Discuss the pathophysiology, management and consequences of chronic renal failure using current literature with special reference to Mr Goodpasture’s clinical presentation.
Discuss the relationship between Mr Goodpasture’s presentation and your own (i.e.
His signs and symptoms, as well as his pathology results. Discuss the pathophysiology and end-stage kidney disease.
Please describe the relationship between Mr Goodpasture’s kidney disease, and his medical history.
Discuss the management of end-stage kidney disease.
Compare and contrast the psychosocial consequences and risks associated with both management options.
The Presentation and Pathophysiology of Mr. Goodpasture’s Kidney Disease
My Goodpasture describes end-stage renal disease as irreversible deterioration of renal function. This is characterized by an inability to maintain a body’s metabolic, fluid, and electrolyte balance (Smeltzer Bare, Hinkle and Cheever, 2010).
It is a complex condition that manifests in many interrelated systems, including cardiovascular, neurologic and pulmonary.
End-stage renal disease patients often experience neurologic complications, such as Mr. Goodpasture’s state of agitation.
Cognitive dysfunction, stroke, encephalopathy, cognitive dysfunction, and peripheral and autonomous neuropathies are all common neurological complications of end-stage renal disease (Arnold. Issar. Krishnan. & Pussell. 2016).
CNS injury in ESRD may be caused by multiple factors, i.e.
This includes both neurodegenerative and vascular mechanisms.
Other common neurologic symptoms and signs include irritability, disorientation and weakness, fatigue, inability or ability to concentrate, behaviour changes and asterixis.
Mr. Goodpasture presents with scattered crackles and bases on a respiratory exam. This is a common presentation of end-stage renal disease.
ESRD can also present with pulmonary symptoms such as shortness of breath and crackles.
Because of the close relationship between kidney function and lung function, pulmonary effects can occur.
The systemic effects of renal acid/base disturbances are mitigated by changes in respiratory function (Cury, Brunetto & Aydos (2010).
A patient may also have cardiovascular problems.
Smeltzer Bare, Hinkle and Cheever (2010) state that typical symptoms of chronic cardiovascular failure include hypertension, hyperlipidemia and pericarditis.
This patient has both hypertension and oedema.
Patients with ESRD are at greater risk of dying from cardiovascular disease than patients who have dialysis. This is due in part to the common risk factors (Sweety Arzu, Rahman Salim, Mahmood 2014).
Anorexia, constipation, diarrhoea, constipation, or diarrhoea and mouth ulcerations and blood can all be signs of gastrointestinal disease (Smeltzer Bare, Hinkle & Cheever 2010, 2010).
A decline in renal function can lead to an increase in the levels of products of protein metabolism.
Actually, urinary protein excretion is a key factor in kidney function decline.
Patients suffering from ESRD are more likely to have elevated creatinine and urea levels (Khalidah & Suhad 2015).
Paige and Nagami (2009) also found that patients with ESRD have higher levels of serum phosphorous, and potassium, as documented in My Goodpasture.
According to hematology, Mr. Goodpasture has a lower than normal haemoglobin and red cell count.
This is in line with the findings of Suresh Mallikarjuna Sharan, Hari Krishna and Shravya (2012), who concluded that chronic renal failure patients have abnormal haematological parameters.
Together with other factors like increased haematuria and haemolysis the authors suggest that haemoglobin, red blood cells count, platelet count and haematocrit are all affected by impaired erythropoietin production.
The Kidney Disease and Medical History of Mr. Goodpasture
Hypertension and an underlying disorder in protein excretion by kidneys are both factors that influence the rate of kidney dysfunction and progression to CKD.
Hypertension is a risk factor for chronic kidney disease, ESRD and hypertension in Mr. Goodpasture.
Hypertension is second to diabetes in kidney disease (Tomiyama and Yamashina 2014).
Yamashina and Tomiyama (2014) report that hypertension has been increasing in both incidence and prevalence for over two decades.
As evidenced by the high incidence of ESRD in patients undergoing haemodialysis, hypertension can be both a cause or consequence of ESRD.
High blood pressure can cause kidney damage in a short time.
Other mild forms of high bloodpressure can also cause damage to the kidneys if they are spread over many years.
Uncontrolled hypertension can lead to rapid progression to end-stage renal disease.
Hypertension, when combined with other risk factors like smoking, obesity, and alcohol intake (as shown in the case of the patient), increases the likelihood of developing ESRD (Rumeyza (2013)).
Hypertension is a condition where the blood pressure is not controlled. This can lead to damage to blood vessels.
The most common areas that suffer the most damage are the arterioles and the venules.
These vessels are damaged by high pressure.
Systemic hypertension occurs when the capillary pressure of glomerulus is increased, leading to glomerulosclerosis, loss of kidney function, and a substantial risk of renal impairment in patients with hypertension (Lastra. Syed. Kurukulasuriya. Manrique. & Sowers. 2014).
Hypertension can lead to worsening of kidney disease and cardiovascular problems in patients with chronic kidney disease.
End-Stage Kidney Disease Management
For patients such as Mr. Goodpasture, there are two options: haemodialysis or kidney transplant.
Most patients suffering from ESRD choose kidney transplantation as their treatment.
This is due to the substantial improvement in quality of life and survival rate compared to patients who are treated with dialysis (Berns 2016,).
Transplants can lead to a life expectancy increase of between 8 and 12 years for patients.
The kidneys of living donors tend to work better and last longer than those from deceased organs.
Transplantation is more beneficial for younger patients than it is for older people.
There are some factors that may prevent a patient from being eligible for transplantation.
These include obesity, severe illness, recent or active cancer treatment, drug abuse, dementia, and inability to remember to take medication (Berns 2016, 2016).
The main downside to transplantation is that patients must take medication and be monitored regularly to reduce the chance of rejection.
Haemodialysis involves the pumping of blood through a dialysis machine in order to eliminate excess fluids and other waste products.
However, haemodialysis should not be used in cases of unstable cardiac rhythm, hemodynamic instability or hypotension.
Concerning risks and psychosocial implications, transplantation studies show that there is a general improvement in quality of life for most recipients but not in physical or emotional well-being (Lopes et al. 2011, 2011).
The most common negative psychosocial effects that recipients report are anxiety and depression.
Some studies show that there are twice as many happy relationships between the donor and recipient after positive outcomes (Pasquale et al. 2014).
There are risks associated with transplantation, including the possibility of rejection and side effects from anti-rejection medication or immunosuppressants. (Saha & Allon (2016).
Psychosocial effects include depression, anxiety, fatigue, and malnutrition (dues to anaemia, sleep disorders, and malnutrition).
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