Chronic Kidney Disease Case Study Answer

Introduction

Chronic kidney disease is defined as a condition which damages the kidneys and it is unable to filter blood the way it should. As there is huge amount of fluid and waste from the blood, it remains in the body. It might also lead to the development of several other health problems like stroke and heart disease. There can be several causes for CKD and two main important causes are blood pressure and diabetes (Kovesdy, 2022). The prevalence of CKD is increasing rapidly in Australia along with age, it affects around 44% of the people who are aged 75 or over. The incidence rate lies between 4.83 and 4.98% which is 0.49% per year. The proportion of the individual with CKD stage 3-5 increases consistently with age. The percentage of women in the CKD group was much higher than the normal population. When the statistics of 2017-18 were studied it has been mentioned that about 1.0% of Australians have been diagnosed with kidney disease. The prevalence of kidney disease has been the same stable since 2011-12. It is about 0.8% of the population which is 181,900 (Bello et al., 2021). This essay will provide an overview of the pathophysiology of CKD, the pharmacological treatment will be provided, and patient education.

Pathophysiology of CKD

The pathophysiology of CKD is divided into three stages or categories, which are mentioned here. First is the prerenal which decreases the renal perfusion pressure, second is intrinsic renal which is the pathology of the vessels or glomeruli, next is the postrenal which is also obstructive. In this the kidney is mainly damaged or their function is lost, this also implies they lose their ability to filter adequately. Due to this, there is an increase in the excretion of urea, potassium, and creatinine. The balance between salt and water is also affected (Vaidya & Aeddula, 2022).

Pharmacological treatment. Renal injury is the main cause of CKD and it is primarily based on the immunological reaction which is initiated by the immune cells or immune complexes. There are several other reasons for renal injury and these are genetic defects, exogenic agents such as drugs, and endogenous substances like paraproteins or glucose. Glomerural impairment is the major cause, it is caused due to hereditary defects. The steps of inherited glomerular disease is also known as Alport syndrome which is mainly transmitted like an X-linked dominant trait (Wilson et al., 2021). Most acquired glomerular disease is affected by an immune-mediated injury and mechanical and metabolic stress. In this condition there is a decrease in the renal flow, it occurs secondary to a reduction in the extracellular fluid volume or if there is a reduction in the volume despite the normal total fluid volume. In some cases, some intrinsic disorders also contribute to the development of CKD. Another major cause that leads to CKD is the obstruction in the urine flow. The pathophysiology of CRF is directly linked to the initiating mechanism. Over a long period, physiology plays an important role while leading compensatory hyperfiltration or hypertrophy (Webster et al., 2017).

Renal failure directly affects hemostasis and it has been associated with chronic and acute kidney failure. Some of the most common abnormalities which are observed are defective platelet aggregation and a decrease in platelet adhesiveness. In addition to it, it prolongs the bleeding time and decreases platelet factor-3 availability. All these factors are highly important, and these need to be taken care of. In CKD, there is a delay in clot formation and the final clot strength is increased, which also decreases the clot breakdown (Kalantar-Zadeh et al., 2021). The kidney maintains the process of homeostasis as it takes care of the number of ions, water, and several other substances in the blood. The kidneys are also involved in secreting hormones that are other than homeostasis function. When the kidney fails to no longer remove excess potassium, the level of potassium builds up. Increased potassium levels in the blood are called hyperkalemia, which might occur in the advanced stage of CKD. There are a large number of people who are at risk due to CKD, and some of the risk factors are: if the patient has diabetes, high blood pressure, a family history of kidney disease, and heart disease. Several conditions lead to CKD and some of them are polycystic kidney disease, membranous nephropathy, kidney function, and lupus. There is a need to urinate or pee in this condition, and weakness and loss of appetite are also present. There is some shortness of breath, and swelling in the hands, ankles, and feet is present. In several cases, blood in the urine is also observed and along with it, foamy urine is present (Shaikh et al., 2023).

Pharmacological treatment

Several types of pharmacological treatment are followed and these are mainly towards controlling blood pressure, which means they are angiotensin-converting enzyme (ACE) inhibitors. Some common examples are enalapril, ramipril, and lisinopril. The ACE inhibitor is used as it effectively reduces systemic vascular resistance among patients with hypertension, chronic renal failure, and heart failure. The antihypertensive efficacy mostly accounts for a vital part of long-term renoprotective effects in the patient either with diabetic or non-diabetic renal disease (Hashmi et al., 2023). The ACE inhibitors have helped to provide some important cardiovascular and renal protection for the CKD patient. However, the efficacy and safety of these agents in non-dialysis CKD 3-5 patients are still uncertain. Ang 2 restricts the efferent arteriole to a great extent, such that glomerular hydrostatic pressure and GFR are maintained. ARB and ACE inhibitors decrease proteinuria as it lowers the intraglomerular pressure and hence it reduces hyperfiltration. All of these drugs tend to raise the serum potassium level and reduce the GFR. Reduction of GFR is because of the ability of ACE inhibitor and ARB, both of these lower the systematic BP and vasodilate the renal efferent arterioles, hence it lowers the intraglomerular pressure (Varughese & Abraham, 2018).

The rise in the serum creatinine value mainly begins a few days just after the therapy with ACE inhibitor or ARB. When the angiotensin 2 levels are reduced rapidly or blocked from binding, it results in arteriolar dilation and there is a decrease in effective GFR. 

Patient education consideration (Neuen et al., 2017).

Patient education consideration

Patient education plays an important role in the treatment of CKD, several things need to be taken care of. When the patient is aware of the steps which should be taken this will speed up the process of recovery. Alcohol amount should be limited, as the kidney works extra when alcohol is consumed. The patient should choose healthy foods such as fruits, vegetables, low-fat dairy food, and whole grain. It will not only help to remain healthy but also help the patient to lose weight. In inpatient education, the patient needs to be physically active, this will help them maintain their health. The nurse should educate the patient about the importance of eating healthy food so they are taking the step to maintain a healthy lifestyle by themselves (Neuen et al., 2017). There are high chances that patients can be diagnosed with diabetes in this condition, hence awareness and management of this condition are highly important. Diabetes management is highly useful and it should be taught. When the patient is aware of how to manage diabetes then extreme levels will not reach and it will be controlled at an early stage. Patient education is important because it promotes patient-centered care and it increases adherence to treatment and medication. When the patient is educated it will take care of continuity of care and decrease the complication which is related to illness. The rise in compliance leads to a highly cost-effective and efficient healthcare delivery system (Chen et al., 2019).

Conclusion

Chronic kidney disease is defined as a state in which the kidneys are damaged and they cannot work properly to filter blood the way they should. If there is increase fluid and waste from the blood, it remains in the body. The pathophysiology of CKD is divided into three stages or categories and these are: prerenal which decreases the renal perfusion pressure, intrinsic renal which is the pathology of the vessels or glomeruli, and last is postrenal which is also obstructive. A wide range of pharmacological treatments is present, however, ACE inhibitor is the most commonly used. Patient education is highly important as it eases the whole treatment process.

References

Bello, A.K., Alrukhaimi, M., Ashuntantang, G.E., Basnet, S., Rotter, R.C., Douthat, W.G., Kazancioglu, R., Köttgen, A., Nangaku, M., Powe, N.R., White, S. L., Wheeler, D. C., & Moe, O. (2017). Complications of chronic kidney disease: Current state, knowledge gaps, and strategy for action. Kidney International Supplements , 7 (2), 122–129. https://doi.org/10.1016/j.kisu.2017.07.007

Chen, T.K., Knicely, D. H., & Grams, M.E. (2019). Chronic kidney disease diagnosis and management: A review. JAMA , 322 (13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

Grill, A. K., & Brimble, S. (2018). Approach to the detection and management of chronic kidney disease: What primary care providers need to know. Canadian family physician Medecin de famille canadien , 64 (10), 728–735.

Hashmi, M.F., Benjamin, O., & Lappin, S.L. (2023). End-stage renal disease. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499861/

Kalantar-Zadeh, K., Jafar, T.H., Nitsch, D., Neuen, B.L., & Perkovic, V. (2021). Chronic kidney disease. Lancet (London, England) , 398 (10302), 786–802. https://doi.org/10.1016/S0140-6736(21)00519-5

Kovesdy C.P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements , 12 (1), 7–11. https://doi.org/10.1016/j.kisu.2021.11.003

Neuen, B.L., Chadban, S.J., Demaio, A.R., Johnson, D.W., & Perkovic, V. (2017). Chronic kidney disease and the global NCDs agenda. BMJ Global Health , 2 (2), e000380. https://doi.org/10.1136/bmjgh-2017-000380

Shaikh, H., Hashmi, M.F., & Aeddula, N.R. (2023). Anemia Of chronic renal disease. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539871/

Vaidya, S.R., & Aeddula, N.R. (2022). Chronic renal failure. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535404/

Varughese, S., & Abraham, G. (2018). Chronic kidney disease in India: A clarion call for change. Clinical Journal of the American Society of Nephrology : CJASN , 13 (5), 802–804. https://doi.org/10.2215/CJN.09180817

Webster, A.C., Nagler, E.V., Morton, R.L., & Masson, P. (2017). Chronic kidney disease. Lancet (London, England) , 389 (10075), 1238–1252. https://doi.org/10.1016/S0140-6736(16)32064-5

Wilson, S., Mone, P., Jankauskas, S. S., Gambardella, J., & Santulli, G. (2021). Chronic kidney disease: Definition, updated epidemiology, staging, and mechanisms of increased cardiovascular risk. Journal of Clinical Hypertension (Greenwich, Conn.) , 23 (4), 831–834. https://doi.org/10.1111/jch.14186

Zou, Y., Liu, F., Cooper, M.E., & Chai, Z. (2021). Advances in clinical research in chronic kidney disease. Journal of Translational Internal Medicine , 9 (3), 146–149. https://doi.org/10.2478/jtim-2021-0041

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