Chronic Kidney Disease Essay

Chronic renal failure (CKD) is defined as a reduction in kidney function or kidney damage that has been present for at least 3 months (Buttaro et al.). This type of kidney disease is one that develops over time, as described in the name. Eventually, the disease will have systemic affects and affect other systems of the body. As opposed to other diseases that are diagnosed by a biopsy, CKD is diagnosed by the loss of function. There are five stages to the progression of the disease, as defined by the level of glomerular filtration rate (GFR). The GFR decreases because there is hyperfiltration in the surviving glomeruli after the other glomeruli have become nonfunctional. This hyperfiltration causes stress and injury which eventually results in destruction and thus a decrease in GFR (Buttaro et al.).
Signs and symptoms of CKD remain unseen until the diseased has progressed and the GFR decreases to 35% functioning level (Buttaro et al.). In order to confirm a diagnosis before this progressive decrease in GFR, it is important to identify risk factors that would lead to the development of CKD, such as diabetes mellitus and hypertension. Diabetics will start diagnostic testing for CKD after their diagnosis of either type I or type II DM. The sooner it is diagnosed, the better the response to treatment and the better the prognosis for the individual. If CKD cannot be diagnosed until the GFR is functioning at 35% or below, individuals will show symptoms from multiple different body systems as complications arise from the disease (Buttaro et al.).
If an individual presents to his doctor and his physician suspects he might have CKD, a physical examination is to follow. The physical examination should include examination to the cause of disease and how far the disease has progressed (Buttaro et al.). The doctor’s visit will start with the route examination of vital signs and a generalized overview of each body system. The assessment will then become more specialized to the renal system and the health care provider will assess for renal artery bruits and bladder distention, to name a few. The doctor will then order laboratory tests to positively determine if the patient has CKD. The most important test is the dipstick urinalysis. If the patient is found to have proteinuria, the doctor will then order a 24-hour urine analysis to measure the urine’s protein and creatinine clearance. Other tests, such as full chemistry panels will be ordered to establish a baseline to refer back to during the progression of the disease. Lastly, ultrasonography is utilized to determine if the cause is a cyst or obstruction in the kidneys (Buttaro et al.).
Treatment of CKD involves the management and prevention of complications (Rosenberg). Because the kidneys function in electrolyte balance and vitamin D synthesis, it is important for the patient to maintain a diet that will balance their electrolytes as well as provide Vitamin D. In addition, it is very important to control the patient’s blood pressure. Increased blood pressure can damage the kidneys so in the case of already altered kidney function, doctors want to decrease its effects and maintain what little renal function the patient has. Lastly, doctors will also assess the patient’s hematocrit to treat anemia. The kidneys are responsible for making erythropoietin, a substance that controls the production of RBCs. If kidney function declines, anemia results and the body’s tissues will receive less oxygen and start to become affected (Rosenberg).
Socioeconomic factors can greatly impact the patient’s ability to receive help and prevent secondary complications. If a patient does not have good health insurance, he will not be able to see the physician routinely to monitor his health and receive medications. Additionally, such a prognosis can be mentally debilitating and stressing. Support from family and friends would greatly affect a sick individual and give him hope and strength to keep on going.

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A
collaborative practice (4th ed.). St. Louis, MO: Mosby
Rosenberg, M. (2014). Overview of the management of chronic kidney disease in adults. In G.C.
Curhan & A.M. Sheridan (Ed.), UpToDate. Retrieved from http://www.uptodate.com/home