HNB3209 Nursing and Community - Chronic Kidney Disease - Essay Assignment Help

Introduction

Chronic Kidney Disease (CKD) is a global health concern, with 10% of the world’s population suffering from it and millions dying from it (National Kidney Foundation, 2015a). CKD is a progressive disease featuring various degrees of renal failure from mild, moderate to severe. If unmanaged, CKD may progress to end-stage renal disease (ESRD) as increased renal impairment disables the kidney to maintain the body’s fluid and electrolyte balance (Malkina, 2018). Patients with CKD are also more susceptible to cardiovascular risks apart from other health risks (Bryant & Knights, 2014). Therefore, it is advisable to prevent CKD progression into ESRD and its associated risks of infection and psychiatric problems. Managing CKD essentially means slowing down the progression of the disease and lowering risks. The patient’s high-level involvement is necessary in order to manage CKD in the long term (Peng, et. al., 2019). Hence, supporting the self-management of CKD is extremely important for nurse practitioners.

CKD: Causes & Pathophysiology

Kidney malfunctions can happen due to various physiological circumstances, however, CKD is primarily caused by diabetes and hypertension or high blood pressure. Increased BP and diabetes comprise more than half of the preconditions behind CKD (National Kidney Foundation, n.d.). When blood glucose levels increase, it causes diabetes and begins to damage various organs of the body, including the kidneys. When blood pressure increases, it often causes the various arteries near the kidneys to weaken, constrict or harden, thus leading to reduced blood flow to the renal tissues and consequent damage (American Heart Association, 2016). Other less common causes of CKD include – glomerulonephritis (inflammatory disease damaging kidney’s filtration), polycystic kidney diseases (kidney cysts damaging tissues), malformations at birth, immune system disorders, kidney stones/tumours and repeated urinary tract infections (National Kidney Foundation, n.d.). 

Initially, when the renal tissues are affected or damaged, some abnormalities are noticed because the other tissues adapt to the situation and over-perform. This often leads to fluid and electrolyte imbalance and kidneys lose their ability to concentrate urine. Consequently, the levels of phosphate, potassium and acids increase in the body. CKD is diagnosed when kidneys are clearly damaged or when the glomerular filtration rate (GFR) falls below 60 mL/min/1.73 m2 over a period of 3 months (Arora, 2019). In advanced CKD, the GFR further drops to ≤ 15 mL/min/1.73 m2 and the kidney loses its ability to process urine (Malkina, 2018). Urea and creatinine levels soar and cause systemic manifestations or uraemia. Hyperparathyroidism is a common manifestation of this CKD condition (Malkina, 2018; Arora, 2019). Hence, the parathyroid hormone (PTH) monitoring is extremely important. 

CKD: Signs & Symptoms

There are many signs and symptoms of CKD, some are more common, while others less. The symptoms include, but are not limited to, the following (National Kidney Foundation, n.d.):

• Sleeping problem (insomnia)
• Poor appetite
• Fatigue or lethargy
• Dry, itchy skin
• Increased tendency to urinate
• Focusing or concentrating problem
• Swollen feet and ankles
• Eye puffiness, particularly during mornings
• Muscle cramps/muscle weakness
• Losing lean body mass
• Restless legs
• Reduced cognitive and immune capabilities