Chronic kidney disease ( chronic Renal failure )

Definition :-

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

CKD is progressive irreversible destruction and dimension in renal function resulting in uremia and azotemia.

It occurs from several days or months to years.

Etiology :-

• Diabetes mallitus 
• Hypertension
• Recurrent episodes of AKI
• Chronic glomerulo nephritis
• Recurrent polynephritis
• Hypotension
• Polycystic kidney Disease
• Obstruction in urinary tract
• Renal artery obstruction or stenosis
• Autoimmune disease (SLE)
• Vasico uretral reflex
• Medication or Drugs
• Poor intake of fluids

Pathophysiology :-

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

 Clinical Manifestation :-

Nervous System :-

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

Cardio vascular system :-

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

Intiguimatory System :-

• Palor appearence
• Orange,green, or grey in color of skin (because of retaining of Urochrome ligand)
• Thin and brittle nails and hair
• Ecchymosis (bruise) >1cm
• Petechie
• Purpura
• Puritis (severe form of itching)
• Edema of Enasarca

G.I. Tract :-

• Nausea ,Vomiting
• Constipation,Diarrhea
• Hiccups
• Anorexia
• Mouth ulcers
• Gastritis
• Stomatitis 
• Gingivitis
• Esophagitis
• 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 :-

• amnorrhea
• Infertility (impotence & sterility)
• Oligospermia
• Testicular atrophy
• Decreased livido

Musculo skeletal System :-

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

Urinary system :-

• Polyurea
• Oligurea
• Hematurea
• Renal insufficiency with azotemia

Metabolic changes :-

• Metabolic acidosis
• Increased BUN
• Serum creatinine
• Serum uric acid
• Decreased GFR

Investigation :-

• History collection
• Physical examination
• Urine culture and urine routine
• Urine measurment
• BUN
• CT scan of K.U.B.
• I.V.P. (Intravenous pylography)
• Renal Angiography

Medical Management :-

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

Surgical management :-

• Catheterization
• Dialysis
• Renal transplantation

Nursing Management :-

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