INTRODUCTION CHRONIC KIDNEY DISEASE

Chronic kidney disease (CKD) is an umbrella term that describes kidney damage or a decrease in the glomerular filtration rate (GFR) for 3 or more months. CKD is associated with decreased quality of life, increased health care expenditures, and premature death. Risk factors include cardiovascular disease, diabetes, hypertension, and obesity. Diabetes is the primary cause of CKD. Between 25% and 40% of patients with type 1 diabetes and 5% to 40% of those with type 2 diabetes develop kidney damage. Diabetes is the leading cause of renal failure in patients starting renal replacement therapy. The second leading cause is hypertension, followed by glomerulonephritis and pyelonephritis; polycystic, hereditary, or congenital disorders; and renal cancers. Source: Brunner and Suddarths Textbook of Medical Surgical Nursing 12 th Edition by Smeltzer et.al Vol. 2 page 1313 The Kidney Disease Outcomes Quality Initiative (K/DOQI) of the National Kidney Foundation (NKF) defines chronic kidney disease as either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 for 3 or more months. Whatever the underlying etiology, the destruction of renal mass with irreversible sclerosis and loss of nephrons leads to a progressive decline in GFR. The different stages of chronic kidney disease form a continuum in time. In 2002, K/DOQI published its classification of the stages of chronic kidney disease, as follows:

In stage 1 and stage 2 chronic kidney disease, GFR alone does not clinch the diagnosis. Other markers of kidney damage, including abnormalities in the composition of blood or urine or abnormalities on imaging studies, should also be present in establishing a diagnosis of stage 1 and stage 2 chronic kidney disease.

The K/DOQI definition and classification of chronic kidney disease allow better communication among physicians and facilitate intervention at the different stages. Patients with chronic kidney disease stages 1-3 are generally asymptomatic; clinical manifestations typically appear in stages 4-5 . Early diagnosis and treatment of the underlying cause and/or institution of secondary preventive measures is imperative in patients with chronic kidney disease. These may delay, or possibly halt, progression. The medical care of patients with chronic kidney disease should focus on the following:

Delaying or halting the progression of chronic kidney disease Treating the pathologic manifestations of chronic kidney disease Timely planning for long-term renal replacement therapy Source: http://emedicine.medscape.com/article/238798-overview

CHRONIC RENAL FAILURE

Description Chronic, or irreversible, renal failure is a progressive reduction of functioning renal tissue such that the remaining kidney mass can no longer maintain the bodys internal environment. CRF can develop insidiously over many years, or it may result from an episode of ARF from which the client has not recovered. Etiology and Risk Factors The causes of CRF are numerous. Chronic glomerulonephritis, ARF, polycystic kidney disease, obstruction, repeated episodes of pyelonephritis, and nephrotoxins are examples of causes. Systemic diseases, such as diabetes mellitus, hypertension, systemic lupus erythematosus, polyarteritis, sickle cell disease, and amyloidosis, may produce CRF. Diabetes is the leading cause and accounts for more than 30% of clients who receive dialysis. Hypertension is the second leading cause of CRF. Clinical Manifestations The clinical manifestations of the early stages of renal failure depend on the disease process and contributing factors. As nephron destruction progresses to ESRD, the manifestations become similar and are described as uremic syndrome. The clinical course of irreversible renal disease and uremic syndrome follows a pattern: Reduced renal reserve refers to the state in which BUN is high normal but the client has no clinical manifestations. Normal functioning is evident as long as the client is not exposed to unusual physiologic or psychosocial stress. Renal insufficiency reflects a more advanced pathophysiologic process with mild azotemia when the client is receiving a general

diet. Impaired urine concentration, nocturia (excessive urination at night), and mild anemia are common findings. Renal function is easily impaired by stress. Renal failure is indicated by severe azotemia, acidosis, impaired urine dilution, severe anemia, and a number of electrolyte imbalances, such as hypernatremia, hyperkalemia, and hyperphosphatemia. ESRD is characterized by two groups of clinical manifestations: deranged excretory and regulatory mechanisms and a distinctive grouping of gastrointestinal, cardiovascular, neuromuscular, hematologic, integumentary, skeletal, and hormonal manifestations. The kidneys can no longer maintain homeostasis.

Source: Medical Surgical Nursing: Clinical Management for Positive Outcomes 7th Edition by: Joyce M. Black & Jane Hokanson Hawks Vol. 1 p. 949 Risk Those at highest risk for CRF are individuals with diabetes (causing 75% of all cases) or hypertension. Disease conditions or toxins that directly affect kidney function increase risk. Advancing age, family history, and smoking also increases the risk of CRF. Men have a slightly higher risk of developing CRF and ESRD than women because they are more likely to have underlying conditions such as hypertension and cardiovascular disease. The incidence of ESRD is 3.6 times higher in African Americans and 1.5 times higher in Hispanics than in whites (Krause). Source: http://www.mdguidelines.com/renal-failure-chronic

INCIDENCE AND PREVALENCE

Chronic kidney disease is now the 10th leading cause of morbidity and mortality in the Philippines, according to the Department of Health. The Philippines as a CKD country has pulled away from being comparable to Southeast Asian neighbors in incidence at 2.6 per 100,000 people in 2003 to 9.75 Filipinos having the disease within that same population as of 2008. Kidney disease is cousin to diabetes and hypertension, and therein lies the roots of nearly 70 percent of the CKD problem as these latter two medical conditions go on a rampage of their own in the Philippines and around the world. Kidney disease is described as a "multiplier," causing death in many people with diabetes and hypertension and increasing a person's risk of suffering a heart attack.

According to the Philippine Renal Disease Registry, diabetes mellitus was responsible for 42 percent of kidney diseases among dialysis patients in 2009. Hypertension, on the other hand, contributed 25 percent, closely followed by kidney inflammation, 20 percent. Kidney disease and kidney failure are important public-health problems because of the increasing prevalence of genetically transmitted diseases like diabetes and hypertension, the two most common causes of CKD worldwide. While it is true that it may not be the no. 1 killer disease among Filipinos, renal disease has its own bizarre way of creeping into a complacent, sedentary population. Source: http://www.pia.gov.ph/news/index.php?article=1141338790357