XI.

Evidenced-based Nursing PRESENT PRACTICE Diagnosis & Tests When kidney function is decreased, substances such as urea, creatinine and certain electrolytes begin to build up in blood. After you are diagnosed with chronic kidney disease, blood and urine tests can help you and your doctor monitor the disease. Blood creatinine test helps to estimate the GFR by measuring the creatinine n your blood. Blood urea nitrogen (BUN) test measures how much nitrogen from the waste product urea is in your blood. BUN level rises when kidneys arent working well enough to remove urea from the blood Fasting blood glucose test is done to measure your blood sugar. High blood sugar level damage blood vessels in the kidneys. Blood tests measure levels of waste products and electrolytes in your blood that should be removed by your kidneys. Parathyroid hormone checks the level of PTH, which helps control calcium and phosphorus levels. CBC measures the hematocrit and the hemoglobin level. Reticulocyte count shows how many red blood cells are being produced by the bone marrow. EVIDENCED-BASED NURSING Did you know that more than half the people with chronic kidney disease have high blood pressure? High blood pressure increases the chance that kidney disease will get worse. High blood pressure makes you more likely to develop heart disease Following your treatment plan carefully and keeping your blood pressure under control can help to prevent these complications. Treatment for high blood pressure and CKD includes following a healthy diet, exercising and taking medications. High blood pressure is a leading cause of CKD. Over time, high blood pressure can damage blood vessels throughout your body. This can reduce the blood supply to the important organs like the kidneys. High blood pressure also damages the tiny filtering units in your kidneys. As a result, the kidneys may stop removing wastes and extra fluid from your blood. The extra fluid in your blood vessels may build up and raise blood pressure even more. High blood pressure can also be a complication of CKD. Your kidneys play a key role in keeping your blood pressure in a healthy range. Diseased RECOMMENDATIONS TO PRESENT PRACTICE Experts recommend screening tests for chronic kidney disease in high-risk groups, such as people with diabetes or high blood pressure. Kidney disease runs in the families, so close family members may also want to have their kidney function tested. Being diagnosed with kidney disease before it has progressed gives you the best chance to control the disease.

Iron studies show your level of iron. Serum ferritin test measures the protein that binds to iron in your body. Renal ultrasound helps estimate how long you may have had chronic kidney disease. It also checks whether urine flow from the kidney is blocked. Duplex Doppler study or angiogram of the kidney may be done to check for problems caused by restricted blood flow.

kidneys are less able to help regulate blood pressure. As a result, blood pressure increases. The National Kidney foundation defined CKD based on glomerular filtration rate (GFR) and divided the disease into five distinct stages. In stage 1 CKD, the GFR is 90 ml/min. in stage 2 CKD, the GFR is 60-89 ml/min. in stage 3 CKD. The GFR is 30-59 ml/min. in stage 4 CKD, the GFR is 15-29 ml/min. and in the final stage, the GFR is 15 ml/min or when the patient requires dialysis.

References: WebMD medical reference from Healthwise www.kidney.org/National Kidney Foundation spectrum.diabetesjournals.org Neeta Bahal Omara, PharmD, BCPS