CHRONIC KIDNEY DISEASE secondary to Chronic Glomerulonephritis

CARANDANG, MONICA SANTA S. G4B

occurs when one suffers from gradual and usually permanent loss of kidney function over time, happens gradually usually months to years y also called Chronic Renal Disease y divided into 5 stages of increasing severity
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chronic kidney disease

Causes:
Although chronic kidney disease sometimes results from primary diseases of the kidneys themselves, the major causes are glomerulonephritis, diabetes and high blood pressure. Others
x Polycystic kidney disease x Use of analgesics -- analgesic nephropathy x Clogging and hardening of the arteries (atherosclerosis) -- ischemic nephropathy x Obstruction of the flow of urine by stones, x HIV infection, sickle cell disease, heroin abuse, amyloidosis, kidney stones, chronic kidney infections, and certain cancers.

chronic kidney disease

the prevalence has increased by 16% from the previous decade. y the increasing incidence of diabetes mellitus, hypertension (high blood pressure), obesity, and an aging population have contributed to this increase in kidney disease y More prevalent -- above 60 years of age (39.4%) y Kidney disease - more common among Hispanic, African American, Asian or Pacific Islander, and Native American people.
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chronic kidney disease

is the inflammation and damage of the filtration system of the kidneys, which can cause kidney failure. Postinfectious conditions and lupus are among the many causes of glomerulonephritis occurs when there is slow, progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function In some cases, the cause is found to be a specific attack to the body's immune system, but in most cases, the cause is unknown. It is generally thought that a still-unidentified abnormality of the immune system is to blame.

CHRONIC GLOMERULONEPHRITIS

Damage to the glomeruli affects the kidney's ability to filter fluids and wastes properly. This leads to blood and protein in the urine. This condition may develop after survival of the acute phase of rapidly progressive glomerulonephritis.. In about one-quarter of people with chronic glomerulonephritis there is no prior history of kidney disease, and the disorder first appears as chronic kidney failure.

CHRONIC GLOMERULONEPHRITIS

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y y y y y y y

Need to urinate frequently, especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; Fatigue and weakness (from anemia or accumulation of waste products in the body); loss of appetite, nausea and vomiting; itching, easy bruising, and pale skin (from anemia); shortness of breath from fluid accumulation in the lungs; Headaches, numbness in the feet or hands (peripheral neuropathy), disturbed sleep, altered mental status (encelophathy from the accumulation of waste products or uremic poisons), and restless legs syndrome; Chest pain due to pericarditis (inflammation around the heart); bleeding (due to poor blood clotting) bone pain and fractures; and decreased sexual interest and erectile dysfunction decreased urine output increases skin pigmentation Foamy urine

Signs and Symptoms

Name: Pateint IFF Age: 38 Gender: Male Date of Birth: August4, 1972 Civil Status: Married Religion: Roman Catholic Educational Attainment: College Graduate Diagnosis: CKD secondary to CGN Attending Physician: Dr. Villena Current Access: AVF left (Sept, 2008)

Patients Profile

ANATOMY AND PHYSIOLOGY

Normal Kidneys and Their Function The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.

Urinary System

The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.

Urinary System

The kidneys are protected by a tough fibrous coat called the renal capsule. Under the capsule, the arrangement of nephrons and capillaries in the kidney produce the appearance of distinct regions when viewed in longitudinal section.

The outer cortex region surrounds darker triangular structures called pyramids which collectively form the medulla. The inner part of the kidney, the renal pelvis, collects the urine draining from the nephron tubules and channels it into the ureter.

Kidney (macrostructure)

The basic functional unit of the kidney is the nephron. There are over one million nephrons in each human kidney and together they are responsible for the complex water regulation and waste elimination functions of the kidneys. The heads of the nephrons are in the cortical region and the tubular component then descends through the medulla and eventually drains into the renal pelvis.

Kidney (microstructure)

The key area of interface between the circulatory system and the tubular part of the kidney is the knot of glomerular capillaries in the Bowman's capsule. Those liquid parts of the blood that are able to cross through the filtration membrane of the capillaries pass into the Bowman's capsule and then into the tubular section of the nephron. The filtration membrane only allows water to pass through it and small molecules that will dissolve in water such as waste (urea, creatinine etc.) glucose, amino acids and ions. Large proteins and blood cells are too large to be filtered and remain in the blood.

Kidney (microstructure)

The filtered fluid or filtrate enters the proximal tubule and then into the loop of Henle which is the part of the nephron which dips in and out of the medulla. From the loop of Henle, the filtrate travels through the distal tubule and then into a common collecting duct which passes through the medulla and into the renal pelvis.

Kidney (microstructure)

PATHOPATHOPHYSIOLOGY

CHRONIC GLOMERULONEPHRITIS

Non-modifiable Risk Factors: Age Gender Heredity

Modifiable Risk Factors: Diet Sedentary Lifestyle Nephrotoxins

Repeated Inflammation Renal Blood STAGE 1 Ischemia, Nephron loss, Shrinkage of Kidney Flow Renal Reserve

Damage to Nephrons GFR 50% Normal BUN, Creatinine

STAGE 2

50% damage

STAGE 3

More than 75% damage

GFR 20-50% BUN, Creatinine

pathophysiology

Renal Insufficiency

As nephrons are destroyed, the remaining nephrons undergo changes to compensate for those that are lost

Remaining nephrons must filter more solute particles from the blood

Hypertrophy of remaining nephrons

Nephrons cannot tolerate the work

Further damage of nephrons

80-90% damage

Renal Failure

GRF 10-20% Sharp BUN, Creatinine

STAGE 4

Chronic Kidney Disease

TREATMENTS AND MANAGEMENTS TO PROLONG THE LIFE (Dialysis or Kidney Transplant)

BAD PROGNOSIS

Date: 06/02/2011 HEMOGLOBIN Normal Value: M:14-18g% F:12-16g% Result: 9.8g% Findings:

Diagnostic Procedures

Date: 06/06/2011 CROSS MATCHING Patient Blood: A Rhtype: Positive Donor: A Rhtype: Positive Serial NO.: B11-2051 Major X-match(PSDR): Compatible Collection Date: 06/02/11 Expiration Date: 07/05/11 Saline, Protein, Anti-human Globulin Phase: Compatible, no hemolysis seen Blood Component: Packed RBC Coombs X-Match: Compatible, no coagulation

Diagnostic Procedures

Date: 12/01/2008 SERUM BUN Creatinine Sodium Potassium RBS Result 38.20 H 990.08 135.00 4.7 11.44 H Normal Value 3.21-7.14mmol/L 70.72-136.20umol/L 137.00-145.00mmol/L 3.5-5.10mmol/L

Diagnostic Procedures

Date: 12/01/2008 CBC Result WBC 8.08 RBC 3.19 Hemoglobon 8.5 Hematocrit 25.7 MCV 80.6 MCH 26.6 MCHC 33.1 RDW-CV 14.1 Platelet 224.0 Differential Count Neutrophil 0.79 Lymphocyte 0.17 Monocyte 0.3 Eosinophils 0.01 Basophils 0.00 Normal Value 5-11 103/uL M: 4.6-6.2 106/uL M:13.5-18.0g/dL M:40-54 % 80-100 fL 27-33pg 31-36g/dL 11-16% 150-400 0.55-0.77% 0.27-0.33% 0-0.12% 0-0.07% 0.01-0.05%

Date: Sept 5, 2008 Anti HCV HBsAg Negative Negative

Date: 04/13/09 BUN Urea Nitrogen Creatinine SGPT Sodium K Calcium Phosphorus 51.0 107.5(5) 22 135.2 4.55 2.4 4.7 1.70-8.30mmol/L 53-176.80mmol/L 0.00-42u/L 135.00-155mmol/L 3.4-5.3mmol/L 2.02-2.60mmol/L 2.5-5mg/dL

Imdur 60mg tab OD y LiFezar 50mg OD y Clopivax 1tab OD y Iberet Folic 1tab OD y NaHCO3 1tab TID y Recormon 5000 once a month
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Drug Study

Goal of Treatment
Slow down the progression of CKD to stage 5

Principles of Management
Control of blood pressure and treatment of the original disease

Treatment & Management

Replacement of erythropoietin and calcitriol

2 hormones processed by the kidney

Phosphate binders (Calcium carbonate)

used to control the serum phosphate levels, which are usually elevated in advanced chronic kidney disease

Renal replacement therapy

dialysis or a transplant

 Dietary modifications limiting protein intake

proven to slow and even reverse further progression

Treatment & Management

Monitor clients fluid volume status during dialysis

x Vital signs (BP, PR), weight, intake and output.

Teach client about their diet (low in protein, low salt low fat) & fluid restrictions
x Remind client about their fluid allowance per day.

Provide rest. Observe infection control during clients hemodialysis schedule.

Nursing Management

There is no cure for chronic kidney disease. The natural course of the disease is to progress until dialysis or transplant is required. Patients with chronic kidney disease are at a much higher risk than the general population to develop strokes and heart attacks. People undergoing dialysis have an overall five year survival rate of 32%. The elderly and those with diabetes have worse outcomes. Recipients of a kidney transplant from a living related donor have a two year survival rate greater than 90%. Recipients of a kidney from a donor who has died have a two year survival rate of 88%.

Chronic Kidney Disease Prognosis

http://www.emedicinehealth.com/chronic _kidney_disease/page8_em.htm#Medical Treatment

References