A diagnosis of chronic kidney disease id made on the basis of a thorough history and physical examination, ultrasonography of the kidneys, and specific laboratory studies, which can provide enough data on which to base a probable diagnosis and begin treatment. Kidney biopsy is performed only when the diagnosis is uncertain and the patient's kidneys are of sufficient size that the risks associated with the procedure, such as bleeding and infection,are't unacceptable.
Chronic kidney disease stages are determined according to the level of kidney function as indicated by glomerular filtration rate (GFR) . Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification,developed by the kidney disease outcomes quality initiative of the national kidney foundation, defines chronic kidney disease as either kidney damage of at least three month' duration or a decreased GFR (less than 60 ml/min/1.73m2) of at least three month' duration. the goal of treatment are to slow disease progression and to reduce the risk of cardiovascular disease and other complication. The progression of the disease varies according to etiology the treatment received, and the effectiveness of self-management. A patient whose kidney function is severely compromised (stage 4 ; a GFR between 15 and 29 ml/min/1.73m2) is approaching kidney failure ( stage 5 ; a GFR below 15 ml/min/1.73m2) . Therefore, nursing intervention for patients in stage 4 must involve preparing the patient for kidney replacement therapy, although management is focused on delaying that probability