Chronic kidney disease ( chronic Renal failure ): Its causes, Pathophysiology, Sign And Symptoms, Medical and Nursing Management

Definition | Etiology | Pathophysiology | Clinical Manifestation | Investigation | medical Management | Nursing Management |

 

Definition:-

Chronic kidney disease is a type of kidney disease in which there is a gradual loss of kidney function over a period of months or years.

Chronic kidney disease is progressive irreversible destruction and dimension in renal function resulting in uremia and azotemia.

It occurs from several days or months to years.

Etiology of Chronic kidney disease:-

  • Diabetes mellitus
  • Hypertension
  • Recurrent episodes of Acute Kidney Injury
  • Chronic glomerulonephritis
  • Recurrent pyelonephritis
  • Hypotension
  • Polycystic Kidney Disease
  • Obstruction in the urinary tract
  • Renal artery obstruction or stenosis
  • Autoimmune disease (SLE)
  • Vesico ureteric reflex
  • Medication or Drugs
  • Poor intake of fluids

Pathophysiology of Chronic kidney disease:-

  • Due to the etiological factor
  • Deterioration or destruction of nephron with progressive loss of renal function
  • GFR (Glomerular filtration rate) falls and clearance of waste is reduced.
  • Serum creatinine and urea nitrogen level rise
  • Hypertrophy in remaining nephrons as they required to filter large load of solutes.
  • kidney losses their ability to concentrate urine adequately.
  • In an attempt to continue excreting the solutes. A large volume of dilute urine may be passed.
  • fluid depletion (loss)
  • Tubules gradually lose their ability to reabsorb electrolytes.
  • Polyurea and results a large amount of Na and water excretion
  • Disease progress toxic condition or toxicity
  • Renal Failure

 Clinical Manifestation of Chronic kidney disease:-

Nervous System:-

  • Confusion
  • Disorientation
  • Weakness
  • Fatigue, malaise, restlessness

Cardiovascular system:-

  • Hypertension
  • cardiac Disrrhythemia
  • Pericarditis
  • Pericardial Effusion
  • Myocarditis
  • Endocarditis

Intiguimatory System:-

  • Pallor appearance
  • Orange, green, or grey in the color of skin (because of retaining of Urochrome ligand)
  • Thin and brittle nails and hair
  • Ecchymosis (bruise) >1cm
  • Petechiae
  • Purpura
  • Pruritis (a severe form of itching)
  • Edema of Anasarca

G.I. Tract:-

  • Nausea, Vomiting
  • Constipation, Diarrhea
  • Hiccups
  • Anorexia
  • Mouth ulcers
  • Gastritis
  • Stomatitis
  • Gingivitis
  • Esophagitis
  • A bitter or salty taste
  • Ammonic or fishy odor from the breath

Respiratory System:-

  • Respiratory Distress
  • dyspnea
  • Shortness of breath

Blood or Hematology:-

  • Anemia

Reproductive System:-

  • amenorrhea
  • Infertility (impotence & sterility)
  • Oligospermia
  • Testicular atrophy
  • Decreased libido

Musculoskeletal System:-

  • Fatigue
  • Muscular cramps
  • Decrease muscular strength
  • Bone pain

Urinary system:-

  • Polyurea
  • Oliguria
  • Hematuria
  • Renal insufficiency with azotemia

Metabolic changes:-

  • Metabolic acidosis
  • Increased BUN (Blood urea nitrogen)
  • Serum creatinine
  • Serum uric acid
  • Decreased GFR (Glomerular filtration rate)

Investigation of Chronic kidney disease:-

  • History collection
  • Physical examination
  • Urine culture and urine routine
  • Urine measurement
  • BUN (Blood urea nitrogen)
  • CT scan of K.U.B.
  • I.V.P. (Intravenous pyelography)
  • Renal Angiography

Management of Chronic kidney disease:-

Medical Management:-

  • Calcium preparation and phosphorus binders.
  • Aluminum-based Antacids
  • Antihypertensive 
  • Diuretics
  • Vitamine and minerals supplements
  • Iron sulfate and folic acid (in severe anemia)
  • Sodium bicarbonate (administered to correct metabolic acidosis)

Surgical management:-

  • Catheterization
  • Dialysis
  • Renal transplantation

Nursing Management of Chronic kidney disease:-

  • Fluid volume excess related to the inability to kidney to promote or excrete urine.
  • Fluid volume deficit.
  • Altered nutrition level.
  • The risk of infection.
  • Disturb thought process.
  • The risk of impaired normal skin integrity related to edema.

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