Introduction:
The tight balance in which kidneys function in relation with other systemic organs in the body has a direct and indirect relation to how it affects the rest of the body by through excretion selectively through its filtration system of electrolytes, pH balance, and blood pressure. Inversely co-morbidities, diet, trauma, and obstruction to generically name a few influences of kidney function. Early recognition of through lab tests, imaging, early symptom recognition, and monitoring risk factors that may be predispositions for future altered kidney function must be done to prevent life threatening circumstances.
Objective 1 Pathophysiology
Acute Renal Failure (ARF)
Symptoms of ARF are more sudden, which blood is unable to filter waste products from blood. Symptoms often occur in a shorter period of time from hours to a few days. After aggressive treatment in an acute hospital setting ARF can be reversed (Acute, 2012). Normal renal function may resume, however it may take longer to recover if critically ill and death may ensue if treatment is not aggressive enough to reverse the failure of kidneys to filter waste products that may increase to very toxic levels in the blood propagating multiple organ failure in the body Lewis, Heitkemper, Dirksen, O’Brien, and Butcher (2012, p.1199).
Symptoms include: Decreased urine output, but may have a normal output in certain cases. Fluid retention occurs in dependent extremities such as lower legs, ankles, and pedal areas. Fatigue and drowsiness are felt as hypertonic electrolytes affect, for example, muscle contractility; spasticity and ultimately seizures may also occur. Azotemia and Uremia may affect cognitive processes such and cause confusion with altered level of consciousness (Acute, 2012).
Disease etiology commonly exhibits itself as anything that causes blood to slow ( hypovolemia of blood or other interstitial fluid, hypotension caused by medications, ischemia that impairs cardiac function, infections, liver failure, nephrotoxic medications used excessively such as aspirin, ibuprofen, and aleve, shock/anaphylaxis, burns, and severe dehydration ) its rate (Acute, 2012). In the kidneys, any damage to the nephrons at the site of glomerular filtration (clots/cholesterol to blood vessels within or close proximity to kidneys, glomerulonephritis, hemolysis of red blood cells, autoimmune disorders, buildup of toxins, and vasculitis) may result in tissue ischemia (Acute, 2012). Obstruction to the ureters which is characterized by physical impediment of urine flow an attempt tor remove wastes occur (Prostate enlargement, clots in urinary tract, cancer growth with in urinary system adjacent organs, nerve damage that controls micturition), (Acute, 2012).
Comorbidities that increase risk of ARF are diabetes, hypertension, liver diseases, kidney diseases, and peripheral vascular disease. Edema from fluid build up can lead to shortness of breath as fluid collects in the lungs from hypervolemia. Symptoms of chest pain may be manifested by inflammation pericardial fluid builds up (Acute, 2012). If treatment is delayed or ineffective, ARF could become end-stage-renal-disease if death is not the result at this time. Treatments such as hemodialysis or kidney transplantation may be imminent to sustain life (Acute, 2012).
Urinalysis, output measurement, BUN and Creatinine levels are common blood tests to indicate ARF. Radiological imaging such as ultrasound or CT scan may be used to help confirm or rule out ARF. A kidney biopsy for tissue analysis may be also done. Medications prescribed to increase renal perfusion and or manage secondary conditions that affect function such as blood pressure help reduce the incidences of renal toxicity. Other medications help aid in restoring depleted electrolytes or by removing electrolytes or other molecules built up in excess (Acute, 2012).
Prevention:
Managing and reading labels of medications, knowing the risks associated with its use. If managing medications is a challenge consult physician to work on regimens that manage comorbidities. Changing frequency, dosage, and interactions with foods or other medications that may produce conditions that limit function to the kidneys (Acute, 2012).
Chronic Kidney Disease (CKD) (also known as Chronic Renal Failure)
CKD is insidious without little or no symptoms until extensive damage has occurred; shows up later as the disease progresses. There are 5 stages of CKD, the final stage being end-stage-renal-disease. Diabetes and hypertension are the two leading causes of CKD. Loss of appetite, illness and fatigue, itching and unintentional weight loss are some common symptoms. Skin may change in pigmentation, light to dark skin. Bone pain and neurological symptoms such as confusion may occur. Poor concentration, numbness to extremities, and twitching or cramps of muscles may be also present. Some symptoms that can be observed are bleeding and bruising. The patient may complain of excessive thirst, shortness of breath, insomnia, sleep apnea, and swelling. There are similarities of symptoms between ARF and CKD; however CKD tends to be more severe and disruptive to processes of normal functioning. The effects on the human body may be physiologically, physically, and emotional (Chronic, 2011).
The lab tests are also similar to that of ARF, but some tests on certain electrolytes are looked with more scrutiny such as albumin, CBC, and magnesium (MedlinePlus). The radiological tests performed for CKD are the same as ARF, but include additional imaging such as, abdominal MRI, kidney scan, and kidney ultrasound. The primary focus on treatment of CKD is to prevent further damage to the kidneys. The state of Kidney function is most likely not going return to a previous state, so it all comes down preserving what is left (Chronic, 2011).
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