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Chronic Kidney disease with Hemodialyis - Case Study Example

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Summary
Chronic kidney disease represents a progressive destruction of nephrons causing a decline in kidney function. It can be caused by many problems including diabetes, hypertension, glomerulonephritis, and other kidney disease. All forms of CKD (chronic kidney disease) are characterized by a reduction in the GFR (glomerular filtration rate)…
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Chronic Kidney disease with Hemodialyis
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Download file to see previous pages The primary reason for her renal failure is obstructive uropathy which has been further complicated by hypertension and diabetes. Hydronephrosis is a condition that is caused by urine filled dilation of the renal pelvis which is then associated with progressive atrophy of the kidneys due to an obstruction of the urine outflow. The kidney eventually becomes a thin walled cystic structure with parenchymal atrophy, complete obliteration of the pyramids and cortex thinning. Bilateral obstruction will lead to renal failure.
Hypertension is one of the major diseases that cause CKD. That is often related to poor control caused because of poor education of the patient and their family. One in three adults in the US and one billion people worldwide have hypertension and 26 million adults in the US have chronic kidney disease (Eskridge, 2010)." The National Committee on Prevention Detection, Evaluation, and Treatment of High Blood Pressure describes the relationship between blood pressure and DVD as continuous, consistent, and independent of other risk factors" (Eskridge, 2010. pg. 55). Hypertension damages the kidneys in a couple of ways. Renal damage causes the activation of the renin-angiotensin system. This can happen from the beginning and then the sympathetic nervous system is activated. As this system continues to be damaged, the damage is measured by the change in the GFR or the serum creatinine. As capillary pressure increases, the endothelial cells are damaged which then activates platelets and interglomerular coagulation (Eskridge, 2010).
All of this chronically leads to neprosclerosis. It also accelerates kidney disease caused by other chronic problems such as diabetes. People with diabetes are recommended to keep their blood pressure at 130/80 or below (Porth & Matfin, 2007). In the case of diabetes, diabetic nephropathy is the leading cause of chronic kidney disease and probably accounts of 40% of all new cases. Both type 1 and type 2 diabetes cause this type of renal failure. Diabetic neuropathy points to lesions in the kidney that are created in the diabetic kidney. The glomeruli are affected more than any other structure and there are some other problems such as capillary basement membrane thickening, diffuse glomerular sclerosis and nodular glomerulosclerosis (Porth & Marfin, 2007 pg. 1072). Renal enlargement as well as nephron hypertrophy and hyperfiltration occur early in the disease. This occurs because of the increased work that the kidneys must go through to pick up the excessive glucose . One of the first things that will be seen in diabetic renal failure is albumin in the urine. Hypertension as noted before push this disease forward and the symptoms manifest faster.
Treatment
Grace is being treated with Dialyzer-Revaclear with treatment time of 4 hours, a blood flow of 350ml/min, Dialysate K 1.5/Ca 1.25/Na (initial Cond 150-Final Cond 135)/ Bicarb 40, Dialysate flow 500ml/min, Dialysate temp 35.5 C, Heparin bolus 1.5u, heparin rate 0.8u/hr, ideal weight 78.5kg, pre weight 79kg, Target wt. 1.0kg. She is being dialyzed three times per week. Though hemodialysis has its own set of problems peritoneal dialysis would not be a good choice for Grace. Grace has a history of infections, she does not get around well, and lives in a retirement ...Download file to see next pagesRead More
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