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Chronic Kidney Disease

Transcript: Abnormally dark or light skin Bone pain Feeling more tired and having less energy Trouble concentrating Poor appetite Trouble sleeping Having dry, itchy skin Numbness or swelling in the hands and feet Muscle twitching or cramps Puffiness around eyes Needing to urinate more often Quality of Life Treatments Chronic Kidney Disease By: Carson Browder https://www.kidney.org/kidneydisease/aboutckd http://www.medscape.com/viewarticle/777996 http://www.webmd.com/a-to-z-guides/chronic-kidney-disease-treatment-overview Chronic Kidney Disease Symptoms Control the disease that is causing the damage to the kidneys Take medications: ACE Inhibitor or Angiotensin II receptor blocker (ARB) help with high blood pressure Have a healthy lifestyle: develop a diet, exercise, and reduce any use of drugs How CKD Affects the Functions of the Kidney Causes Scientific Name: Chronic Renal Disease A condition characterized by a gradual loss of kidney function over time. Wastes can build to high levels in your blood and make you feel sick. You may possibly develop high blood pressure, anemia (low blood count), weak bones, poor nutritional health, and nerve damage. Increases your risk of having heart and blood vessel disease A low health-related quality of life is associated with Chronic Kidney Disease. However, acceptance of the disease contributes to a better physical and mental health-related quality of life! Chronic Kidney Disease is mainly caused by diabetes and high blood pressure. *Not Hereditary* Sources

Chronic Kidney Disease

Transcript: A few risk factors for CKD are: Diabetes High blood pressure Obesity Smoking Identify risk factors for Chronic Kidney Disease (CKD). Identify ways to prevent CKD. Verbalize understanding of the consequences of CKD. Prevention begins with eliminating possible risk factors. Diabetes management and/or prevention Blood pressure management and/or preventing low or high blood pressure Maintain/achieve a healthy weight No smoking (Crockell, 2012; Curhan, 2014) Crockell, Y. J. (2012). Management of chronic kidney disease: An emphasis on delaying disease progression and treatment options. (cover story). Formulary, 47(6), 228-CV3. Curhan, G. (2014). BE KIND TO YOUR KIDNEYS. (Cover story). Nutrition Action Health Letter, 41(2), 1-6. dLifedotcom (2013). Ben On Dialysis. Retrieved from www.youtube.com Lewis, R. (2013). An overview of chronic kidney disease in older people. Nursing Older People, 25(10), 31-38. Reddenna, L., Basha, S., & Reddy, K. (2014). Dialysis Treatment: A Comprehensive Description. International Journal Of Pharmaceutical Research & Allied Sciences, 3(1), 1-13. Westwood, W. (2014). Preventing and Treating Kidney Disease. Retrieved from www.youtube.com Preventing CKD (Crockell, 2012; Curhan, 2014) By Samantha Costello, RN Discussion Risk Factors for CKD Questions? Comments? References 1. What are two risk factors for CKD? 2. What are two ways you can prevent CKD? 3. What are two undesirable consequences of CKD? GOAL! Goal: “Reduce new cases of chronic kidney disease (CKD) and its complications, disability, death, and economic costs” -Healthy People 2020 The Ultimate Consequence: See "Be Kind To Your Kidneys" handout, page number 3; "Why is kidney disease harmful?" (Curhan, 2014). Also see "What a Kidney Does" on the same page of the handout. If the kidneys fail due to end stage renal failure, all of these functions are compromised. Chronic Kidney Disease Objectives See short video (2:11): Consequences of CKD Watch this short video about one man's journey (4:19):

Chronic Kidney Disease

Transcript: Chronic Kidney Disease hypertension Arteries carry blood low blood pressure Pyelonephritis Damaged blood vessels Retain electrolytes and water Inheritance and Lifestyle choices People who are: Aboriginal Asian African Caribbean Hispanic Seniors Chronic kidney disease is not inheritable. Lifestyle choices that can affect CKD is becoming: Dehydrated regularly Taking medication Smoking Increases of salt in diet Symptoms of Chronic disease are: Change in urine Swelling in body Skin rash Metallic taste in mouth/ammonia breath Nausea and vomiting Shortness of breath Circulatory System Skeletal System Integumentary system Nervous system Treatment for Chronic Kidney Disease Hemodialysis Dialysis Transplants Renal replacement therapy (RRT) Healthcare Team Dietitan Nephrologist and Nephrology nurse Johns Hopkins & Other Kidney Resources, Symptoms - http://www.nationalkidneycenter.org/chronic-kidney-disease/symptoms/ Johns Hopkins & Other Kidney Resources, Prevention & Test - http://www.nationalkidneycenter.org/chronic-kidney-disease/prevention-tests/ Unknown Author, What is Kidney Disease - http://www.kidney.ca/Page.aspx?pid=320 Unknown Author, Conservative Care - http://www.kidney.ca/page.aspx?pid=341 Dr. Joanne Kappel, Kidney disease - http://www.kidney.ca/document.doc?id=242 National Kidney Foundation, Kidney Disease - http://www.kidney.org/atoz/content/kidneysnottowork.cfm William Hartston, Top 10 facts about kidneys - http://www.express.co.uk/fun/top10facts/464510/Top-10-facts-about-kidneys Tsagalis G, Zerefos S, Zerefos N. Cardiorenal syndrome at different stages of chronic kidney disease. Int J Artif Organs. 2007 Jul;30(7):654-76 Efstratiadis G, Tziomalos K, Mikhailidis DP, Athyros VG, Hatzitolios A. Atherogenesis in renal patients: a model of vascular disease? Curr Vasc Pharmacol. 2008 Apr; 6(2):93-107 Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD, Cleland JG, van Veldhuisen DJ, Hillege HL. Worsening renal function and prognosis in heart failure: systematic review and meta-analysis. J Card Fail. 2007 Oct;13(8):599-608 Raizada V, Skipper B, Luo W, Griffith J. Intracardiac and intrarenal renin-angiotensin systems: mechanisms of cardiovascular and renal effects. J Investig Med. 2007 Nov;55(7):341-59 What is affected by Chronic Kidney Disease DID YOU KNOW...... Erythropoietin (EPO) Inheritance and Lifestyle choices Stage 1 ~ 90 % Stage 2 ~ 60 - 89 % Stage 3a ~ 45 - 59 % Stage 3b ~ 30 - 44 % Stage 4 ~ 15 - 20 % Stage 5 ~ 15% Heart Water and salt Causes of Chronic Kidney Disease Development of Chronic Kidney Disease High blood pressure Hardening of the arteries Inflammation of the kidney Diabetes Chronic kidney disease CKD Renal disease In 2003, doctors in Latvia reported a case of a man with four kidneys Every day our kidneys filter about 50 gallons of blood through their 140 miles of tubes DID YOU KNOW...... DID YOU KNOW...... Compensate Bibliography Developments of stem cells research for new nephrons (tubule that filters the kidney) have been researched since the 1900's. http://santaclaracampaigndollars.org/useful-tips/63-how-to-treat-kidney.html In snake, the right kidneys is closer to the head than the left kidney Chronic Kidney Disease Red blood cells Chronic kidney disease starts slowly, and progresses over a number of years. There are 5 stages in chronic kidney disease. http://www.buzzle.com/articles/kidney-diseases/ DID YOU KNOW...... What is Chronic Kidney Disease? Photos bibliography

Chronic Kidney Disease

Transcript: DIALYSIS KIDNEY TRANSPLANT Signs and Symptoms Changes in Urination Swelling Fatigue Skin Rash/Itching Metallic Taste in Mouth/ Ammonia Breath Nausea and Vomiting Shortness of Breath Feeling Cold Dizziness and Trouble Concentrating Prognosis Chronic Kidney Failure, also called Chronic Kidney Disease, is the slow loss of kidney function over time. Earlier stage may have no symptoms as loss of function may take months or years to occur. The main functions of the kidneys is to remove wastes and excess water from the body Many people are not diagnosed with chronic kidney disease until they have lost most of their kidney function. There is no cure for chronic kidney disease, but lifelong treatment may control the symptoms. However, if untreated, it usually worsens to end-stage renal disease where the kidneys has completely failed. From here, the patient will have to undergo dialysis or kidney transplant in order to live longer. By: Vivian Pham Thy Hua Regine Lasam Brooke Nose Period 2 Treatment Chronic Kidney Disease Background TREATMENT TO SLOW DOWN OR MAINTAIN STATE: CONTROL BLOOD SUGAR & BLOOD PRESSURE EXERCISE HEALTHY DIET LIMIT ALCOHOL CONSUMPTION MEDICINE PRESCRIBED BY DOCTOR Type 1 or type 2 diabetes High Blood Pressure Glomerulonephritis Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers Vesicoureteral reflux Recurrent kidney infection (pyelonephritis) Etiology Diagnosis Blood Tests Urine Tests Imaging Tests Kidney biopsy PROGNOSIS Kidney Bladder Ureter ETIOLOGY DIAGNOSIS SIGNS & SYMPTOMS

Chronic kidney disease

Transcript: DMII HTN Ethnicity (African American) Cardiovascular disease (CAD,CABG) Age >60 (75y/o) Family hx (mom:CKD, dad: renal failure) Smoking Dyslipidemia 2) Weigh the patient and monitor trends to evaluate intervention Pt medical/surgical/psychological hx 1) Monitor resp. pattern for symptoms of resp. difficulties (dyspnea, tachypnea, & SOB) that are indicators of fluid excess T: 100.6 HR: 100 R:25 & labored BP: 152/97 02: 96% RA Radiology Meds Subjective data Medical/Surgerical: DM 2 X 15 yrs w/ diabetic neuropathy & retinopathy. HTN x 20 years CAD x 10 years Obesity Osteoarthritis Dyslipidemia Laparoscopic cholecystectomy in 2006 CABGx2 in 2010 Chronic kidney disease Chronic Kidney Disease Excess fluid volume AEB edema, HTN, shortness of breath secondary to CKD At risk for impaired breathing r/t fluid overload At risk for ineffective coping r/t chronic illness Promote exercise O2 to carry out ADLs Encourage rest between activites Promote independence in self-care Vasotec 2.5 mg PO daily for HTN Lasix 40mg PO daily for edema Vytorin 10mg PO qHS for high cholesterol Glipizide 6mg PO daily for DMII Metformin 1000mg PO BID for DMII Levaquin 250mg IVPB q24hrs for infection Insulin sliding scale for DM management Erythropoetin therapy to increase RBC NS flush 10cc q8h Tachycardia, VS increased Skin pale w/ dry skin, bruises & edema Lethargic; answers questions slowly Mild edema noted at feet & ankle Palpable pedal pulses VS increased Wt gain of 10lbs Labs Objective data Diet ADL 4) Provide appropriate diet to help control edema & HTN Progressive, irreversible loss of kidney function Presence of kidney damage OR Decreased GFR (<60ml/min for >3mo.) Controlling DM 2, HTN, dsylipidemia Diet Symptom relief Prevent complications VS / Physical assessment 3) Monito I/Os to determine effect of treatment on kidney function Excess fluid volume AEB edema, HTN, shortness of breath secondary to CKD Chest X-ray PA/LAT Pulmonary Function Test EKG Renal Ultrasound CT scan Renal scan Low protein diet 1800 cal. ;no added salt Diabetic diet Fluid restriction 1500cc Low cholesterol Nursing Dx Lethargy Painful urination w/ decreased urine output Anorexia Muscle cramps Itchiness Psych: Parents dying young, being in a nursing home, living w/ chronic illness 5) Instruct the pt on measures instituted to treat hypervolemia (daily wt, fluid restriction) to help monitor & control fluid overload & related HTN Treatment Na+: 138 (135-145) K+: 5.9 ( 3.5-5.0) Cl-: 112 (96-106) Mg++: 0.9 (1.5-2.5) Phosphorus: 6.2 (2.4-4.4) Ca++: 5.2 (8.6-10.2) CO2: 36 (35-45) BUN: 26 (10-30); creatinine: 2.1 (0.5-1.5) GFR: 55 ( Stage III 30-59) Glucose:290 (70-100) WBC: 12.5 (4-11) RBC: 3.2 (3.8-5.1) Hgb: 8.4/Hct:25.2 (11.7-15.5/35-47) LDL:220 (<100) HDL: 30.0 (>50) Tryglycerides:230 (<150) Total cholesterol: 250.0 (<200) Urinalysis: protein & microalbuminuria, RBCs, WBCs, casts & glucose Urine cultures done: Final results pending. Preliminary results: microorganisms detected Predisposing conditions

Chronic Kidney Disease

Transcript: Chronic Kidney Disease Diabetes & High Blood Pressure may lead to kidney failure 2 out of 3 cases of CKD happen because of diabetes. Stages 3&4 Signs of end renal failure (ESRD) (GFR less than 15%) 1.Slow the progression of disease 2.Treat underlying causes and contributing factors 3. Treat complications of disease 4. Replace lost kidney function Serum creatinine higher Tiredness or fatigue Puffiness or swelling (hands,feet, and ankles) Back pain mid lower portion of back Food start tasting funny Urine changes in amount, color, and frequency High blood pressure Poor digestion Symptoms Blood work will be abnormal (Slightly elevated serum creatinie) Urinalysis (urine abnormality) Blood & Protein in the urine does not say anything about the kidney function Protein restriction Salt restriction Fluid Intake Potassium Restriction Phosphorus Restriction Signs of severe chronic renal insufficiency (GFR 15% to29% kidney function) Cited Work Stages 3 Summary Video Clip Treating underlying conditions Stage 2 Causes Signs of mild kidney disease with normal or better kidney function. (GFR indicates greater than 90% kidney function) 4 Goals of Therapy Signs of moderate chronic renal insufficiency (GFR indicates 40% to 59% kidney function) Stage 5 Treatments Stage 4 Diabetes High Blood Pressure Family History of CKD Older in Age Final Stage Stages Control blood glucose Control high blood pressure Diet Fluid Retention Anemia Bone Disease Acidosis http://www.nationalkidneycenter.org/chronic-kidney-disease/?gclid=CLbvj9j44a8CFQSxnQodqEjPXg http://www.kidney.org/kidneydisease/aboutckd.cfm http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001503/ http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm What this means: What Does This Mean Anemia Headache Fatigue and drowsiness (more than normal) Lowered mental alertness Trouble concentrating Confusion & seizures Nausea & Vomiting Nocturia Diarrhea Skin color changes Difficulty breathing Excessive Loss of Energy Trouble Concentrating Poor Appetite Trouble Sleeping Muscle Cramping (Night) Swollen Feet or Ankles Puffiness Around Eyes Dry Itchy Skin Urinate More Often (Night) What Puts One More At Risk? What Is CKD: Slow Down The Process What does this mean: Stage 1 Signs of mild chronic renal insufficiency (GFR indicates 40% to 59% kidney function) Stage 1 & 2

Chronic Kidney Disease

Transcript: The first kidney transplantation in the United States was performed on Ruth Tucker, a 44 year old woman on June 17,1950. The transplant was performed at Little Company of Mary hospital in Evergreen Park, Illinois. Even though the transplanted kidney was rejected 10 months later, it gave enough time for Ruth's kidney to recover and she lived another 5 years. The development of anti-rejection drugs came years later. As you can see, the kidney transplantation method really helps the lives of the suffering patients and helps make their lives a lot longer. What is Chronic Kidney Disease? Chronic Kidney Disease (CKD) is the slow loss of kidney function over time. The kidneys are responsible for removing wastes and excess water from the body. The biggest symptoms of CKD are high blood pressure and Diabetes. Mohamad Ali 8-5 Although there is no true cure for CKD, there is something called a kidney transplantation. Kidney transplantation or Renal Transplantation is also referred to as donor or living donor transplantation depending on the source of the donor organ. Kidney Transplantation's are characterized as related (living-related) or non-related (living-not related) transplants. This procedure involves the transplant of the organ from one doner to the infected patient to replace their infected organ. Successful Kidney Transplantation's do not cure CKD, but they certainly extend the lives of others if performed successfully. Chronic Kidney Disease CKD has been raised to awareness worldwide, and we know, as shown in this presentation, that there are ways to help the lives of those suffering from this terrible disease, like kidney transplants and artificial kidneys. These operations are very helpful to those who need help, but, what people are not aware of is the fact that these methods are very expensive and it requires a lot of money and donations for these operations to be put through. In order for this to happen, we need to donate and try to help the research department in any way so we can help people all over the world. How technology has affected Chronic Kidney Disease. - The two main causes of CKD are Diabetes and high blood pressure. - CKD is called a silent killer because there are few symptoms and by the time the patient realizes what is happening, damage has been made. Sources: The Kidneys Technology and CKD - In Canada, 1.9 to 2.3 million people have CKD Overall, I think that technology has made a huge impact on CKD (Chronic Kidney Disease) as before kidney transplantation was discovered, there was pretty much no hope for patients suffering with CKD. But now, since we have Kidney transplantation, we can dramatically change and increase the length of the lives of the patients. The History of Kidney Transplantation's Information: http://en.wikipedia.org/wiki/Chronic_kidney_disease Notes: http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm Kidney Transplantation Info: http://en.wikipedia.org/wiki/Kidney_transplantation Why should you donate? The Kidneys are a pair of bean shaped organs that lie on either side of the spine in the lower middle of the back. These organs are responsible for cleaning out waste products and excess water from the blood. Interesting Facts About CKD

Chronic Kidney Disease

Transcript: • Glomerulonephritis. It’s an inflammation of the kidney’s filtering units called glomeruli • Interstitial nephritis, which is an inflammation of the kidney tubules and structures surrounding it • Inherited diseases, such as polycystic kidney disease, which causes large cysts to form in the kidneys and damage the surrounding tissue. • Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men. • Vesicoureteral reflux. This is a condition in which urine backs up into your kidneys • Recurrent kidney infection, also called pyelonephritis • Malformations that occur as a baby develops in mothers womb. Signs & Symptoms http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/definition/con-20026778 By Andrea Hamm http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm Treatments High blood pressure medications - Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are used most often. Also known as Chronic Kidney Failure A lower protein diet to minimize waste products in your blood Medications to lower cholesterol levels However, these signs and symptoms are non-specific, which means they may show up due to some other illness. They may not appear till when the damage is irreversible. For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body. Prevention of blood pressure-related cardiovascular and kidney diseases through pharmacologic and non-pharmacologic approaches, often nutrition-based http://www.doctortipster.com/25094-chronic-kidney-disease.html Treatment for end-stage kidney disease Current Research Medications to relieve swelling Chronic Kidney Disease 5. Chronic kidney disease may not become apparent until your kidney function is significantly impaired. Often, though, chronic kidney disease has no cure. Causes Case Study References Uncle - Nils Muralles • Smoking • Obesity • High cholesterol • Being African-American, Native American or Asian-American • Family history of kidney disease • Age 65 or older Epidemiology and prevention of CKD, cardiovascular disease in CKD and ESRD, biomarkers in CKD Medications to treat anemia 4. Not everyone is a candidate for a kidney transplant. Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. Genetic epidemiology of diabetic nephropathy; hypertension and CKD • Nausea • Vomiting • Loss of appetite • Fatigue and weakness • Sleep problems • Changes in urine output • Decreased mental sharpness • Shortness of breath, if fluid builds up in the lungs • Muscle twitches and cramps • Hiccups • Chest pain. It happens when fluid deposit around the lining of the heart • Swelling of feet and ankles • Persistent itching • High blood pressure, which is difficult to control • Need to urinate more often, especially at night. Kidney transplant Chronic kidney disease shows up if a disease or medical condition interferes with the kidney functions and damage the kidneys over a duration of a few months. http://www.emedicinehealth.com/chronic_kidney_disease/article_em.htm Medications to protect your bones Risk Factors https://www.kidney.org/kidneydisease/aboutckd 1. Chronic kidney disease can affect almost every part of your body. 2. Kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled. 3. The number of transplants per year is from 15,000 to 18,000. Dialysis. Kidney disease complications can be controlled to make you more comfortable Two main causes of chronic kidney disease are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Quality of primary care for patients with CKD, patient education interventions to improve clinical outcomes and address race disparities in CKD care In the early stages of chronic kidney disease, you may have few signs or symptoms. Facts