dry skin
• Sensory neuropathy
• Uremic frost

26. • 12.Reproductive
• Decreased libido
• Infertility
13.Psychologic changes
• Depression
• Withdrawal
• Personality and behavioural
change
• Emotional lability

27. Diagnostic measures..
• History and physical examination
• Renal ultrasound
• Renal scan
• Ct scan
• Renal biopsy
• Bun, s. creatinine
• Serum electrolytes
• Lipid profile
• Protein to creatinine ratio
• Urinalysis
• Hct and Hb level

28. 1.History collection
• Family history
• Any drugs
• Dm
• Hypertension
• LBW babies
• Older age

29. 2.Physical examination

30. Abdominal findings Bruit (atherosclerotic renal stenosis, fibromuscular
dysplasia, distended bladder, flank pain )
Cardiovascular HF, ventricular hypertrophy
Carotid bruit CAD
Decreased peripheral pulses Peripheral Vascular Disease
Increased BP and weight Hypertension
Weight obesity
Musculoskeletal findings Arthritis
synovitis
Ophthalmoscopic findings Hypertensive or diabetic renal disease
Skin changes Rash and Skin changes, dry pale or earthy hue, Hemorrahage
Petechiae, Ecchymosis, Pruritis

31. • Renal ultrasound • Renal biopsy

32. • GFR and s. creatinine • urinalysis

33. ESTIMATION OF GFR 76 YR OLD WOMEN
(56KG)
28 YR OLD MAN
(74 KG)
Serum creatinine 1.4 mg/dl 1.4mg/dl
GFR estimated by Cockcroft Gault
Formula
30.2ml/min 82.2ml/min
GFR estimated by MDRD equation 47ml/min/1.73msq 67ml/min/1.73msq

34. Management

35. 1. Medical management
a) Pharmacological therapy
 a)hyperkalemia
 IV glucose and insulin
 IV calcium gluconate
Dialysis
b) hypertension
Target BP= less than 130/80
Weight loss
Therapeutic lifestyle
(exercise ,alcohol , smoking)
Diet recommendations : DASH diet

36. Antihypertensive medications
Diuretics
Calcium channel blockers
ACE inhibitors
Angiotensin receptor blocker agents

37. c) CKD- MBD
• Administer potassium binder
• Supplementing vit D
• Control hyperparathyroidism
• Cinacalcet, calcimimetic agent-control sec hyperparathyroidism

38. d)Anemia
• Exogenous erythropoietin (EPO)
• Dose – as ordered
• Route: IV or Subcutaneous
• Frequency: 2 or 3 times per week
• Darbopoietin Alfa – longer acting
• Administerly weekly or biweekly
• Significant increase in Hct and hb level is usually not seen for 2-
3weeks
• IV iron sucrose –For HD patients

39. e) Dyslipidemia
• Atorvastatin –to lower cholesterol
• Fibrates such as gemfibrozil used to lower Tgl levels

40. diet

41. Nutritional therapy
• A) Protein restriction
• PEM malnutrition
• Evaluate nutritional status:
S .albumin
Pre albumin
Ferritin
Anthropometric measurement
Recommended protein intake 1.2g/kg of IBW Per day

42. B) Water restriction
C) Sodium and potassium restriction
• Sodium restricted diets:2-4g/kg
• Dietary potassium : 2-3g

46. Nursing management
• Nursing assessment

47. Nursing diagnosis
• Excess fluid volume related to impaired kidney function
• Risk for electrolyte imbalance related to impaired kidney function
resulting in hyperkalemia, hypocalcemia , hyperphosphatemia and
altered vitamin d metabolism
• Imbalanced nutrition less than body requirement related to
restricted intake of nutrients ,nausea , vomiting , anorexia and
stomatitis

48. Dialysis
• Hemodialysis
• Peritoneal dialysis
• CRRT
• KIDNEY TRANSPLANTATION

49. Round
:
tyk

50. Qn 1:Team 1
1.Modifiable risk factors for CKD include:
• a. Diabetes
• b. Hypertension
• c. History of AKI
• d. Frequent NSAID use
• e. All of the above

51. E. All of the above
Rationale: Diabetes, hypertension, history of AKI, and
frequent NSAID use can all damage the kidneys and are
risk factors for CKD

52. Qn 2: Team 2
2. World kidney day is celebrated on:
• A)May 10
• B)June 12
• C)March 10
• D)October 10
• Answer: March10

53. Qn 3: Team 3
3. GFR (ml/mt/1.73sq) rate for stage 3a CKD:
• A)39-45
• B)30-44
• C)40-59
• D)15-29
• C) 40-59

54. Qn 4: Team 4
4. The most important nutrition goal/s for patients with CKD
include:
• a. Limit Na, decrease HTN
• b. Reduce Protein
• c. Glycemic Control/Weight
• d. All of the above

55. D. All of the above
Rationale: There are several important nutrition goals for
patients with CKD, including limiting Sodium, decreasing
hypertension (if elevated), reduce protein intake, and
maintaining a proper weight.

56. Qn 5 Team 5
• A)Hypercalcemia
• B)Anemia
• C)Blood clots
• D)Hyperkalemia
• Answer: Anemia
5. A patient with CKD has a low erythropoietin
(EPO) level. The patient is at risk for?*

57. Round 2:
Rapid fire
Round 2:

58. Complete the abbrevations :
• ESRD
End Stage Renal Disease
• ARDS
Acute Respiratory Distress Syndrome
• CAPD
Continuous Ambulatory Peritoneal Dialysis
• ECMO
Extra Coporeal Membrane Oxygenation
• IVP
Intravenous Pyelogram

60. Conclusion

61. Reference
• Joyce .M .Black
• Lewis Medical Surgical
• www.medline.in