Application– Chronic Kidney Disease
(Author, Department, University,
Chronic Kidney Disease
Chronic kidney disease is related to a decrease in kidney function or damage to the kidney function for a minimum of 3 months. Actually, it is an ongoing process in which nephrons’ functioning decrease, glomeruli are destroyed, and glomerular stress is increased as a result of more work by surviving glomeruli to increase glomerular filtration rate (GFR); thereby, resulting in predictable steady decline of the function of kidneys (Buttaro, 2013).
Chronic kidney disease is usually difficult to detect or grasp, and symptoms may not appear with a GFR more than 35%. However, when the GFR decreases below 35%, various psychiatric, metabolic, cardiovascular, hematologic, and acid-base regulatory problems start arising. At this level, clinical presentation is dependent on specific combination of problems as well as the underlying causes of renal failure (Buttaro, 2013).
Cardiovascular complications, in chronic kidney disease may include congestive heart failure, atherosclerosis, hypertension, pericarditis, and pulmonary edema. Metabolic complications may include hyperkalemia, hyperlipidemia, anorexia, nausea, vomiting, hyperparathyroidism, and alterations in vitamin D, phosphorus, and calcium levels. Psychosocial complications may include depression, impoverishment, sexual dysfunction, insomnia, and unemployment. Hematologic complications may include leucopenia, anemia, and erythropoietin deficiency (Buttaro, 2013).
Diagnosis of a patient with chronic kidney disease
Chronic kidney disease can be diagnosed solely by the loss of renal function. However, patient history, physical exams, and diagnostics play an important role in the diagnosis of the disease (Buttaro, 2013).
Patient history is important in the diagnosis of chronic kidney disease. It has been reported that patients having kidney disease usually had hyponatremia that is of prerenal origin (Adams, de Jonge, van der Cammen, Zietse, & Hoorn, 2011).
Physical examination includes focused examination for the evaluation of problems related to primary diseases such as hypertension or diabetes mellitus, and broader examination including the evaluation of the progressive renal failure. In physical examination, vital signs including blood pressure of the patient are assessed; heart sounds are assessed; diabetic retinopathy is checked; jugular vein distention is checked, and edema or ascites are assessed. Moreover, abdominal examination, skin examination, rectal examination, and prostate examination are also involved in the diagnosis of kidney disease (Buttaro, 2013).
Dipstick urinalysis is the most important diagnostic tool for checking the renal failure. The presence of proteinuria may lead to further 24-hour urine analysis for protein as well as creatinine clearance. Moreover, microalbuminuria testing is also important for diabetic patients. Along with urinalysis, renal patients have also to be checked for full chemistry including magnesium, electrolytes, phosphorus, fasting blood glucose, creatinine, complete blood count, and liver enzymes (Buttaro, 2013).
Potential treatment options for chronic kidney disease
One of the most important strategies to deal with the problem of chronic kidney disease is appropriate diet modification that is especially important for patients having diabetes or some weight problems. Diet modification includes protein restriction, maintaining serum potassium concentrations, and control of intake of phosphorus and calcium concentrations. Moreover, vitamin D2 is prescribed in chronic kidney disease. In severe cases of kidney disease, hypertension may increase; thereby, requiring higher doses of diuretics as well as antihypertensive medications. In order to treat secondary hyperparathyroidism in renal failure, cinacalcet, a calcimimetic, can be used. In case of anemia, erythropoietin therapy is started and dosages have to be adjusted according to the weight of the patient. Most importantly, psychosocial support is important as depression and suicide are among the most important considerations in severe kidney problems. In case of depression, selective serotonin reuptake inhibitors could be administered (Buttaro, 2013).
Impact of different patient factors on the diagnosis and treatment of patients
History of patient helps in establishing appropriate diagnostic and treatment plans. For example, if the patient had hyponatremia along with kidney injury, isotonic fluid replacement can be used for the correction of both disorders (Adams et al., 2011).
Genetics
Genetics can play an important role in the disturbed magnesium levels in the body as, for example, elevated level of renal magnesium loss can be caused by genetic or acquired renal diseases. This is showing the effect of genetics on the development of kidney diseases. However, in case of hypomagnesemia in kidney diseases, it is important to establish proper kidney function before treating the magnesium deficiency with the help of oral magnesium supplements or diet (Assadi, 2010).
Gender
Gender can also influence the development of chronic kidney disease as, for example, it has been reported that estrogen that is found in females has more chances of attenuating the progression of chronic kidney disease as compared testosterone that is found in males (Norris & Nissenson, 2008).
Race and Ethnicity
Along with genetics, race and ethnicity may also impact the development, diagnosis, and treatment of chronic kidney disease. For example, it has been reported that individuals of West African Descent largely contain APOL1 that is a high risk allele predisposing to chronic kidney disease. Moreover, a family history of end-stage renal disease (ESRD) is two times more common among black people as compared to white people (Patzer & McClellan, 2012). Therefore, blacks would require more diagnosis and treatment schedules for chronic kidney disease.
Age
Age has also been found to be an important factor in ESRD (Norris & Nissenson, 2008). For example, due to aging, hormonal changes may occur in older people; thereby, requiring different treatment strategies.
Behavior
Health-related behaviors and lifestyles are also important for patients as, for example, if the patient keeps on using the same lifestyle that is damaging to the kidney functions, he or she could aggravate the problem; thereby, reducing the efficacy of treatment.
References
Adams, D., de Jonge, R., van der Cammen, T., Zietse, R., & Hoorn, E. J. (2011). Acute kidney injury in patients presenting with hyponatremia. Journal of nephrology, 24(6), 749.
Assadi, F. (2010). Hypomagnesemia: an evidence-based approach to clinical cases. Iranian journal of kidney diseases, 4(1), 13.
Buttaro, T. M. (2013). Primary Care: A Collaborative Practice: Elsevier/Mosby.
Norris, K., & Nissenson, A. R. (2008). Race, gender, and socioeconomic disparities in CKD in the United States. Journal of the American Society of Nephrology, 19(7), 1261-1270.
Patzer, R. E., & McClellan, W. M. (2012). Influence of race, ethnicity and socioeconomic status on kidney disease. Nature Reviews Nephrology, 8(9), 533-541.
