Fluid Imbalances Caused by Renal Failure - Essay Example

Renal Failure Introduction In mammals the kidneys are the twin organs in the lower abdomen that work to filter waste products from the bloodstream. As well as this they are involved in the regulation of blood pressure, the removal of excess water from the body, as well as affecting the body’s electrolyte balance and the production of red blood cells. When the kidneys fail the body experiences a build-up of waste products which would otherwise have been excreted. This causes a number of symptoms which vary in degree according to amount that the organs are damaged. It causes general weakness and lethargy, apnoea and mental confusion. Because levels of toxic substances build up in the body the heart may develop a disturbance to its regular rhythm, and death can occur suddenly. Within Australia one in ten deaths in 2007 were related to chronic kidney disease, and, among indigenous Australians the amount of end stage chronic renal failure is six times higher than among the rest of the population ( Australian Institute of Health and Welfare , 2013). How chronic renal failure occurs. According to Kidney Health Australia (2014) ( Chronic kidney disease can be defined as a progressive slow loss of kidney function over time ( Medline Plus, 2014). Progress can be very so that the affected person may not be aware of real problems until a late stage. By that time the kidneys are failing to remove either water or waste products and kidney dialysis or a transplant is required if the person’s life is to be saved. High blood pressure and diabetes are the two major causes of this problem, but many other diseases can only bring it on. The process begins when the kidney’s filtering process becomes partially blocked. This can be because the kidney tissue is being damaged, as can occur with diabetes. A more indirect blockage, as occurs when a kidney stone blocks the exit of urine from the organ. At first the damage may be slight , but gradually, as either the diabetes affects more and more renal cells, so leaving fewer to carry on the work of filtering waste products, or as the kidney stone grows in size over time, more and more urine backs up and causes damage. The symptoms the person experiences, or which can be measured and observed by medical staff, will vary according to the severity of the kidney failure, the underlying condition which causes it, and the rate at which the failure progresses. Symptoms may not be noticed however until the kidneys are only working at about 20% or less of their normal functioning level ( Urology Care 2013). Fluid imbalances caused by renal failure The body requires a certain amount of fluid in order to function properly. It is the salts in the body which control the amount of fluid within the body, so these have an effect upon blood pressure and the amount of urine excreted. When kidney failure occurs these electrolyte levels and the amount of water retained in the body are adversely affected as the body becomes unable to eliminate any excesses. As fluid builds up in the body the person may experience swelling and oedema. The retention of fluid is the result of protein loss in nephrotic syndrome, and in chronic renal failure it is because of an inability to remove sufficient sodium into the urine. If the patient takes in more sodium than their kidneys can successfully excrete then oedema will build up. The fluid is heavy and so tends to settle in the lower limbs, causing thickening and oedema. Electrolyte imbalances caused by RF, including changes in potassium, calcium, phosphate, sodium. If a person is known to have any degree of kidney failure then levels of the electrolytes potassium, calcium, phosphate and sodium must be measured regularly in order to know the progress of the condition. The aim of any treatment is to achieve homeostasis, that is to maintain function at a constant and normal level by regulating electrolyte levels within a small normal range. The kidneys encourage the adrenal glands to secrete the aldosterone. This then enables the kidneys to retain needed sodium and to excrete excess potassium. When sodium is retained, less urine is produced, eventually causing blood volume to increase. When intake and excretion of these electrolytes are not balanced the amount of these items in the blood circulation is affected, and this can adversely affect the heart rhythms ( Patient Co.Uk, undated) The condition can be diagnosed by a physician if he suspects its presence, by doing blood tests to measure electrolytes, in particular measuring blood creatinine levels. Creatinine, is a by-product of muscle metabolism. If renal function is compromised then levels will rise. Normal blood levels of electrolytes Creatinine 0.6 - 1.2 mgs per deciliter ( men) 0.5 – 1.1 mgs per deciliter ( women) Sodium 135 - 145 milliEquivalents/liter Potassium 3.5 - 5.0 milliEquivalents/liter Chloride 98 - 108 mmol/liter. Calcium 2.2 and 2.6 mmol/liter Phosphate 0.8 to 1.4 mmol/liter Acid base imbalances caused by renal failure According to Adrogué and Madias an important function of any living organism is the maintenance of homeostasis in the body’s acid base balance. The means keeping a balance of the carbonic acid-bicarbonate system, and maintaining adequate hydrogen ion levels in the blood serum. Buffers are compounds that do this by limiting the change in hydrogen ion concentration , and so the degree of acidity or alkalinity , the pH. Buffering (Acid –Base balance and disbalance , undated) If a strong acid is added to the system >this is removed to restore an equilibrium If a strong alkali is added to the system >this is removed to restore the equilibrium Signs and symptoms that can be expected, and how these relate to imbalances. According to the Mayo clinic (2014) symptoms may include those linked to the gastrointestinal system such as nausea, vomiting and general loss of appetite, due to increased levels of toxins. Urinary output will change. Retained fluid will cause swelling of the feet and legs. In severe cases there will be chest pain, as fluid builds up around the pericardium. As fluid increases in the lungs their function is also affected and the person will experience shortness of breath. Fatigue is a common symptom because the kidneys, as they fail in their normal functions, cause anaemia , as less of the hormone erythropoietin, which normally instructs the body to make red blood cells (DaVita 2014) . A balance in electrolytes is needed for normal nervous system function, and so when imbalance occurs, and toxins build up, there may be mental confusion, a lack of mental sharpness and sleep disturbance and even seizures (C Health, 2014). If calcium and other electrolytes are in imbalance they may increase in the tissues, causing in the case of phosphorus or parathyroid hormone, itchy skin ( pruritis) and dry skin ( DaVita, 2014). If the patient scratches to any great extent then skin damage will occur and then secondary infections can occur. There may also be cramps and muscle twitching. These are again due to the variation in electrolyte levels. If less fluid is being excreted then blood pressure will rise. If there is an increase in excretion the person may get very thirsty as the body tries to maintain haemostasis. If too much magnesium is excreted the heart rhythm is affected. This is most likely when kidney failure has progressed to a high level. Interventions paramedics can commence pre-hospital These will depend upon the degree of kidney failure, its acuteness and the symptoms experienced. It is important that paramedics understand normal renal anatomy and physiology, pathophysiology and, if necessary the dialysis procedure, in order to assess and treat these people before they are handed over into the care of hospital staff. A full medical history should be taken. If the person is retaining too much fluid they may well be experiencing hypertension, peripheral oedema, ascites and /or pulmonary oedema. All of these can be relieved, if there is any degree of remaining viable kidney function, by the administration of diuretics (Fairbanks et al , 2005) . Vital signs should be measured , and if the diagnosis is known then blood should be taken for creatinine and electrolyte levels. Administering oxygen may be helpful if the person is short of breath. Most of all the patient should be made as comfortable as possible and reassured. A specimen of urine should be obtained if possible. This will help to identify the condition. I.V. access should be established. The patient should then be transported as quickly as possible to an appropriate medical facility. Conclusion Renal failure is a complicated condition with many possible causes and symptoms. Untreated it will progress and the patient will gradually become more and more incapacitated unless there are successful interventions, such as dialysis or kidney transplant, then it may prove to be fatal. It is a particular problem among indigenous Australian people, who are much more likely than average to develop this problem, because of high levels of diabetes and heart disease. References Acid –Base balance and disbalance ,( undated) , retrieved from http://www.jfmed.uniba.sk/fileadmin/user_upload/editors/PatFyz_Files/Handouty/angl/Acid-Base_balance_and_disbalance.pdf Adrogué , H.and Madias, N. (undated) Disorders of Acid-Base Balance, retrieved from http://www.kidneyatlas.org/book1/adk1_06.pdf Australian Institute of Health and Welfare, (2013), Chronic kidney disease, retrieved from http://www.aihw.gov.au/chronic-kidney-disease/ C Health, (2014), Chronic renal failure retrieved from http://chealth.canoe.ca/channel_condition_info_details.asp?disease_id=258&channel_id=143&relation_id=1711 DaVita, (2014), Lifestyle Choices for Those with Chronic Kidney Disease, retrieved from http://www.davita.com/kidney-disease/overview/the-basics/lifestyle-choices-for-those-with-chronic-kidney-disease/e/4663 Fairbanks, R., Goyal, M. and Marks, A., (2005), Renal Failure and Dialysis Patients: What the EMS Provider Should Know, EMS World, retrieved from http://www.emsworld.com/article/10323936/renal-failure-and-dialysis-patients-what-the-ems-provider-should-know Kidney Health Australia,( 2013), Risk factors &symptoms of kidney disease? retrieved from http://www.kidney.org.au/KidneyDisease/RiskFactorsandSymptoms/tabid/819/Default.aspx Mayo Clinic, (2014), Chronic kidney disease: symptoms, retrieved from http://www.mayoclinic.org/diseases-conditions/kidney-disease/basics/symptoms/con-20026778 Medicine Net ( 2014) Creatinine blood test, retrieved from http://www.medicinenet.com/creatinine_blood_test/page2.htm Medline Plus, (2014), Chronic kidney disease, retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000471.htm Patient Co.UK,( undated), Chronic kidney disease, retrieved from http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/electrolyte_balance/overview_of_sodium.html Urology Care, (2013), Kidney ( renal ) failure, retrieved from http://www.urologyhealth.org/urology/index.cfm?article=20 Conclusion Read More