UNIVERSIDAD DE MANILA

Arroceros St., Corner Palma St.,

Mehan Garden, Manila

CHRONIC KIDNEY DISEASE

(CKD)

In Partial Fulfillment of the Requirement

For the subject Related Learning Experience

Submitted to:

Arlene Paduada, RN
Clinical Instructtor

Submitted by:

Kristine Pangindian
Nr-42

INTRODUCTION
Chronic kidney disease occurs when one suffers from gradual and usually progressive or
permanent loss of kidney function over time. It is irreversible. This happens gradually, usually
months to years. The term "renal" refers to the kidney, so another name for kidney failure is
"renal failure." Mild kidney disease is often called renal insufficiency. With loss of kidney
function, there is an accumulation of water; waste; and toxic substances, in the body, that are
normally excreted by the kidney. Loss of kidney function also causes other problems such as
anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of
cholesterol and fatty acids, and bone disease. The effects and symptoms of chronic renal
failure or chronic kidney disease include; need to urinate frequently, especially at night
(nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood
pressure; fatigue and weakness (from anemia or accumulation of waste products in the
body); loss of appetite, nausea and vomiting; itching, easy bruising, and pale skin (from
anemia); shortness of breath from fluid accumulation in the lungs; headaches, numbness in
the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status
(encephalopathy from the accumulation of waste products or uremic poisons), and restless
legs syndrome, chest pain due to pericarditis (inflammation around the heart); bleeding (due
to poor blood clotting); bone pain and fractures; and decreased sexual interest and erectile
dysfunction.

Stages of Chronic Kidney Disease

Stage Description GFR*mL/min/1.73m2
1 Slight kidney damage with normal or increased filtration More than 90
2 Mild decrease in kidney function 60-89
3 Moderate decrease in kidney function 30-59
4 Severe decrease in kidney function 15-29
5 Kidney failure Less than 15 (or dialysis)

*GFR is glomerular filtration rate, a measure of the kidney's function.

ANATOMY AND PHYSIOLOGY

KIDNEY

The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower
middle of the back. Each kidney weighs about ¼ pound and contains approximately one
million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule.
The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like
structure attached to the glomerulus.

The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in
the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the
outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the
blood. The kidneys process about 200 liters of blood every day and produce about two liters
of urine. The waste products are generated from normal metabolic processes including the
breakdown of active tissues, ingested foods, and other substances. The kidneys allow
consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess
fluids without worry that toxic by-products will build up to harmful levels. The kidney also
plays a major role in regulating levels of various minerals such as calcium, sodium, and
potassium in the blood.

* As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky
blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red
blood cells, proteins, and large molecules are retained in the capillaries. In addition to
wastes, some useful substances are also filtered out. The filtrate collects in a sac called
Bowman's capsule.

* The tubules are the next step in the filtration process. The tubules are lined with highly
functional cells which process the filtrate, reabsorbing water and chemicals useful to the body
while secreting some additional waste products into the tubule.

The kidneys also produce certain hormones that have important functions in the body,
including the following:

* Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates

absorption of calcium and phosphorus from foods, promoting formation of strong bone.

* Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.

* Renin, which regulates blood volume and blood pressure.

PATHOPHYSIOLOGY

Chronic kidney disease or chronic renal failure involves deterioration and destruction of
nephrons with progressive loss of renal function. As the total GFR decreases and clearance
is reduced, serum urea nitrogen and creatinine levels increase. Remaining functioning
nephrons hypertrophy as they filter a larger road of solutes. A consequence is that the
kidneys lose their ability to concentrate urine adequately. To continue excreting the solutes, a
large volume of dilute urine may be passed, which makes the client susceptible to fluid
depletion. The tubules gradually lose their ability to reabsorb electrolytes. Occasionally, the
result is salt wasting, in which urine contains large amounts of sodium, which leads to more
polyuria. As renal damage advances and the number of functioning nephrons declines, the
total GFR decreases further. Thus the body becomes unable to rid itself of excess water, salt,
and other waste products through the kidneys. When the GFR is less than 10 to 20 ml/min,
the effect of uremic toxins on the body becomes evident. If disease is not treated by the
dialysis or transplantation, the outcome of CKD/CRF is uremia and death.

NURSING RESPONSIBILITIES/ INTERVENTIONS

Maintain fluid and electrolyte balance.

 - Weigh the client daily. To assess edema.
-Measure and record I and O accurately.
-Assess presence and extent of edema.
-Auscultate breath sounds.
-Restrict fluids as indicated.
-Monitor cardiac rhythm for dysrhythmias; BP for hypertension
-Avoid over-the counter medications.

Provide adequate nutrition.

-high carbohydrates, diet provides caloric requirements of the body.

- low protein diet reduces urea and nitrogenous waste products.
-low sodium diet prevents further water retention and edema.
-low potassium diet to help resolve hyperkalemia.

Prevent infection and injury.

-Maintain asepsis during treatments and procedures.

-Avoid aspirin products. To prevent bleeding.
-Encourage the client to use soft- bristled toothbrush.

Promote comfort.

-Relieve pain.
-Relieve pruritus due to uremic frost.