Pathophysiology and Pharmacology - Acute-Chronic Renal Failure - Case Study Example

ACUTE/CHRONIC RENAL FAILURE By: Course: Instructor: University, City, State: Date: Acute/Chronic Renal Failure Urine production, sweats, waste removal and electrolyte regulation are some of the main bodily functions that are performed by the kidneys. Under certain conditions, our kidneys tend to reduce its proper functioning over time. Chronic renal failure (CRF) is a term use to describe the decline of our kidneys' ability to do their jobs accordingly. On the other hand, acute renal failure (ARF) is defined or characterized by a worsening of renal function within a time frame of hours or even days, which will result in to the failure of the kidneys to send out the nitrogenous waste products like sweats and urine. Also, there will be an increase in creatinine and serum urea due to the fact that the kidneys will lose its ability to maintain electrolyte and fluid homeostasis. Since acute renal failure happens rapidly, we may ignore the early signs and symptoms just because they could be all part of another sickness. Because of this kidney changes, it is usually, if not always, urine output reduces dramatically. This condition can be reversed in routine clinical practice by studying the changes in glomerular filtration rate (GFR). GFR changes can only be determined by measuring serum creatinine. The prediction and treatment of ARF most of the time depend on how soon the problem is identified. Appropriate treatment usually stabilizes the condition and reduces the probability of end stage renal disease (May & Langston, 2009). In the past few decades, several medical researchers have understood the causes and treatment of ARF and the pathophysiologic mechanisms that cause renal dysfunction. This paper will highlight the pathophysiology and pharmacology, general signs and symptoms, and evaluation of CRF as suspected on Mrs. Georgina Lawson in case study 1. Excess waste will not accumulate and run throughout our bodies if we have well and fully functioning kidneys. Kidneys have a duty to release waste products such as urea into the lower parts of the urinary tract. Once the kidneys start to fail, the kidneys' ability to create and excrete waste diminishes too. Serious health conditions such as liver failure, heart problems and immune system problems may arise because of waste build-up in the body. Many patients have run into major problems because they allowed their kidneys to fail and body waste to build-up for longer period of time. If this happens and left untreated, acute kidney failure may become so severe that the patient will require dialysis or kidney transplant may be the only option (Silkensen, 2000). Causes People do not just wake up in the morning and "catch" acute/chronic renal failure. To a certain extent, ARF is a sign or a symptom of a larger underlying deadly disorder. As in the case of Mrs. Georgina (case study 1), diabetes and high blood pressure are two main causes of chronic renal failure. On the other hand, as far as renal anatomy is concerned, the causes of ARF can be classified into pre-renal, renal and post-renal. Additional causes CRF may include but are not limited to: frequent kidney infections, long exposure to high levels of lead, backed-up urine flow etc. Other renal problems can include the blockage of the flow of urine by an enlarged prostate or kidney stones. Diabetes: Type 2 diabetes mellitus is a serious disease, due to various number of related health problems it can cause. Chronic renal failure is one of the many serious health problems caused by type 2 diabetes (Murphy, 2001 & Thakar et al, 2011). Diabetes occurs when the body starts to reduce production of insulin or being resistant to utilizing the insulin produced by the body and this will lead to kidney spoiled, if not treated. Because insulin is the responsible hormone to alert the cells to filter sugar from the blood stream, diabetic patients naturally have got high blood sugar levels. As time goes by, these high blood sugar levels will force the kidneys to filter too much blood, thus damages the kidneys. If not treated early, the kidney will not be able to filter, and waste products will accumulate in the blood, hence kidney failure will be the end result. According to ADA (2012) and National Institute of Diabetes and Digestive and Kidney Diseases (2007), type 2 diabetes mellitus is the main contributor to chronic renal disease in the United States. As far as Centers for Disease Control and Prevention is concerned, diabetes accounts for up to 45% of new cases of end-stage renal diseases (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011). As claimed by National Institute of Diabetes and Digestive and Kidney Diseases (2007), over 45,000 people in the United States had started renal replacement therapy, and more than 175,000 people with type 2 diabetes mellitus had received a kidney transplant or were on dialysis in 2005. As suggested by Shurraw et al (2011), better glycemic control can lead to better results in this category of patients. Blood pressure: Researchers believe that the number one cause of CTF is high blood pressure. When blood vessel walls are stressed to the limit by the pressure of the blood, it will destroy the functioning of the kidneys and the end result is kidney failure. Signs and Symptoms Early stage symptoms of chronic renal failure can be very slight and a person may ignore the early signs and symptoms just because they could be all part of another sickness. The early symptoms may include but not limited to: decreased urine production, abnormal dark urine, swelling of the body, headache, confusion, fatigue, nausea, lack of appetite, and itchy skin. These symptoms match with previous medical records of Mrs. Georgina. So, the possibility of Mrs. Georgina having chronic renal failure is very high as far as her hospital progressive notes indicate. Female patients with chronic kidney disease most often develop menstrual irregularities and experience normally amenorrheic and infertile. Kidney Disease Tests Usually the first test taken to a patient with a possibility of CRF is by checking patient’s blood pressure as in the case of Mrs. Georgina. As mentioned before, having high blood pressure may cause kidney disease or that is an indication of an existing kidney problems. It is recommended for any patient with kidney disease to keep his/her blood pressure below 130 over 90 because blood pressure of 120 over 80 is considered normal (Baylor College of Medicine, 2012). But as far as Mrs. Georgina’s Special Nurse Record shows, Georgina might be at risk of CRF because her blood pressure was 160 over 80 on admission. Two urine tests are also recommended for a patient suspected of kidney disease. As suggested by Richards (2009), healthy kidneys always leave particles of proteins in your blood stream but the presents of albumin (protein) traces in the urine is one of the early warnings of having kidney disease. These tests are considered as an accurate way to test for renal failure if taken every other week. Glomerular Filtration Rate test should be done on patient’s blood to see if there is a waste in the blood stream. The main purpose here is exclusively to check for the presents of the waste product creatinine. This test will help to determine if the patient have reduced his/hers kidney functions. Blood Urea Nitrogen (BUN) test is nothing but a simple and safe blood test that can help to tell how well the patient’s kidneys are functioning in excreting the waste products from the body. Any presents of nitrogen in the blood will mean either liver or kidney is undergoing some problems (Humbel, Idoux, & Ragenard, 1968). If the previous tests appear to be normal, then ultrasound images of the kidneys will be considered. Ultrasound images will show if the patient has growths in his/her kidneys or if urine track is blocked. Laboratory & Diagnostic Tests Glucose and Calcium: Blood sample of about 10 ml should collect and taken to lab to test the levels of glucose and other elements like calcium etc. Any high glucose can be a sign of diabetes or if the level of glucose is low, then this will indicate hypoglycemia. Calcium levels will show that the patient might be heading to experience thyroid complications or liver disorders and osteoporosis. Electrolytes: Routinely, levels of potassium, sodium, carbon dioxide and chloride should be checked. Any imbalances in sodium can be a sign that the patient may experience hypernatremia and any excessive amount of sodium will decreases the amount of potassium in the body. Acidosis or alkalosis is determined by carbon dioxide and chlorine levels. References Baylor College of Medicine retrieved on May 07, 2012 from http://www.bcm.edu/search/searchresults.cfm Humbel, R., Idoux, I. & Ragenard, S., 1968. Determination of blood urea nitrogen by a new rapid test. Das Medizinische Laboratorium, 21(12), p.269-271. May, S.N. & Langston, C.E., 2009. Managing Chronic Renal Failure. Managing, p.1-7. Murphy, T.E., 2001. Underwriting chronic renal failure. Journal of Insurance Medicine, 33(4), p.358-359. Richards, L., 2009. Biomarkers: Rapid urine test for kidney disease. Nature Reviews Nephrology, 5(10). Silkensen, J.R., 2000. Long-term complications in renal transplantation. J Am Soc Nephrol. 11(3):582-8 Thakar, C.V, Christianson, A., Himmelfarb, J., Leonard, A.C., 2011. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 6(11):2567-72. Read More