CKD

CKD

1. Clinical Manifestations (Headley, 2014)

   • Urinary System
     • Early Stages
       • Nocturia & Polyuria-Kidneys inability to concentrate urine
     • Late Stages
       • Oliguria, then eventually anuria (40ml/24hr output), possible proteinuria casts, hematuria & pyruia
   • Cardiovascular System
     • Hypertension, heart failure, edema and Coronary Artery Disease
       • figure 4
   • Respiratory System
     • Dyspnea- from fluid overload, uremic pneumonitis and pleuritis
   • Gastrointesinal System
     • Nausea, vomiting, poor appetite and GI bleed
       • Figure 7
   • Hematological System
     • One of the most common- Anemia
     • Infection- increased susceptibility in CKD patients
     • Bleeding tendancies
   • Neurological System
     • Fatigue, Headache, and sleep disturbances

2. Stages (Adhikari, 2011)

   • Stage 1
     • Early Kidney damage, with early or elevated GFR
       • Glomerular Filteration Rate- ml per min per 1.73m^2
         • GFR greater than 90 (normal)
           • Action
             • Diagnosis and treatment of co-morbid conditions
   • Stage 2
     • Progressive kidney damage with mildly decreased GFR, (early renal insufficiency)
       • GFR- 60-89
         • Action
           • Estimation with Progression
   • Stage 3
     • Moderate decreased GFR, (moderate kidney failure)
       • GFR- 30-59
         • Action
           • Evaluation and treatment of complications
   • Stage 4
     • Severe decrease GFR- (pre-end stage kidney disease)
       • GFR- 15-29
         • Action
           • Begin the preparation for renal replacement therapy
   • Stage 5
     • Kidney failure (end stage kidney disease)
       • GFR- 15 or less or dialysis
         • Action
           • The starting process of renal replacement therapy
   • Figure 1

3. Figure 2

4. Treatment and Management (Nordquvist, 2017)

   • Early Stages
     • Anemia Treatment
       • Iron supplements or blood transfusions (only in acute blood loss)
     • Nutritional Therapy
       • Phosphate and potassium ( prevent hyperkalemia) balance
         • Reduce the consumption of phosphate and potassium because kidneys will not be able to eliminate
           • eg. dairy products, eggs, fish, beans, spinach
             • figure 6
       • Protein Restriction
       • Sodium and Fluids Management
         • To manage sodium retention, sodium intake depending on the degree of edema or hypertension
     • Hypertension Management
       • Control/bring down blood pressure by:
         • Use of antihypertensive medications
         • Lifestyle modifications (eg physical exercise, and stress management)
         • Sodium restriction
   • Late Stages
     • Dialysis (Headley, 2014)
       • Hemodialysis
         • Blood pumped out of an individual's body, through a dialyzer. Performed three times a week, each session about 3 hours in length
           • Advantages
             • Rapid fluid removal, effective potassium removal, less protein loss, home dialysis possible, temporary access at bedside
           • Disadvantages
             • Vascular access problem, fluid restrictions, hypotension during the dialysis, added blood loss, longer training time for home dialysis, surgergy for permanent access placement
           • Figure 5
       • Peritoneal Dialysis
         • Blood filtered through patient's own abdomen (peritoneal cavity). A catheter is inserted where the dialysis solution will infuse and drain out to remove excess wastes and fluid
           • Disadvantages
             • Protein loss, hyperglycemia, surgery for catheter placement, bacterial peritonitis, contraindication for those patients with abdominal surgeries
           • Advantages
             • Less complicated than hemodialysis, fewer dietary restrictions, less cardiovascular stress, home dialysis is possible
       • Figure 3
     • Kidney Transplant
       • Best Option, in terms of quality of life for the individual
         • Can be difficult to find donor/waitlisted
         • Will need to be on dialysis until potential kidney transplant
   • Patient Education (RNAO, 2009)
     • Present all possible treatment options and use client centred dialogue to involve the patient in the decision making process
       • Ask open ended questions to enhance dialogue such as:
         • What are your hopes and dreams? What are your fears? What is your quality of life like now?

5. Main Causes (RNAO, 2009)

   • Diabetes
   • Hypertension
   • Unknown Cause
     • The causes for CKD are not always clear because there are several risks and etiologies.
       • Risk Factors
         • 1. Susceptibility Factors
           • Eg. older age, family history of CKD, culture/ethnicity
             • Figure 10
         • 2. Initiation Factors
           • Diabetes, hypertension, systemic infections, urinary stones, urinary tract infections, drug toxicity
             • Primary Prevention ("Chronic Kidney Disease" [CKD], 2018)
               • Controlling environmental factors and eliminating predisposing factors such keeping normal body weight (BMI average 18-23), diet modifications
                 • Secondary Prevention
                   • Screening for high risk groups, early diagnosis and treatment
         • 3. Progression Factors
           • Smoking, higher level of proteinuria, higher blood pressure, poor glycemic control
         • 4. End stage Factors
           • Lack of dialysis treatment, anemia, low serum albumin
             • Figure 9

6. Pathophysiology (Garcin, 2015; "About Chronic Kidney Disease", 2017)

   • Disease of the kidneys begins by attacking the filtering units of the kidney (the nephrons), which irreversibly reduces the nephron numbers and their function
     • Nephrons' function
       • Damages the ability to adequately filter blood, eliminate wastes and excess fluids, the destruction of the nephrons result in specific etiology or progressive mechanisms
         • As some of the nephrons begin to destruct, the remaining and active nephrons workload rapidly increase resulting in hyperfiltration causing structural alterations to the afferent arterioles
           • Figure 8
         • Etiology examples: autoimmune conditions, glomerulonephritis
         • Progressive mechanism examples: diabetes, hypertension

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