Pathophysiology Diagnosis Paper Example

A. Explain the pathophysiology.

Chronic renal failure is a functional diagnosis is characterized by a progressive decrease in the patient's glomerular filtration rate (GFR). The patient's case is not unique because the glomerular rate has been reduced to only 20ml/min which is approximately 10% of the normal function. Chronic renal failure is associated with flowing medical conditions: Diabetes mellitus, Hypertension, Glomerulonephritis, Polycystic kidney disease, and chronic pyelonephritis (Twardowski, 2004). The CRF is also characterized by the nephron loss but there is some nephron that survives or is not significantly damaged that adapt then enlarges to increase the clearance per nephron.

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In most patients, the initiating process of the CRF is diffuse or severe leading to the rapid development of the end-stage renal disease (ESRD) as a result of rapidly progressive crescentic Glomerulonephritis (Rafeek & Karthikeyan, 2017). However, in the patient where the disease progression is gradual and the nephron can adapt, the CRF can be corrected (McCance, & Huether, 2010). Focal glomerulosclerosis can easily develop in the damaged glomeruli making them nonfunctional. However, even during the development of the focal glomerulosclerosis, proteinuria can increase significantly contributing to the development of systemic hypertension which later worsens. The adaption of nephrons to enhanced the kidney's ability to postpone uremia (final common path) helps in improving tubular functions in terms of sodium, Potassium and magnesium, and proton secretion (Twardowski, 2004).

B. Discuss common clinical manifestations.

The most common clinical manifestations include increased urination frequency, decreased urination, bloodstained urine, and tea-colored urine. Other symptoms that can signal the development of CRF include edema, high blood pressures as well as fatigue that show that the kidney is having difficulties eliminating waste. It is important to note that weightless, muscle cramps and jaundice may also signal chronic renal failure (Rafeek, & Karthikeyan, 2017).

C. List differential diagnosis.

The differential diagnosis of chronic renal failure considers condition and disorders such as Systemic lupus erythematosus (SLE), Renal Artery Stenosis, Urinary Tract Obstruction and Granulomatosis with Polyangiitis (Wegener Granulomatosis). The differential diagnoses of chronic renal failure include the Acute Kidney Injury which is characterized by a rapid decrease in the renal filtration function. The Antiglomerular Basement Membrane Disease is also another possible differential diagnoses and so is the Chronic Glomerulonephritis, Diabetic Nephropathy, and Nephrolithiasis or the Rapidly Progressive Glomerulonephritis

D. Determine which lab tests would confirm the diagnosis and expected results.

Several lab tests can be conducted urinalysis to reveal hematuria and proteinuria. The hematologic can significantly help in demonstrating the degree of the renal insufficiency. The urine can be tested using a dipstick which is analyzed in the lab. However, it is important to note that there are chances of a false positive test. Microscopic hematuria is useful in determining if there are t6races of blood in urine making it pink, red, brownish-red, or tea-colored. A biopsy can also be done by taking tissue from the patient's kidney and skin for ultra-structural examination to see if there are abnormalities. The kidney biopsy is the most effective for providing the diagnosis. Additionally, genetic testing may be recommended for patient selected to be having CRF. The genetic testing will help in understanding the CRF's mode of inheritance. Over the past twenty years, audiometry has been the preferred method for diagnosing CRF in children.

The renal ultrasonography is also preferred for those whose CRF is suspected to be in the early stages of development by showing the kidney size whether they have shrunk or they are becoming echogenic. Other test includes the blood test for keratinizing and best tests for the urea nitrogen. The blood test would help in evaluating the kidney function. Final, the patient will need further follow-up testing which is mandatory for evaluating the health of the kidneys and their functionality (McCance, & Huether, 2010). For example, testing the urine albumin (microalbumin), estimated glomerular filtration rates, cystatin-C test, and urine culture to determine if the CRF is caused by bacterial infections.

Stage eGFR value

Stage 1 - Kidney damage with normal kidney function From 90-120

Stage 2 - Kidney damage with mild loss of kidney function From 60-89

Stage 3a - Mild to moderate loss of kidney function From 45-59

Stage 3b - Moderate to severe loss of kidney function From 30-44

Stage 4 - Severe loss of kidney function From 15-29

Stage 5 - Kidney failure, also known as an end-stage renal disease (ESRD) Less than 15

E. Analyze a current protocol for treatment and discuss how the treatment works from the pathophysiological perspective

The main protocols currently followed for the treatment of the disease is the f K/DOQI that seeks to address the problems that are associated with the disease. For example, The National Kidney Foundation produces clinical practice guidelines through the NKF Kidney Disease Outcomes Quality Initiative (NKF KDOQI) is based on the evaluation or laboratory measurements for clinical assessment of kidney disease. The protocols are defined by the estimated GFR, the results of the Proteinuria assessment, and the assessment of the other markers of CKD apart from Proteinuria. The treatment protocol or intervention measures are aligned with the stages of development fo the CRF (National Kidney Foundation, 2018).

References

McCance, K, & Huether, E. (2010). Pathophysiology: The biological basis for disease in adults and children (7th Ed.). St.Louis: Mosby (chapters 37-39 & 43-44).

Rafeek M., M., & Karthikeyan, K. (2017). A clinical study of cutaneous and mucosalmanifestations in patients with chronic renal failure on hemodialysis. International Journal Of Research In Dermatology, 3(1), 120. Doi: 10.18203/issn.2455-4529.intjresdermatol20170799

Twardowski, Z. (2004). Effect of long-term increase in the frequency and/or prolongation of dialysis duration on certain clinical manifestations and results of laboratory investigationsin patients with chronic renal failure. Hemodialysis International, 8(1), 30-38. Doi: 10.1111/j.1492-7535.2004.00084.x

National Kidney Foundation. (2018). K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Am J Kidney Dis 39: S1-S266,