Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).

1. Mr.Sachin Dwivedi
M.SC. Medical surgical Nursing
K.G.M.U Institute of Nursing ,
Lucknow

2. Chronic kidney
Disease

3. Chronic kidney disease
(CKD)
 Chronic kidney disease (CKD)
consists of a spectrum of
different pathophysiologic
processes associated with
abnormal kidney function, and a
progressive decline in glomerular
filtration rate (GFR).

4. Acc. To National kidney foundation,
It is defined as……….
1.Kidney damage for ≥3 months, as defined by
structural or functional abnormalities of the
kidney, with or without decreased GFR,
manifest by either:
 Pathological abnormalities or
 Markers of kidney damage
2. GFR <60ml/min/ for ≥3mths, with or
without kidney damage.

5. Epidemiology
 Chronic kidney disease is a growing
health problem in the United States.
 A report by the Centers for Disease
Control (CDC) determined that 16.8% of
all adults above the age of 20 years may
have chronic kidney disease.
 Incidence: 200 cases per 1 million
persons U.S.

6. Risk factors
 Diabetes mellitus,
 Hypertension,
 Autoimmune disease,
 Older age,
 A family history of renal disease,
 A previous episode of acute renal
failure,
 Structural abnormalities of the
urinary tract.

7. Causes of chronic kidney
disease
Primary glomerular diseases:
 Glomerulonephritis, IgA nephritis, pyelonephritis.
Systemic disease:
diabetes mellitus, hypertension, Postinfectious
glomerulonephritis, SLE,
Hereditary nephropathies:
 Hereditary nephritis
 Polycystic kidney disease

8. Cont…
Vascular causes:
 Large vessel disease such as bilateral renal artery
stenosis
 Small vessel disease such as ischemic
nephropathy and vasculitis.
Obstructive causes: such as
 bilaterl kidney stones and
 diseases of the prostate,
 urinary system tumors,
 Vesicoureteral reflux

9. Compensatory
hypertrophy of
surviving nephrons
adaptive hyper filtration
& hypertrophy.
Loss of
excretory
function
Loss of non-
excretory renal
function.
sclerosis of remaining
nephrons, & total
function loss.
Decreased ph, k+,
nitrogenous waste
excretion.
Like failure to
produce
erythropoietin &
to convert
inactive form of
calcium
Pathophysiology

10. Classification of Chronic Kidney
Disease (CKD)
Stage Description GFR, ml/min
0 With risk factors. >90,
1 Kidney Damage
with normal GFR.
≥90,
2 Kidney Damage
with mild ↓ in GFR.
60-89
3 Moderate ↓ 30-59
4 Severe ↓in GFR 15-29
5 Kidney failure <15
http://www.kidney.org/

11. Stage 5 CKD is also
called established chronic kidney
disease and is synonymous with the now
outdated terms
 end-stage renal disease (ESRD),
 chronic kidney failure (CKF) or
 chronic renal failure (CRF).

12. Chronic renal failure :
Applies to the process of
continuing significant
irreversible reduction in
nephron number, and
typically corresponds to
CKD stages 3–5.

13. End-stage renal disease
 The term represents a stage of CKD where the
accumulation of toxins, fluid, and electrolytes
normally excreted by the kidneys results in the
Uremic syndrome.
 No more compensation; all other organ systems
will end up with some kind of dysfunction.
 This syndrome leads to death unless the toxins
are removed by renal replacement therapy,
using dialysis or kidney transplantation.

14. Clinical manifestations
Neurological –
Central:
 Slurred speech
 Asterixis and myoclonus
 Seizures
 Disorientation and confusion
 Increased muscle fatigability

15. Clinical manifestations
 Failure of kidneys to remove excess
fluid may cause:
 Edema of the legs, ankles, feet, face
and/or hands
 Shortness of breath due to extra fluid on
the lungs (may also be caused by
anemia)
 hypertension and/or congestive heart
failure

16. Metabolic changes
1.An increase in serum creatinine or BUN.
High levels of urea in the blood, which can
result in:
 Vomiting and/or diarrhea, which may
lead to dehydration.
 Weight loss
 Nocturnal urination
 Azotemia and ultimately uremia.

17. Metabolic changes
2. Proteinuria
3.Hyperphosphatemia

18. Metabolic changes
5. Hyperkalemia
may cause:
 Abnormal heart rhythms
Metabolic acidosis: due to
accumulation of sulfates,
phosphates, uric acid etc.

19. Hematological changes
 Erythropoietin synthesis is decreased
leading to anemia, which causes:
 Feeling tired and/or weak
 Memory problems
 Difficulty concentrating
 Dizziness
 Low blood pressure

20. GIT changes
 Appetite loss, a bitter, metallic or
salty taste in the mouth
 Fishy or ammonia-like smell in
breath
 Difficulty sleeping
 Gastritis,
 constipation

21. Cardiovascular changes
 50%-65% deaths occur due to
cardiac complications of CKD.
 Hypertention
 Left ventricular hypertrophy
 Electrolyte imbalance
 Myocardial calcification

22. Respiratory changes
 Pulmonary edema
 Pleuritis
 Tachypnea

23. DIAGNOSIS

24. 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

25. DIAGNOSIS
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

26. MANAGEMENT
Goals of treatment:
1. To preserve renal function
2. To delay the need for dialysis or
transplantation as long as feasible.
3. To alleviate extra renal manifestations as
much as possible.
4. To improve body chemistry values.
5. To provide an optimal quality of life for the
client & significant others.

27. Preserve renal function & delay dialysis:
PHARMACOLOGICAL THERAPY:
 Antihypertensive: goal is to keep blood
pressure at or below 130/80 mmHg. ACE
inhibitors or angiotensin receptor blockers
(ARB) are usually prescribed.
 Cardiovascular agents: diuretics,
ianotropic agents.
 Antacids: phosphorus binding antacids
 Metabolic acidosis: sodium bicarbonate,
dialysis.
 Anemia: Erythropoietin
 Control of blood glucose levels.

28. Alleviate extra renal manifestations:
 Seizures :Antiseizure agents,
safety measures to protect pt.
 Hyper parathyroid:
parathyroidectomy

29. Improve body chemistry:
Medications
 Diet management
 Renal replacement therapy:
dialysis , renal transplantation.

30. Dietary management:
General dietary guidelines:
 Protein restriction: Decreasing protein
intake may slow the progression of
chronic kidney disease. Allowed protein
of high biological value.
 Salt restriction: Limit to 4-6 grams a day
to avoid fluid retention and help control
high blood pressure.
 Restrict Fluid intake

31. Dietary management:
 Potassium restriction: High levels of potassium can
cause abnormal heart rhythms.
Examples of foods high in potassium include
bananas, oranges, nuts, and potatoes.
 Phosphorus restriction: Decreasing phosphorus
intake is recommended to protect bones.
 Eggs, beans, cola drinks, and dairy products are
examples of foods high in phosphorus.
 High calorie diet
 Vitamin supplements

32. Nursing management
Assessment:
1. Complete history taking:
 Past & present history regarding illness, any
medication, diet, wt. changes, patterns of urination etc.
2. Assess pt for the multiple effects of
CRF on all body systems.
3. Assess the pt’s understanding of CRF, the
diagnostic tests,& the treatment regimens.
4. Assess the pt’s need for dialysis.
5. Assess the significant other’s understanding of the
treatment regimen.

33. Nursing diagnosis.
1. Deficient fluid volume or excess fluid
volume.
2. Imbalanced nutrition: less than body
requirements.
3. Constipation.
4. Activity intolerance related to fatigue,
anemia, retention of waste products,
dialysis.
5. Risk for impaired skin integrity.

34. Nursing diagnosis.
6. Risk for infection.
7. Risk for injury.
8. Risk for compromised family and
ineffective individual coping.
9. Risk for ineffective family & individual
therapeutic regimen management.
10. Disturbed self- esteem related to
dependency, role, change in body image,
& change in sexual function.

35. REFERENCES
 Brunner & Suddarth’s, Textbook of
Medical Surgical Nursing.10th ed.
Lippincott.
 Black M. Joyce, Hawks Hokanson Jane,
Medical Surgical nursing.7th ed.2005,
Saunders
 http://www.emedicinehealth.com/