Chronic renal disease
- Explain what happens physiologically with chronic renal failure and the GFR. Support with evidence. Include important labs that are monitored in the process.
Chronic renal failure, also referred to as chronic kidney disease, is a condition where the kidney decline in its functions. The disease is usually progressive, with the condition deteriorating with time. The renal failure condition level is estimated by the use of the glomerular filtrate rate (GFR) (Vaidya & Aeddula, 2019). Glomerular filtrate rate is the percentage filtration capability of the kidney at a given time. Chronic renal failure affects the normal functioning of the kidney and the organs connected to the kidney functionally.
Chronic kidney failure interferes with the kidney’s central function of maintaining fluid and electrolyte balance in the body. The disease results in decreased glomerular filtrate rate; hence the filtration of body fluids is lowered. Low filtration leads to less excretion of the waste products like urea and creatinine by the kidney. These waste products after filtration are normally passed out through the urine. Reduced excretion of these waste products leads to their accumulation in the blood, bringing a uremic condition. Urea and creatinine are the only known substances that contribute to uremia, but there is a large number of substances emanating from low GFR that cause uremia despite their identity being less defined. Chronic renal failure also reduces the renal capability to maintain the plasma level at the equilibrium, especially when its intake is high. The disease also leads to the impaired regulation of calcium, phosphates, and parathyroid hormone leading to alteration of human bones’ skeletal morphology. The effect in the secretion of the above substances in the body starts with the reduced calcitriol production in the body, which causes a condition referred to as hypocalcemia (MALKINA.ANNA, 2019). The reduction in the production of phosphate in the kidney results in a condition known as hyperphosphatemia.
The chronic renal disease also influences the ability of the kidney to regulate ph. and bicarbonate levels. This leads to acidosis, which is associated with muscle wasting as a result of protein catabolism. The condition also exposes the bones to high acidic levels, which reduce bone buffering, increasing the bones’ dissociation.
To diagnose the chronic renal failure, a GFR test is conducted in the lab to show the rate of filtration of kidney glomeruli. The test usually assesses the level of creatinine in the blood to estimate the GFR. Creatinine level increases with the severity of the renal disease. The second test includes a urine albumin test. Albumin is a protein component found in the blood. Passage of albumin shows a malfunction in the kidney as a healthy kidney does not allow the passage of albumin to the urine. The lower the urine albumin levels in the kidney, the better it’s functioning. Albumin test is conducted via a dipstick test where urine is collected in a container. A deep stick is then dipped in the urine, where a change in color indicates albumin presence. It can also be conducted using a urine albumin-to-creatinine ratio (UACR) test (Gaitonde et al., 2017). In this test, a comparison of albumin level to that of creatinine in the blood is conducted.
- Explain the role of Angiotensin II and proteinuria as they relate to advancing renal disease.
Angiotensin II is one of the components that make the renin-angiotensin system, which plays a key role in controlling blood pressure. The primary function of this hormone is increasing blood pressure by inducing triggering vasoconstriction. The Angiotensin II hormone also triggers the production of the aldosterone as well as the vasopressin hormones. The Angiotensin II hormone plays the greatest role in the Renin-Angiotensin aldosterone system (RAAS). The vasoconstriction effect triggered by the Angiotensin II hormone impacts greatly on the arterioles supplying blood to the glomeruli of the kidney. The vasoconstriction effect results in high hydraulic pressure impacting the glomerulus, leading to the plasma proteins’ ultrafiltration. This effect leads to the initiation of renal damage and contributes to the progression of the condition (Vejakama et al., 2017). The hormone also contributes to other cellular effects that also deteriorate renal injuries like cell inflammation, fibrosis, and increased cell multiplication.
Proteinuria increases the production of proteins in the urine due to the reduced glomerular filtration rate. The condition occurs as a result of renal disease, and at the same time, it impacts the progression of the disease. Proteinuria also acts as an alarm to effects on the body, whether dietary or physical injuries can cause renal injuries leading to renal disease. The increased urinary protein due to injuries on the glomerular capillaries’ walls or reduction in the reabsorption of the proteins in the convoluted tubules leads to the destruction of the renal tubular cells (Ene-Iordache et al., 2016). Thus, proteinuria is known to be one of the most factors that increase the risks of suffering from chronic renal disease and increase the severity of the condition.
- List at least three other body systems that are impacted by chronic kidney disease and why.
Chronic renal disease impacts negatively on the circulatory system. The damage in the kidney glomerulus decreases the production of the hormone erythropoietin. The reduction in the production of erythropoietin decreases the production of the red blood cells as well as iron production (Webster et al., 2017). This condition leads to anemia associated with signs such as breath shortness, failure of organs such as the heart, including dizziness.
The integumentary system is also affected by the chronic renal disease due to the kidney’s inability to balance the mineral concentration such as calcium, potassium, and phosphorous. The reduced concentration of calcium in the blood makes the body utilize the calcium from the bones due to over secretion of the parathyroid hormone. The increased level of the hormones in the blood leads to the itching of the skin (Webster et al., 2017). The accumulation of phosphorous in the blood increases the itching feeling, especially on the back and the chest. Itching makes people scratch the skin, which increases skin damage by causing punctures and wounds, increasing the body’s exposure to more infections.
The chronic renal disease also affects the skeletal system. This effect is triggered by the parathyroid hormone extraction of the calcium mineral in the bones to the bloodstream. The altered concentration of the minerals in the bones leads to bone weaknesses resulting in malformation (Miller, 2019). The effects on the skeletal system are highly prevalent in older women mostly above menopause.
References
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MALKINA.ANNA. (2019). Chronic Kidney Disease. Merck Manuals Professional Edition; Merck Manuals. https://www.merckmanuals.com/professional/genitourinary-disorders/chronic-kidney-disease/chronic-kidney-disease
Gaitonde, D. Y., Cook, D. L., & Rivera, I. M. (2017). Chronic Kidney Disease: Detection and Evaluation. American Family Physician, 96(12), 776–783. https://www.aafp.org/afp/2017/1215/p776.html
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The lancet, 389(10075), 1238-1252.
Miller, P. (2019). UpToDate. Uptodate.com. https://www.uptodate.com/contents/osteoporosis-in-patients-with-chronic-kidney-disease-diagnosis-and-evaluation
Vejakama, P., Ingsathit, A., McKay, G. J., Maxwell, A. P., McEvoy, M., Attia, J., & Thakkinstian, A. (2017). Treatment effects of renin-angiotensin aldosterone system blockade on kidney failure and mortality in chronic kidney disease patients. BMC Nephrology, 18(1). https://doi.org/10.1186/s12882-017-0753-9
Ene-Iordache, B., Perico, N., Bikbov, B., Carminati, S., Remuzzi, A., Perna, A., … & Zhang, L. (2016). Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. The Lancet Global Health, 4(5), e307-e319.
Vaidya, S. R., & Aeddula, N. R. (2019, June 6). Chronic Renal Failure. Nih.Gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535404/