1. Clinical Manifestation
1.1. Peripheral neuropathy -a disorder of the peripheral nervous system, is present in some patients
1.2. Severe pain -Patients complain of severe pain and discomfort
1.3. Restless leg syndrome -Restless leg syndrome and burning feet can occur in the early stage of uremic peripheral neuropathy
2. Complications
2.1. Hyperkalemia -Hyperkalemia due to decreased excretion, metabolic acidosis, catabolism -excessive intake (diet, medications, fluids)
2.2. Hypertension -Hypertension due to sodium and water retention -malfunction of the renin-angiotensin-aldosterone system
2.3. Anemia -due to decreased erythropoietin production decreased RBC lifespan -bleeding in the GI tract from irritating toxins and ulcer formation, and blood loss during hemodialysis
2.4. Pericarditis -due to retention of uremic waste products and inadequate dialysis
2.5. Bone disease -metastatic and vascular calcifications due to retention of phosphorus -low serum calcium levels -abnormal vitamin D metabolism -elevated aluminum levels
3. Managements
3.1. Pharmacological
3.1.1. Antihypertensive,Cardiovascular agents
3.1.2. Anti-seizures agents
3.1.3. Erythropoietin
3.1.4. Antidiuretic
3.1.5. Antacids
3.2. Non-pharmacological
3.2.1. Physical Assessment
3.2.1.1. Assess for signs of kidney failure such as chest pain, jugular veins distention, edema -present of hyperglycemia secondary to Diabetes
3.2.2. Fluid management
3.2.2.1. -Monitor for Intake and Output, weight and hydration status -Monitor for fluid overload, sodium retention causes hypertension and edema
3.2.3. Enhancing Nutritional
3.2.3.1. -Collaborate with dietitian to determines calories;protein,fluid, potassium and sodium -phosphate restrictions, vitamins and mineral supplements -provide balance food to avoid malnutritions
3.2.4. Preventing Infection
3.2.4.1. -Provides meticulous skin care -inspect vascular access site or peritoneal dialysis catheter for redness,swelling, pain and drainage -monitor v/s
3.2.5. Monitoring Cardiac output
3.2.5.1. -Assess for sign of heart failure to administer Calcium Channel Blocker, Ace Inhibitor to control blood pressure
3.2.6. New Topic
4. what is it
4.1. CKD is the end result of a gradual, progressive loss of kidney function
4.2. the kidneys cannot remove the body’s metabolic wastes or perform their regulatory functions
5. Causes
5.1. chronic infections e.g glomerulonephritis and pyelonephritis
5.2. Vascular Disease e.g Hypertension and Nephrosclerosis
5.3. Obstructive process e.g Renal Calculi
5.4. Collagen disease e.g systemic lupus
5.5. Nephrotoxic agent e.g drugs such as Aminoglycosides
5.6. Endocrine disease e.g Diabetes and Hyperparathyroidism
6. Predisposing factor
6.1. Age 60 above
6.2. Congenital Kidney disease
6.3. Family history of Kidney disease
6.4. Diabetes (most common risk factor)
6.5. Bladder Outlet obstruction e.g Benign Prostate Hyperplasia and Prostatitis
6.6. High residue diet
6.7. Overexposure to toxins and some medications
6.8. Sedentary lifestyle e.g Hypertension and atherosclerosis
7. Assessment and Diagnostic findings
7.1. Blood test
7.1.1. Blood Urea Nitrogen(BUN) Level increase
7.1.2. Serum Creatinine Level Increase
7.1.3. Serum Electrolyte e.g Potassium High
7.2. Radiology
7.2.1. Ultrasonography
7.2.2. X-ray KUB(Kidneys, Ureter, Bladder)
7.2.3. Magnetic Resonance Imaging
7.2.4. Renal Biopsy
7.2.5. ECG