Chronic Renal Failure Progressive Disease †Myassignmenthelp.Com

Question: Discuss About The Chronic Renal Failure Is A Progressive Disease? Answer: Introducation Chronic renal failure is a progressive disease that results in inability of the kidney to maintain normal levels of certain substances such as urea, creatinine, sodium, water, haematocrit and so on. Several risk factors may play part in causing nephron damage ultimately debilitating kidney function. However, not all nephrons are damaged and the surviving ones suffer enlargement due to increased load. Glomerulonephritis may occur in a rapid and severe manner leading to end stage renal failure or in some patients it is progresses gradually (Lo et al., 2009). No functionality of the kidney causes rise in systemic blood pressure and proteinuria. Although initially the nephrons try to adopt cope up for the damaged ones they eventually fail to do so resulting in uremia. Glomerular filtration rate is enhanced in adapted nephrons. The primary complain of Mr Goodpasture during admission was nausea, malaise, low mood and pruritus. He suffers from end stage renal disease, hypertension, seasonal rhinitis and depression. His biochemistry results show a marked increase in urea and creatinine in blood resulting from the kidney disease he suffers from. Blood creatinine value is overwhelming high at 825 micromol/L. Kidney failure is almost always associated with raised urea and creatinine concentration in blood due to retention of the nitrogenous waste products by the kidney. Increased blood urea concentration is a better index for measuring the severity of acute renal failure, whereas increased creatinine concentration provides a better index for chronic renal failure. Hence it is evident that Mr Goodpastures condition has deteriorated markedly and requires immediate medical intervention to prevent adverse consequences. The haematology report further shows serious abnormalities in the patient. The haemoglobin and red cell count are low and levels of white cell count and neutrophils are markedly high. This is a clear sign of acute infection associated with kidney failure or certain other conditions. As the patient is a rural sheep farmer and suffers from seasonal rhinitis, he might be suffering from acute infection. Further, studies have shown that patients suffering from chronic kidney disease have an increased susceptibility towards infectious diseases, probably due to reduced immune function. Kidney is a self-regulatory system that is essential to perform a number of physiological functions and maintain normal health. It relieves the body from nitrogenous waste products, maintains water and electrolyte balance and reduces essential hormones and enzymes. In end-stage kidney disease the chronic gradual loss of kidney function reaches an advanced stage where extreme measures like dialysis or organ transplant is required to sustain life (Levey et al., 2007). Medical History Mr Goodpasture has a medical history of hypertension, end stage renal disease, seasonal rhinitis and depression. As the primary function of the kidney is to filter out waste products from the blood, its functionality hugely depends on the blood pressure, especially inside the glomerulus. High blood pressure exerts increased pressure on the vessel walls, stretching them, which eventually scars and weakens the vessel tissues (Coresh et al., 2007). The same phenomenon may occur in the blood vessels of the kidney reducing the ability of the nephrons to filter blood properly due to lack of oxygen and nutrients. Studies have shown that high blood pressure is the second leading cause of kidney disease worldwide. Although kidneys themselves are equipped with controlling the systemic blood pressure prolonged high blood pressure renders them unable to control the same, further worsening the situation (Schiffrin, Lipman Mann, 2007). As the patient was born and raised in a rural community and s uffers from seasonal rhinitis, the allergic syndrome might have play a role in progression of nephrotic syndrome from an early age (Salsano, Graziano, Luongo, Pilla, Giordano Lama, 2007). There are significant evidences supporting the link between allergic rhinitis and nephrotic syndrome especially in children. Lastly the patient also suffers from depression. Studies have proposed a more rapid progression of renal disease in patients suffering with comorbid depression and conversely patients with chronic kidney disease often suffer from depression (Abdel-Kader, Unruh Weisbord, 2009). Hence, both the factors work in a cyclic pattern augmenting the effect of one another. Management Incidence of end stage kidney disease has been increasing in recent years and patients are treated by providing dialysis. However, several associated secondary symptoms are prevalent after receiving dialysis. Managing such symptoms and providing optimal care for those patients are mandatory to maintain a standard quality of living. It has been observed that there is an increased incidence of coronary artery disease, cancer and chronic obstructive pulmonary disease in patient who receive dialysis. Pain is one of the most commonly reported symptoms in patients with end stage kidney disease. However, it may result from renal aetiologies such as polycystic kidney, hyperparathyroidisism or due to non-renal aetiologies such as skin ischemia and calciphylaxis (Liyanage et al., 2015). Medications should be provided taking into account the patients renal status and etiology. Opioids can be prescribed for such patients but non-steroidal anti-inflammatory drugs must be strictly avoided for pati ents with renal disease. Non-pain symptoms also contribute significantly in maintaining normal lifestyle. Weakness, lack of energy and pruritus are the most common non-pain symptoms reported by chronic renal disease patients. Other non-pain symptoms include loss of appetite, sleep disturbances, dry mouth, muscle cramps and constipation (Murtagh et al., 2007). Most of these symptoms can be kept under control by providing simple healthcare interventions while some other requires medications. Pruritus is managed by administration of phosphate binders and antihistamines. Fatigue, loss of appetite and muscle cramps can be managed by maintaining a healthy diet, encouraging physical activity and evaluating depression. Further, initiation of dialysis can be delayed to prevent secondary symptoms in appropriate conditions with supervision form a nephrologist. Pain management with drugs must be regulated both in terms of dosage and frequency of administration. As kidney is one of the organs responsible for metabolising certain drugs, additional load must be prevented. When the patient is suffering from comorbid life threatening conditions delay of dialysis initiation may prove to be an important decision, which must be taken by collaborative consultation of respective specialists to prevent any detrimental consequences to the patient. References Abdel-Kader, K., Unruh, M. L., Weisbord, S. D. (2009). Symptom burden, depression, and quality of life in chronic and end-stage kidney disease.Clinical Journal of the American Society of Nephrology,4(6), 1057-1064. Coresh, J., Selvin, E., Stevens, L. A., Manzi, J., Kusek, J. W., Eggers, P., ... Levey, A. S. (2007). Prevalence of chronic kidney disease in the United States.Jama,298(17), 2038-2047. Levey, A. S., Atkins, R., Coresh, J., Cohen, E. P., Collins, A. J., Eckardt, K. U., ... Powe, N. R. (2007). Chronic kidney disease as a global public health problem: approaches and initiativesa position statement from Kidney Disease Improving Global Outcomes.Kidney international,72(3), 247-259. Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H. M., Okpechi, I., ... Rodgers, A. (2015). Worldwide access to treatment for end-stage kidney disease: a systematic review.The Lancet,385(9981), 1975-1982. Lo, L. J., Go, A. S., Chertow, G. M., McCulloch, C. E., Fan, D., Ordoez, J. D., Hsu, C. Y. (2009). Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease.Kidney international,76(8), 893-899. Murtagh, F. E., Marsh, J. E., Donohoe, P., Ekbal, N. J., Sheerin, N. S., Harris, F. E. (2007). Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.Nephrology Dialysis Transplantation,22(7), 1955-1962. Salsano, M. E., Graziano, L., Luongo, I., Pilla, P., Giordano, M., Lama, G. (2007). Atopy in childhood idiopathic nephrotic syndrome.Acta paediatrica,96(4), 561-566. Schiffrin, E. L., Lipman, M. L., Mann, J. F. (2007). Chronic kidney disease.Circulation,116(1), 85-97.