END

April 29
STAGE
RENAL 2019
DISEASE

A case assignment in partial fulfillment of the

requirements for the Nursing Education
Research and Development of Makati Medical
Center

Submitted by:
Dela Cruz, John Nikko L., RN
Nurse Residency Probationary Program
BATCH 51
Part I. Introduction

A. Definition
End-stage renal failure, also known as end-stage renal disease (ESRD), is the final,
permanent stage of chronic kidney disease, where kidney function has declined to the
point that the kidneys can no longer function on their own. A patient with end-stage
renal failure must receive dialysis or kidney transplantation in order to survive for more
than a few weeks. It is divided into acute kidney failure (cases that develop rapidly) and
chronic kidney failure (those that are long term). It also called established chronic
disease and occurs when GFR falls below 15 mL/min/1.73 m2 or 15 %. Glomerular
filtration rate is the best test to measure your level of kidney function and determine
your stage of kidney disease. Patients with ESRD are dependent on renal replacement
therapy (RRT) to survive. Renal Replacement Therapy is done by replacing the normal
blood-filtering function of the kidneys.
Reference:
(John Hopkins Medicine, 2019)
(National Institute of diabetes and Digestive and Kidney Diseases, 2017)
(National Kidney Foundation, 2019) https://www.kidney.org/atoz/content/gfr
(EAC BSN Students Batch 2011, 2009)

B. Statistics
B.1 International
The GBD 2015 study estimated that, in 2015, 1.2 million people died from kidney failure,
an increase of 32% since 2005.In 2010, an estimated 2.3–7.1 million people with end-
stage kidney disease died without access to chronic dialysis. Each year, around 1.7
million people are thought to die from acute kidney injury. Overall, therefore, an
estimated 5–10 million people die annually from kidney disease. In 2016, the DALYs
associated with chronic kidney disease, along with those associated with cardiovascular
disease, cancers, diabetes and neurological disorders, were found to have increased
significantly between 1990 and 2015. Kidney disease is associated with a tremendous

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economic burden. High-income countries typically spend more than 2–3% of their
annual health-care budget on the treatment of end-stage kidney disease, even though
those receiving such treatment represent under 0.03% of the total population. In 2010,
2.62 million people received dialysis worldwide and the need for dialysis was projected
to double by 2030.
Reference:
(World Health Organization, 2013)
(United States Renal Data System, 3017)
(Global Burden of Disease Study, 2016)
(Couser WG. Kidney Int, 2011)

B.2 Local
Every year, more and more Filipinos are afflicted with kidney or renal disease that could
result to their death, based on data presented by an expert, Tuesday.
“We see an increase of [around] 10 to 12 percent per year in the number of new
patients undergoing dialysis,” said nephrologist Dr. Russel Villanueva.
Chronic kidney disease (CKD) is one of the primary causes of mortality among Filipinos.
Doctors consider CKD as a “silent killer” type of illness. Many with the condition
experience no symptoms until their kidneys fail completely. Health practitioners link the
increase to the epidemic of obesity and hypertension. Obesity, caused by unhealthy diet
and sedentary lifestyle, can lead to diabetes, and diabetes and hypertension, on the
other hand, can lead to kidney disease.
Reference:
(Paunan J.C. PIA, 2018)

C. Risk Factors
Differences in overall health, economic status, and even ethnicity can contribute to the
probability of having chronic kidney disease. Certain groups of people are more likely to
develop chronic kidney disease. Some risk factors include people with diabetes or high
blood pressure. People with a family history of diabetes, high blood pressure, or ESRD

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are also a factor. African Americans are three times more likely than average to suffer
from kidney disease because they are more likely to have high blood pressure,
diabetes, and heart problems, all of which can lead to kidney failure and chronic kidney
disease. You become more likely to develop chronic kidney disease as you grow older.
Reference:
(Prevalence of Chronic Kidney Disease and Associated Risk Factors—United States,
1999 – 2004)

D. Signs and Symptoms

Patients may experience a wide variety of symptoms as kidney failure progresses.
These include fatigue, drowsiness, decrease in urination or inability to urinate, dry skin,
itchy skin, headache, weight loss, nausea, bone pain, skin and nail changes and easy
bruising. Signs and symptoms of kidney disease are often nonspecific, meaning they
can also be caused by other illnesses. Because your kidneys are highly adaptable and
able to compensate for lost function, signs and symptoms may not appear until
irreversible damage has occurred.
Reference:
(Mayo Clinic Org. 2019) https://www.mayoclinic.org/diseases-conditions/end-stage-
renal-disease/symptoms-causes/syc-20354532

E. Preventive Measures
Small lifestyle changes can make a big difference in helping to prevent kidney disease.
Careful glycemic control can prevent diabetes nephropathy. BP control can likely
prevent the large majority of hypertensive renal disease. Testing for diabetic renal
disease is well founded. In contrast, screening for hypertensive kidney disease is less
well defined. Most established renal disease can be treated with glycemic control in the
case of diabetes, BP treatment with angiotensin-converting enzyme inhibitors or
angiotensin receptor blockers, and dietary protein restriction. Future research should
focus on defining the high risk patients, developing better markers of risk, and designing
additional therapies.

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Reference:
(Hostetter, T. 2003 JASN)

F. Medical, Surgical, Pharmacological, and Nursing Management

The goal of management is to maintain kidney function and homeostasis for as long as
possible. Calcium and phosphorus binders treat hyperphosphatemia and hypocalcemia.
Antihypertensive and cardiovascular agents (digoxin and dobutamine) manage
hypertension. Anti-seizure agents (IV diazepam or phenytoin) are used for seizures, and
Erythropoietin (Epogen) is used to treat anemia associated ESRD. Dietary intervention
includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium
intake to balance sodium losses, and some restriction of potassium. Dialysis is usually
initiated if the patient cannot maintain a reasonable lifestyle with conservative treatment.
Maintain homeostasis. Prevent complications. Provide information about disease
process/prognosis and treatment needs. Support adjustment to lifestyle changes.
Reference:
(Belleza, M. RN 2018) https://nurseslabs.com/chronic-renal-failure/

G. Complication
Potential complications of chronic renal failure that concern the nurse and necessitate a
collaborative approach to are Hyperkalemia due to decreased excretion, metabolic
acidosis, catabolism, and excessive intake (diet, medications, fluids). Pericarditis due to
retention of uremic waste products and inadequate dialysis. Hypertension due to
sodium and water retention and the malfunction of the renin-angiotensin-aldosterone
system.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. Bone disease and metastatic and vascular calcifications due to retention
of phosphorus, low serum calcium levels, abnormal vitamin D metabolism, and elevated
aluminum levels.
Reference:
(Belleza, M. RN 2018) https://nurseslabs.com/chronic-renal-failure/

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Part II. Pathophysiology

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PART III. Nursing Care Plan

Assessment Nursing Planning Interventions Evaluation

Diagnosis

Objective: Impaired Short Term: 1. Establish rapport. The patient shall

 Increase in Urinary After 2-3 hours of 2. Monitor and record have demonstrated
participation in
Lab results Elimination nursing vital signs.
his/her
(BUN, R/T interventions, the 3. Assess pt’s general recommended
Creatinine glomerular patient will condition treatment program
4. Review for
, Uric Acid Malfiltration verbalize
laboratory test for
Level) AEB Impaired understanding of
changes in renal The patient shall
 Oliguria excretion of condition have demonstrated
function.
 Anuria nitrogenous behavior/lifestyle
5. Establish realistic changes to prevent
 Hesitancy products 2O
activity goal with complications
 Urinary Renal Failure Long Term:
client.
Retention After 1-2 days of
6. Determine clients
Subjective: nursing pattern of
interventions, the elimination
None
patient will 7. Palpate bladder
participate in 8. Investigate pain,
measures to noting location
correct/compensat 9. Determine client’s
e for defects usual daily fluid
intake
10. Note condition of
skin and mucous
membranes, color
of urine.
11. Observe for signs of
infection

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