CHRONIC KIDNEY DISEASE (CKD)
(Also called Chronic Renal Failure)
DEFINITION
CKD is a progressive, irreversible loss of kidney function lasting ≥ 3 months, resulting in
decreased GFR and accumulation of wastes, fluids, and electrolytes in the body.
NORMAL KIDNEY FUNCTIONS
• Excrete metabolic wastes (urea, creatinine)
• Regulate fluid & electrolytes
• Maintain acid–base balance
• Control blood pressure (Renin)
• Produce erythropoietin (RBC production)
• Activate vitamin D (calcium absorption)
CAUSES (ETIOLOGY)
Most Common
1. Diabetes Mellitus (Diabetic nephropathy)
2. Hypertension
Others
• Glomerulonephritis
• Polycystic kidney disease
• Chronic pyelonephritis
• Autoimmune diseases (e.g., SLE)
• Long-term use of nephrotoxic drugs (NSAIDs)
• Obstruction (stones, BPH)
RISK FACTORS
• Diabetes
• Hypertension
• Family history of CKD
• Old age
• Smoking
• Obesity
STAGES OF CKD (VERY IMPORTANT FOR EXAMS)
Stage GFR (mL/min/1.73 m²) Description
Stage 1 ≥ 90 Kidney damage with normal GFR
Stage 2 60–89 Mild decrease
Stage 3a 45–59 Mild–moderate
Stage 3b 30–44 Moderate–severe
Stage 4 15–29 Severe decrease
Stage 5 < 15 End-Stage Renal Disease (ESRD)
PATHOPHYSIOLOGY (SIMPLIFIED)
1. Nephrons are damaged
2. Remaining nephrons work harder (hyperfiltration)
3. Progressive nephron loss
4. ↓ GFR
5. Accumulation of urea, creatinine, fluids, electrolytes
6. Systemic complications occur
CLINICAL MANIFESTATIONS
(Depend on stage)
Early Stage
• Often asymptomatic
• Polyuria, nocturia
• Fatigue
Late Stage
Renal
• Oliguria or anuria
• Edema
Cardiovascular
• Hypertension
• Heart failure
• Fluid overload
Hematologic
• Anemia (↓ erythropoietin)
GI
• Anorexia
• Nausea & vomiting
• Uremic breath (ammonia smell)
Neurologic
• Confusion
• Peripheral neuropathy
• Seizures (severe)
Skin
• Pruritus
• Dry skin
• Uremic frost (late sign)
COMMON COMPLICATIONS
• Fluid overload
• Hyperkalemia ⚠️ (life-threatening)
• Metabolic acidosis
• Anemia
• Renal osteodystrophy (bone disease)
• Cardiovascular disease
DIAGNOSTIC TESTS
Blood Tests
• ↑ BUN
• ↑ Creatinine
• ↓ GFR
• ↑ Potassium
• ↓ Calcium
• ↑ Phosphorus
• ↓ Hemoglobin
Urine Tests
• Proteinuria
• Albuminuria
Imaging
• Ultrasound (small, shrunken kidneys in CKD)
MEDICAL MANAGEMENT
Goals
• Slow progression
• Treat complications
• Prepare for renal replacement therapy
Medications
• Antihypertensives (ACE inhibitors / ARBs)
• Diuretics
• Erythropoietin (for anemia)
• Phosphate binders
• Vitamin D supplements
• Sodium bicarbonate (acidosis)
DIETARY MANAGEMENT (VERY EXAM-FAVORITE)
• Low protein
• Low sodium
• Low potassium
• Low phosphorus
• Fluid restriction (if oliguria)
🚫 Avoid:
• Banana, orange, potato (high K⁺)
• Dairy, nuts (high phosphorus)
• Processed salty foods
RENAL REPLACEMENT THERAPY
1. Hemodialysis
• Blood filtered through machine
• 3x/week
• AV fistula
2. Peritoneal Dialysis
• Uses peritoneum as membrane
• Can be done at home
3. Kidney Transplant
• Best long-term treatment
• Requires lifelong immunosuppression
NURSING MANAGEMENT
• Monitor I&O
• Daily weight
• Monitor electrolytes
• Assess for edema & lung sounds
• BP monitoring
• Patient education (diet, meds, dialysis care)
NURSING DIAGNOSES
• Excess fluid volume
• Imbalanced nutrition
• Fatigue
• Risk for electrolyte imbalance
• Impaired skin integrity
PREVENTION
• Control blood sugar
• Control blood pressure
• Avoid nephrotoxic drugs
• Regular kidney check-ups
KEY EXAM TIPS 💡
• CKD is irreversible
• Most common cause = Diabetes
• ESRD = Stage 5
• Anemia = ↓ erythropoietin
• Hyperkalemia is most dangerous