📌 Definition
Chronic Kidney Disease (CKD) is the gradual loss of kidney function over time, characterized by kidney damage or a decreased glomerular filtration rate (GFR) for ≥3 months. CKD is classified into 5 stages from mild (stage 1) to kidney failure (stage 5).
🧠 Anatomy & Physiology: Kidneys
- Kidneys are bean-shaped organs below the rib cage on each side of the spine.
- Main roles: Filter waste from blood, regulate electrolytes, form urine.
- Produce hormones for blood pressure and red blood cell production.
⚠️ Etiology: Causes & Risk Factors
- Diabetes mellitus: Damages kidney blood vessels.
- Hypertension: Damages nephrons and kidney vasculature.
- Glomerulonephritis: Inflammation of glomeruli impairs function.
- Polycystic kidney disease: Inherited, cyst growth damages kidneys.
- Other: Autoimmune diseases, urinary tract obstruction, recurrent kidney infections, certain medications.
🩺 Symptomatology
- Often asymptomatic early; symptoms appear as function declines.
- Fatigue, weakness
- Edema (swelling of ankles, legs, hands)
- Shortness of breath
- Changes in urination (frequency, color)
- Persistent itching
- Loss of appetite, weight loss
- Difficulty concentrating
- Hypertension
- Elevated BUN and serum creatinine
🔁 Pathophysiology (Simplified)
- Progressive nephron/kidney loss impairs filtration.
- Waste products accumulate, electrolyte imbalances and fluid retention develop.
- Complications: anemia, bone disease, cardiovascular disease, electrolyte disturbances.
🧪 Medical Management
🔬 Diagnostics
- Blood tests: Serum creatinine, BUN, electrolytes, GFR estimation
- Urinalysis: Proteinuria, hematuria, abnormalities
- Imaging: Ultrasound, CT scan, MRI to assess kidney size and structure
💊 Medications
- ACE inhibitors/ARBs: Control BP, reduce proteinuria, slow CKD
- Erythropoiesis-stimulating agents (ESA): Treat CKD anemia
- Phosphate binders: Manage serum phosphate, prevent bone disease
🛠️ Dietary & Lifestyle
- Low-protein diet: Reduce kidney workload
- Sodium and fluid restriction: Manage hypertension, fluid overload
- Smoking cessation: Reduce CV risk, slow CKD progression
🩻 Renal Replacement Therapy
- Hemodialysis: Blood filtered by dialysis machine
- Peritoneal dialysis: Dialysis fluid exchange in peritoneum
- Kidney transplantation: Best long-term option for end-stage CKD
🧑⚕️ Nursing Management: 5 Key Interventions
- Monitor and manage fluid/electrolyte balance
- Assess for signs of infection (immunocompromised, dialysis access)
- Support coping with chronic illness and lifestyle changes
- Educate about CKD, medications, and self-care strategies
- Prepare and assist with renal replacement therapy if indicated
🩹 Priority Nursing Diagnoses
- Fluid and electrolyte imbalance related to impaired kidney function
- Risk for infection related to immunocompromised state/dialysis access
- Ineffective coping related to chronic illness/lifestyle changes
- Knowledge deficit related to CKD management and self-care
