Chronic kidney disease (CKD) means your kidneys are damaged and can't filter blood the way they should. The disease is called “chronic” because the damage to your kidneys happens slowly over a long period of time.

1. CHRONIC KIDNEY DISEASE
PRESENTED BY:
MR: ABHAY RAJPOOT

2. INTRODUCTION
 Chronic kidney disease, also called chronic kidney failure, describes the
gradual loss of kidney function. The kidneys filter wastes and excess fluids
from the blood, which are then excreted in the urine. When chronic
kidney disease reaches an advanced stage, dangerous levels of fluid,
electrolytes and wastes can build up in the body.
 In the early stages of chronic kidney disease, you may have few signs or
symptoms. Chronic kidney disease may not become apparent until the
kidney function is significantly impaired.

3. Normal kidney vs. diseased kidney
A normal kidney has about 1 million filtering units. Each unit, called a
glomerulus, connects to a tubule, which collects urine. Conditions such as
high blood pressure and diabetes take a toll on kidney function by damaging
these filtering units and collecting tubules and causing scarring

5. DEFINITION
Chronic kidney disease (CKD) means the kidneys are damaged and can't filter
blood the way they should. The disease is called “chronic” because the
damage to the kidneys happens slowly over a long period of time. This
damage can cause wastes to build up in the body. CKD can also cause other
health problems

6. INCIDENCE
The overall prevalence of CKD in the general population is approximately 14
percent. High blood pressure and diabetes are the main causes of CKD.
Almost half of individuals with CKD also have diabetes and/or self-reported
cardiovascular disease (CVD). More than 661,000 Americans have kidney
failure.

7. RISK FACTOR
 Diabetes
 High blood pressure
 Heart and blood vessel (cardiovascular) disease
 Smoking
 Obesity
 Family history of kidney disease
 Abnormal kidney structure
 Older age

8. CAUSES
 Type 1 or type 2 diabetes
 High blood pressure
 Glomerulonephritis an inflammation of the kidney's filtering units (glomeruli)
 Interstitial nephritis an inflammation of the kidney's tubules and surrounding
structures
 Polycystic kidney disease
 Prolonged obstruction of the urinary tract, from conditions such as enlarged
prostate, kidney stones and some cancers
 Vesicoureteral reflux, a condition that causes urine to back up into your
kidneys
 Recurrent kidney infection, also called pyelonephritis

9. Polycystic kidney:
A healthy kidney (left) eliminates waste
from the blood and maintains the body's
normal chemical balance. Fluid-filled sacs
(right), called cysts, characterize
polycystic kidney disease.

12. PATHOPHYSIOLOGY

13. SIGN AND SYMPTOMS
 Nausea
 Vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Changes in how much you urinate
 Decreased mental sharpness
 Muscle twitches and cramps
 Swelling of feet and ankles
 Persistent itching
 Chest pain, if fluid builds up around the lining of the heart
 Shortness of breath, if fluid builds up in the lungs
 High blood pressure (hypertension) that's difficult to control

14. DIAGNOSTIC EVALUATION
 History collection
 Physical Examination
 Urine output measurements. Measuring how much urinate in 24 hrs.
 Urine tests. Analyzing a sample of the urine (urinalysis) may reveal abnormalities that
suggest kidney failure.
 Blood tests. A sample of the blood may reveal rapidly rising levels of urea and creatinine
two substances used to measure kidney function.
 Imaging tests. Imaging tests such as ultrasound and computerized tomography may be
used to help the doctor see your kidneys.
 Removing a sample of kidney tissue for testing. In some situations a kidney biopsy to
remove a small sample of kidney tissue for lab testing. Your doctor inserts a needle
through the skin and into the kidney to remove the sample

16. COMPLICATION
 Fluid retention, which could lead to swelling in the arms and legs, high blood
pressure, or fluid in the lungs (pulmonary edema)
 A sudden rise in potassium levels in your blood (hyperkalemia), which could impair
your heart's ability to function and may be life-threatening
 Heart and blood vessel (cardiovascular) disease
 Weak bones and an increased risk of bone fractures
 Anemia
 Decreased sex drive, erectile dysfunction or reduced fertility
 Decreased immune response, which makes you more vulnerable to infection
 Pericarditis, an inflammation of the saclike membrane that envelops in heart
(pericardium)
 Pregnancy complications that carry risks for the mother and the developing fetus
 Irreversible damage to the kidneys (end-stage kidney disease), eventually
requiring either dialysis or a kidney transplant for survival

17. PREVENTION
 Follow instructions on over-the-counter medications. When using nonprescription
pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and
acetaminophen (Tylenol, others), follow the instructions on the package. Taking too
many pain relievers could lead to kidney damage and generally should be avoided if
you have kidney disease.
 Maintain a healthy weight
 Don't smoke. Cigarette smoking can damage the kidneys and make existing kidney
damage worse. Support groups, counseling and medications can all help you to stop.

18. MANAGEMENT
 High blood pressure medications. People with kidney disease may experience
worsening high blood pressure. The doctor may recommend medications to lower
the blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or
angiotensin II receptor blockers — and to preserve kidney function. High blood
pressure medications can initially decrease kidney function and change electrolyte
levels, so you may need frequent blood tests to monitor your condition.
 Medications to lower cholesterol levels. People with chronic kidney disease often
experience high levels of bad cholesterol, which can increase the risk of heart
disease.
 Medications to treat anemia. In certain situations, the doctor may recommend
supplements of the hormone erythropoietin sometimes with added iron.
Erythropoietin supplements aid in production of more red blood cells, which may
relieve fatigue and weakness associated with anemia.

19. CONTI…
 Medications to relieve swelling. People with chronic kidney disease may retain
fluids. This can lead to swelling in the legs, as well as high blood pressure.
Medications called diuretics can help maintain the balance of fluids in the body.
 Medications to protect the bones. Your doctor may prescribe calcium and
vitamin D supplements to prevent weak bones and lower your risk of fracture. You
may also take medication known as a phosphate binder to lower the amount of
phosphate in your blood, and protect your blood vessels from damage by calcium
deposits (calcification).
 A lower protein diet to minimize waste products in the blood. As your body
processes protein from foods, it creates waste products that the kidneys must
filter from the blood

20. TREATMENT FOR END-STAGE KIDNEY
DISEASE
 Dialysis. Dialysis artificially removes waste products and extra fluid from the blood
when kidneys can no longer do this. In hemodialysis, a machine filters waste and
excess fluids from your blood. In peritoneal dialysis, a thin tube (catheter) inserted
into the abdomen fills the abdominal cavity with a dialysis solution that absorbs
waste and excess fluids. After a period of time, the dialysis solution drains from the
body, carrying the waste with it.
 Kidney transplant. A kidney transplant involves surgically placing a healthy kidney
from a donor into the body. Transplanted kidneys can come from deceased or living
donors. Patient need to take medications for the rest of your life to keep the body
from rejecting the new organ.

23. NURSING MANAGEMENT
 Excess fluid volume related to decreased Glomerular filtration
rate and sodium retention as evidenced by edema
 Risk for infection related to alterations in the immune system
and host
 Risk for injury related to GI bleeding
 Sleep pattern disturbances related to disease condition defenses
 Imbalanced nutrition: less than body requirements related to
less intake of food