Chronic Kidney Disease

CHRONIC KIDNEY
DISEASE
The Integration of Adult Nursing Practice
Sophie Dickens

CONTENTS PAGE
Slide One – Introduction and aims of the presentation
Slide Two – Anatomy and Physiology of the Kidneys - Structure
Slide Three – Anatomy and Physiology of the Kidneys - Nephron
Slide Three – Pathophysiological changes
Slide Four - Signs and Symptoms
Slide Five - Causes and Factors
Slide Six – Diagnosis of Chronic Kidney Disease
Slide Severn - Interventions
Slide Eight – Implications of Nursing Care
Reference List

INTRODUCTION AND AIMS
• This presentation will be approximately 10 minutes long. However, this is a limitation as I was unable to discuss chronic kidney disease in great details
• To discuss the normal anatomy and physiology of the kidneys
• To explore the pathophysiological changes in the kidneys
• The signs and symptoms that occur and the changes to be expected
• To outline diagnosis and interventions
• To discuss what are the implications for the nursing care of a person with the condition

ANATOMY AND PHYSIOLOGY OF
THE KIDNEYS
FUNCTIONS OF THE KIDNEYS
• CONTROLS FLUID LEVEL
BALANCE
• REGUALTES ACID BASED
BALANCE
• REMOVAL OF TOXINS AND
WASTE
• REGUALTES BLOOD
PRESSURE AND RENIN

ANATOMY AND PHYSIOLOGY OF
THE KIDNEYS

http://www.healthline.com/vpvideo/kidney-physiology

CHRONIC KIDNEY DISEASE
PATHOPHYSIOLOGICAL CHANGES
• Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Function is measured using THE GLOMERULUS
FILTRATION RATE (GFR). These are the stages of CKD;
Stage

GFR

Description

1
With normal or high GFR

>90

Normal kidney function but tests show early signs of kidney damage

2
Mild CKD

60-89

Mildly reduced kidney function, test results point to some kidney damage 3
Moderate CKD

30-59

Moderately reduced kidney function

4
Severe CKD

15-29

Severely reduced kidney function 5
End-stage CKD

<15 or on dialysis

Established kidney failure, kidney dialysis or transplant may be needed SIGNS AND SYMPTOMS
There are no warning signs for CKD and individuals can lose up to 90% of their kidney function before they feel any symptoms - and by then it's too late. As Kidney Function declines the symptoms may worsen. (KIDNEYHEALTH 2015)
• Increased urination especially at night
• Decreased urination
• Blood or protein in the urine
• Cloudy urine
• Shortness of breath
• Fatigue
• Loss of appetite/weight loss
• Nausea and vomiting
• Thirst
• Muscle cramping
• High blood pressure
• Fluid retention
• Oedema
• Lower Back Pain
(KIDNEYHEALTH 2015)

CAUSES AND RISK FACTORS
• The Two main causes are:
HIGH BLOOD PRESSURE

DIABETES

High blood pressure can damage the kidneys as the force of blood flow weakens the kidneys blood vessels therefore this can reduce the kidneys ability to function properly.

Consistently high blood sugar levels can cause pressure on the GFR causing them to leak protein. Factors that may increase your risk of chronic kidney disease include:
Diabetes
High blood pressure
Heart disease
Smoking
Obesity
High cholesterol
Being African-American, Native American or Asian-American
Family history of kidney disease
Age 65 or older

DIAGNOSIS OF CKD
To determine chronic kidney disease there are tests and procedures that can be done.
Biopsy’s
Blood Tests

Tests and
Procedures
Imaging Tests:
Ultrasound Scan

Urine Tests

INTERVENTIONS AND TREATMENT
Depending on your stage of Chronic Kidney Disease depends on the level of intervention and treatment required. • Interventions for stage one, two and three of chronic kidney disease
•

Proteinuria Screening

•

Blood Pressure Screening

•

Smoking Cessation

•

Glycaemic Control

Treatment for Stages four and Five
• Kidney transplant
•

Dialysis

Provide
Physical
patients with
Management
of pain
Emotional
Support with Support

Provide Spiritual
Support

Manage
Disease Control
Emotional

NURSING IMPLICATIONS
Intellectual

Provide
Physical
Support

Spiritual

Encouraging
Referrals

Educate patients on
Chronic Kidney
Disease

REFERENCE LIST
• Theaidentist (2015) Kidney location in human. Available from: bodyhttp://www.thaidentist.org/kidneys-location-inhuman-body/ [Accessed 22/01/2015]
• Unknown (2015) Kidney. Available from: http://www.middletownurology.com/kidney-stones [Accessed 22/01/2015]
• Unknown (2015) http://www.umich.edu/~elements/web_mod/viper/kidney_function.htm [Accessed 22/01/2015]
• Healthline (2015) Kidney Video. Available from: http://www.healthline.com/vpvideo/kidney-physiology [Accessed
22/01/2015]
• Kidney Health (2015) Signs and Symptoms. Available from: http:// www.kidney.org.au/KidneyDisease/RiskFactorsandSymptoms/tabid/819/Default.aspx [Accessed 22/01/2015]
• Diabetes (2014) Kidney Disease (Nephropathy). Available from: http:// www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html [Accessed 22/01/2015]

REFERENCE LIST
• National Kidney and Urologic Diseases Information (2014) High blood pressure and kidneys.Available from: http
://kidney.niddk.nih.gov/KUDiseases/pubs/highblood/ [Accessed 22/01/2015]
• Mayo Foundation for Medical Education and Research (2015) Chronic Kidney Disease. Available from: http:// www.mayoclinic.org/diseases-conditions/kidney-disease/basics/risk-factors/con-20026778 [Accessed 23/01/2015]