NSG 5003 Connection Between CKD and Bone Disorders Response
Sample Answer for NSG 5003 Connection Between CKD and Bone Disorders Response Included After Question
NSG 5003 Connection Between CKD and Bone Disorders Response
Description
Respond to at least two of your classmates. Participate in the discussion by analyzing each response for completeness and accuracy and by suggesting specific additions or clarifications for improving the discussion question response. Complete your participation for this assignment by the end of the week. Use APA format and site all resources.
Question #1 Reply to Professors question:
Can you talk a bit more about the connection between CKD and bone disorders?
Question #2 Caitlin
W8D8
A Sample Answer For the Assignment: NSG 5003 Connection Between CKD and Bone Disorders Response
Title: NSG 5003 Connection Between CKD and Bone Disorders Response
Effective kidney function is vital to perform daily functions that keep the body regulating. Huether discusses, the kidneys accomplish life-sustaining tasks by balancing solute and water transport, excreting metabolic waste products, conserving nutrients, and regulating acids and bases (2018, pp1229). Disease of the kidney can often be masked until damage exceeds treatment. Patients often are unaware of progressed kidney disease is until treatment options are limited or irreversible damage has occurred. Dr. Levey, Becker and Dr. Inker discuss, markers of kidney damage include albuminuria, urine sediment abnormalities, electrolyte abnormalities related to tubular disorders, or structural abnormalities detected by histology or imaging (2015).
Chronic kidney disease is the progressive loss of renal function associated with systemic diseases such as hypertension, diabetes mellitus, systemic lupus erythematosus, or intrinsic kidney disease, including acute kidney injury, chronic glomerulonephritis, chronic pyelonephritis, obstructive uropathies, or vascular disorders (Huether, 2018). Chronic kidney disease (CKD) is the presence of kidney disease as well as an estimated glomerular filtration rate (eGFR) less than 60ml/min, for 3+ months. The National Kidney Foundation (NKF) stages GFR in 5 levels to determine the stage of disease. Stage 1 GFR is >90, stage 2 GFR 60-89, stage GFR 30-59, stage 4 GFR 15-29 and <15 is stage 5 kidney failure. Common labs that may be trended may include, serum creatinine, blood urea nitrogen (BUN), urine protein, serum albumin, calcium, and electrolyte panel (NKF, 2017).
Patients may present with an array of symptoms, which often are used to detect kidney function. The Mayo Clinic reports patients with CKD may present with nausea/vomiting/diarrhea, chest pain, shortness of breath, high blood pressure (that is difficulty to control), fatigue/weakness, changes in mental clarity and swelling/twitching of lower extremities (2020).
Proteinuria and Angiotensin II are two prominent factors that are noted in pathogenesis of CKD. Huether discusses that glomerular hyperfiltration and increased glomerular capillary permeability lead to proteinuria. Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension (2018). When proteinuria and Angiotensin II are induced renal function declines at a rapid rate.
Whether acute or chronic, kidney disease is life-threatening and is linked to all bodily functions. Three systemic effects include skeletal, cardiovascular, and endocrine.
The skeletal system may manifest with spontaneous fractures and bone pain. The mechanism as discussed in readings includes mineral bone disorders, which can interfere with inflammation and reabsorption of vitamin D. Treatment may include administration of calcium and antacids (as they bind with phosphate), vitamin D replacement, and avoidance of magnesium.
The cardiovascular system may manifest with left ventricular hypertrophy, cardiomyopathy, and ischemic heart disease; hypertension and arrythmias. The mechanism as discussed in readings include extracellular volume expansion, increased cardiac workload, and hyperlipidemia accelerates arthrosclerosis. Treatment may include non-potassium sparing diuretics, lipid lowering agents and control of blood pressure.
The endocrine system may manifest with restricted growth in children, and higher incidence of goiters. The mechanism as discussed in readings include elevated parathyroid hormone levels or decrease in thyroid hormone. Treatment would include endogenous recombinant human growth hormone as well as thyroid hormone replacement.
Huether, S. H. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.) [E-book]. Mosby. https://digitalbookshelf.southuniversity.edu/#/boo…
National Kidney Foundation. (2020, April 27). Kidney Basics. https://www.kidney.org/atoz/content
Levey, A. S., Becker, C., & Inker, L. A. (2015). Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA, 313(8), 837–846. https://doi.org/10.1001/jama.2015.0602
Mayo Clinic. (2019b, August 15). Chronic kidney disease – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/chr…
Question #3
Melissa
Renal Case Study Questions:
1. Explain what happens physiologically with chronic renal failure and the GFR. Support with evidence. Include important labs that are monitored in the process.
Approximately 37 million people in the US have kidney disease many of which have no knowledge or diagnosis of it (CDC, 2020). What is chronic renal failure? This condition occurs when the kidneys become damaged and unable to filter the blood as well as they should, causing the body to accumulate excess fluid and wastes (CDC, 2020). Our patient has a PMH of Type 1 DM from the age of 8 that has more than likely caused her chronic kidney disease (CKD). Diabetes is the leading cause of CKD that accounts for approximately 44% of the cases seen (Fresenius Kidney Care, 2019).
How would her diabetes affect her kidneys? I believe the patient has developed diabetic nephropathy that is the accumulation of metabolic products, inflammation caused by growth factor-beta and protein kinase, and vascular changes of the large and small blood vessels due to hyperglycemia (McCance & Huether, 2018, p. 1262). The initiation of the polyol pathway that causes the decrease of an antioxidant called glutathione causes blood vessels to encounter an oxidative injury that is specifically related to DM.
What is the significance of the glomerular filtration rate (GFR) in chronic renal failure? The GFR correlates directly to the production of urine, renal blood flow that is regulated by hormonal and neural regulation, and intrinsic autoregulation (McCance & Huether, 2018, p. 1235). It measures how much blood can pass through the kidney’s glomeruli per minute. Our glomerular filtration rate naturally declines slowly as we age, but those who lose kidney function at an above-average rate will see a decline much quicker. For example, the normal GFR is 90 mL/min or >, mild loss of kidney function 60-89 mL/min, mild to moderate loss 45-59 mL/min, moderate to severe loss 30-44 mL/min, severe loss 29-25 mL/min, and kidney failure < 15 mL/min (National Kidney Foundation, 2020).
Important labs to closely monitor the process while the patient is hospitalized will include GFR, complete blood count (CBC), creatinine, urea clearance, cystatin C, urine albumin-to-creatinine ratio (UACR), aldosterone (ALD), prostaglandin D2 (PG D2) serum/plasma, natriuretic peptides (BNP), antidiuretic hormone (ADH), proteinuria, potassium, glucose, calcium, phosphorus, and albumin. Monitoring electrolytes, kidney function, hormones, and blood counts are imperative to maintain patient stability. All labs will direct the plan of care for further testing and treatment based on the severity of the kidney damage and effects on other organs. For example, based on the results and the effectiveness of dialysis, her Lasix dose may be increased, and Labetalol changed to another antihypertensive like Angiotensin II receptor blockers (ARBs) since it is removed during dialysis.
2. Explain the role of Angiotensin II and proteinuria as they relate to advancing renal disease.
The roles of both Angiotensin II and proteinuria in advancing renal disease are due to glomerular hyperfiltration and nephron injury. Proteinuria specifically causes tubulointerstitial injury by initiating macrophages and complement proteins to assist in inflammation and fibrosis amongst the tubules of the kidneys and the tissues that surround them (McCance & Huether, 2018, p. 1268). As injury to the nephron increases, the work of Angiotensin II increases that also causes increases in sodium reabsorption. With increased levels of sodium in the body, it elevates the blood’s osmolarity that creates a fluid shift into both the extracellular space and blood volume which can cause lower extremity edema like our patient (Fountain, 2020). This fluctuation of sodium and imbalance of fluid causes an increase in arterial pressure and total peripheral resistance leading to vasoconstriction and elevated blood pressure. The increase of tubule fibrosis and decrease in vascular blood flow causes kidneys to continue to malfunction and allows the progression of the advancing renal disease.
3. List at least three other body systems that are impacted by chronic kidney disease and why.
The first body system that is affected by chronic kidney disease is the heart. The heart and kidneys work interchangeably, so if there is a disease in the kidneys, cardiovascular disease will develop as well. When the kidneys are under stress, the hormone system in which it regulates causes increases in blood pressure to supply blood flow to the kidneys (American Kidney Fund, 2020). The elevated stress on the heart and its major arteries can lead to heart attack, congestive heart failure, arrhythmias, and other serious conditions.
Patients with CKD are very susceptible to neurologic complications. The brain can be affected by CKD that can cause severe complications such as encephalopathy, cognitive dysfunctions, autonomic and peripheral neuropathy, headache and stroke (Arnold, Issar, Krishnan & Pussell, 2016). These can be caused by hypertension, hypercholesterolemia, atrial fibrillation, anemia, and hyperparathyroidism that are attributes of CKD. The rapid effects that can occur during dialysis can create changes in urea and osmolalities that can cause cerebral edema (Arnold et al., 2016). The overall vascular impairment and neurodegeneration that CKD can cause greatly affects the brain and its functionality.
The pulmonary system can also be impacted by chronic kidney disease due to the inflammatory process that occurs during protein-energy wasting (PEW). The lowered GFR rate that is produced by CKD is closely associated with the increase of inflammatory cytokines like interleukin-6 and tumor necrosis factor (Mukai et atl., 2018). These cytokines promote muscle proteolysis that increases energy expenditure and contributes to PEW. This inflammation has been linked to patients with lung dysfunctions and COPD. Studies have shown that PEW is significant in the pulmonary-cardio-renal interactions that consequently lead to an increased prevalence of restrictive lung disorder (Mukai et atl., 2018).
Melissa
Reference
American Kidney Fund. (2020). Heart disease & chronic kidney disease (CKD). https://www.kidneyfund.org/kidney-disease/chronic-kidney-disease-ckd/complications/heart-disease/
Arnold, R., Issar, T., Krishnan, A., & Pussell, B. (2016, November 3). Neurological complications in chronic kidney disease. National Institute of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102165/
Centers for Disease Control and Prevention, CDC. (2020, February 07). Chronic kidney disease basics. https://www.cdc.gov/kidneydisease/basics.html
Fountain, J. (2020, July 27). Physiology, renin angiotensin system. National Institute of Health. https://www.ncbi.nlm.nih.gov/books/NBK470410/
Fresenius Kidney Care. (2019). Diabetes and Kidney Disease. https://www.freseniuskidneycare.com/kidney-disease/managing-ckd/diabetes
McCance K., L., & Huether, S., E. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473
Mukai, H., Ming, P., Lindholm, B., Heimbürger, O., Barany, P., Anderstam, B., Stenvinkel, P., Qureshi, A. (2018, April 27). Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease. National Institute of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922538/
National Kidney Foundation. (2020, September 14). Estimated glomerular filtration rate (eGFR). https://www.kidney.org/atoz/content/gfr
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