Clinical Manifestations : chronic kidney disease

  • Clinical Manifestations
    • Result of retained
      • Urea
      • Creatinine
      • Phenols
      • Hormones
      • Electrolytes
      • Water
    • Uremia is a syndrome in which kidney function declines to the point that symptoms may develop in multiple body systems
    • Manifestations of uremia vary among patients according to the cause of the kidney disease, co-morbid conditions, age, and degree of adherence to the prescribed medical regimen
    • Cultural and ethnic health disparities
      • Chronic kidney disease (CKD) has a high incidence in minority populations, especially African Americans and Native Americans.
      • Hypertension and diabetes mellitus are also more common in African Americans and Native Americans.
        • African Americans
          • The risk of CKD as a complication of hypertension is significantly increased in African Americans.
          • African Americans have the highest rate of CKD, nearly four times that of whites.
        • Native Americans
          • Native Americans have a rate of CKD twice that of whites.
          • The rate of CKD is six times higher among Native Americans with diabetes than among other ethnic groups with diabetes.
        • Hispanics
          • The rate of CKD in Hispanics is 1.5 times higher than in non-Hispanic whites.
    • Urinary system
      • In the early stages of CKD, patients usually do not report any change in urine output
      • Since diabetes is the primary cause of CKD, polyuria may be present, but not necessarily as a consequence of kidney disease
      • As CKD progresses, patients have increasing difficulty with fluid retention and require diuretic therapy
      • Anuria may develop after a period on dialysis
    • Metabolic Disturbances
      • Waste Product Accumulation.
        • As the GFR decreases, the BUN and serum creatinine levels increase.
        • The BUN is increased not only by kidney disease but also by protein intake, fever, corticosteroids, and catabolism.
        • For this reason, serum creatinine clearance determinations (calculated GFR) are considered more accurate indicators of kidney function than BUN or creatinine.
        • Significant elevations in BUN contribute to development of nausea, vomiting, lethargy, fatigue, impaired thought processes, and headaches.
      • Altered Carbohydrate Metabolism.
        • Defective carbohydrate metabolism is caused by impaired glucose metabolism, resulting from cellular insensitivity to the normal action of insulin.
      • Mild to moderate hyperglycemia and hyperinsulinemia may occur.