Free Report on Understanding Renal Failure: Causes, Stages, and Complications

Q1. Explain renal failure at the cellular level.

There are two types of renal failure; acute and chronic renal failure (National Kidney Foundation, n.d.). Acute renal failure is the abrupt onset of renal dysfunction characterized mainly by oliguria, anuria, and an increase in urea and creatinine in blood and afterward development of uremia (Mohan, 2018). Chronic renal failure, on the other hand, is a progressive and irreversible loss of renal function due to the destruction of the renal parenchyma, which leads to the development of acidosis and azotemia (Mohan, 2018).

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Etiopathogenesis of Acute renal failure

The causes of acute renal failure can be grouped into three, pre-renal, renal, and postrenal causes. Pre-renal causes lead to decreased blood flow through the afferent and efferent blood vessels into the kidney nephrons, causing a decrease in GFR (Mohan, 2018). They include decreased cardiac output and hypovolemia. Renal causes affect the renal tissue, and they include vascular diseases like atherosclerosis of arteries and arterioles in the kidney, necrosis of the tubules due to ischemia, which leads to a decline in urine formation and accumulation of waste products resulting in azotemia, metabolic acidosis, hyperkalemia, and hypervolemia, tubulointerstitial nephritis, and pyelonephritis, which increase the permeability of the glomerular capillaries and increase passage of blood proteins into the Bowman’s capsule and decrease in GFR (Mohan, 2018). In some instances, nephrotoxins may be involved. Post-renal causes affect the distal part of the kidney from the opening of collecting ducts. It is chiefly due to obstruction by a mass, usually calcium stones within the lower urinary tract; ureter, bladder, and urethra.

Etiopathogenesis of Chronic renal failure

The cause of death in CRF is eventual damage of nephrons and subsequent development of acidosis, biochemical azotemia, and clinical uremia syndrome. Its causes are classified into two; those are causing glomerular pathology and those causing tubulointerstitial pathology (Mohan, 2018). Conditions that cause glomerular diseases affect the filtering processes of the glomerular and the development of nephrotic syndrome, which is characterized by proteinuria a decrease in albumin levels, and consequent development of edema (Mayo Clinic, 2019). These conditions include glomerulonephritis, for example, membranous glomerulonephritis. Other systemic conditions like systemic lupus erythematosus and diabetic nephropathy can also be involved (Mayo Clinic, 2019).

Diseases that cause tubulointerstitial diseases lead to changes in the reabsorption of substances that passed through the glomerular capillaries and (tubule-secretion) secretion of products from the tissues of the kidney tubules; proximal, a loop of Henle and distal tubules. This leads to the excretion of large volumes of dilute urine (Roy, et al., 2012; Pierson, 2006). The conditions that cause tubule diseases are grouped into vascular, infectious, toxic, and obstructive causes. Vascular causes include essential and primary hypertension and nephrosclerosis, which obstruct renal vascular structures, and eventually ischemia, which continues to damage the nephrons. An excellent example of an infectious cause is pyelonephritis, which results in increased epithelial tissue and decreased GFR (Pierson, 2006). Obstructive causes like stones, blood clots, and tumors cause fluid back pressure, which consequently damages the nephrons (Mayo Clinic, 2019; Pierson, 2006). Though rare, toxic causes like high doses of analgesics like aspirin and phenacetin may induce damage to nephrons.

Stages of chronic renal failure

Chronic renal failure involves four stages; decreased renal reserve, renal insufficiency, renal failure, and end-stage kidney failure (National Kidney Foundation, n.d.). In decreased renal reserve, renal tissue damage is marginal, and kidneys are still functional with creatinine and BUN values being normal and GFR at 50 percent (Mohan, 2018). Individuals at this stage are asymptomatic except in times of pressure. Renal insufficiency is characterized by 75 percent damage to renal tissue and a GFR of 25 percent with elevated blood creatinine levels. Polyuria and nocturia are present. The renal failure stage is characterized by 90 percent damage to renal parenchyma and a GFR of 10 percent (National Kidney Foundation, n.d.). This results in edema, metabolic acidosis, and hypocalcemia due to loss of sodium and water regulation properties. End-stage kidney failure is characterized by a GFR of less than 5% and a complex clinical picture of the uremic syndrome, and both renal and extra-renal symptoms (National Kidney Foundation, n.d.).

Q2 What does dialysis do to the patient?

Dialysis is indicated when one develops end-stage kidney failure, whereby it helps keep the body in balance by removing excess water, wastes, and salts. It also helps maintain a homeostatic level of ions like potassium, sodium, and bicarbonate in blood and, controls blood pressure (Mayo Clinic, 2019; National Kidney Foundation, n.d.). It is achieved through the use of artificial kidneys whereby blood is passed through minute blood channels, which are bounded by a thin membrane that contains a dialyzing fluid on the other side, into which unwanted materials diffuse (Mayo Clinic, 2019). The rate of diffusion across the dialyzing membrane depends on the concentration gradient of the solutes, the surface area of the membrane, the permeability of the membrane, and the time the dialyzing fluid remains in contact with the blood (National Kidney Foundation, n.d.).

Q3. The different types of dialysis and how does each work?

There are two types of dialysis hemodialysis and peritoneal dialysis (National Kidney Foundation, n.d.). In hemodialysis, blood is cleaned by being passed through a dialyzer and returned to the body through soft tubes through access usually in the arm. The access can either be a fistula, a graft, or a catheter (National Kidney Foundation, n.d.). In peritoneal dialysis, the dialyzing fluid is allowed to flow through a catheter into the peritoneal wall (Mayo Clinic, 2019). The peritoneum acts as an artificial kidney to filter out the waste products in the blood. The dialysate that usually contains dextrose is allowed to dwell for a few hours to filter waste substances from blood through the tiny abdominal vessels (Mayo Clinic, 2019). Once the dwell time is finished, the dialyzing fluid and the waste products from blood are drained into a collecting bag through a process referred to as an exchange.

There are two types of peritoneal dialysis; continuous ambulatory and continuous cycling peritoneal dialysis (Mayo Clinic, 2019; National Kidney Foundation, n.d.). In the continuous ambulatory type, the fluid flows through the catheter into and out of the peritoneum through gravity (Mohan, 2018). Unlike the continuous ambulatory type, continuous cycling uses an automated cycler machine to perform the exchanges, usually at night.

Q4 Changes renal failure has on the cardiovascular and the respiratory systems?

Cardiovascular complications due to renal failure are the primary cause of death in end-stage kidney failure (Roy, et al., 2012; Pierson, 2006). They include hypertension, which results in left ventricular hypertrophy and increases its wall stress, cardiac chamber dilation, and myocardial fibrosis (Roy, et al., 2012). Besides, it results in reduced coronary vasodilator reserve and coronary artery blood flow, ischemia, myocardial infarction, and eventually cardiac failure (Pierson, 2006). The numerous lipid abnormalities experienced in renal failure, for example, increased harmful cholesterol levels and serum triglyceride levels, can result in atherosclerosis. Also, hypotension is evident after dialysis (Roy, et al., 2012).

Due to the close relationship between the lungs and the kidney, several respiratory complications follow renal failure. They include volume overload and metabolic acidosis (Pierson, 2006). Hypoxemia is experienced during dialysis due to the loss of carbon (ii) oxide into the dialyzing fluid. Moreover, individuals may experience pulmonary edema due to cor-pulmonale, fibrinous pleuritis, and calcification of the pulmonary artery, leading to cardiac calcification. All of this increases the risk of suffering from tuberculosis (Pierson, 2006). However, rare prothorax due to obstructive uropathy can occur. Sleep disturbances, chiefly sleep apnea.

Q5 What electrolyte imbalances are seen with renal failure?

The most evident electrolyte imbalances include hyperkalemia and hypocalcemia due to decreased potassium ions and increased calcium ions released in the urine (National Kidney Foundation, n.d.; Mohan, 2018). Decreased fluid release in urine results in hypovolemia and hyponatremia following dilution of sodium ions by retained fluid (Mohan, 2018). Hyperphosphatemia and bicarbonate deficiency may be experienced.

References

Mayo Clinic. (2019, April 24). Peritoneal dialysis. Retrieved from Mayo Clinic: https://www.mayoclinic.org/tests-procedures/peritoneal-dialysis/about/pac-20384725#:~:text=Peritoneal%20dialysis%20(per-ih-,blood-filtering%20procedure%20called%20hemodialysis

Mohan, H. (2018). Textbook of Pathology + Pathology Quick Review and MCQS (8th ed.). Jaypee Brothers Medical Pub.

National Kidney Foundation. (n.d.). Dialysis. Retrieved from National Kidney Foundation: https://www.kidney.org/atoz/atozTopic_Dialysis

Pierson, D. J. (2006). Respiratory Considerations in the Patient with Renal Failure. Respiratory Care, 51(4), 413-422.

Roy, G. C., Sutradhar, S. R., Barua, U. K., Datta, N. C., Debnath, C. R., Hoque, M. M., . . . Das, M. (2012). Cardiovascular complications of chronic renal failure - an updated review. Mymensingh Med. J., 21(3), 573-79. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22828566/#:~:text=In%20order%20of%20incidence%20and,various%20cardiovascular%20complications%20encountered%20in