Understanding Renal System and Chronic Kidney Disease: A Case Scenario

This document explains the renal system and chronic kidney disease through a case scenario. It covers the risk factors, interventions, and medications used for treatment.

Assessment task 2 - Case Scenario
Student Name
University Name
Student Notes

Part 1.1
The renal system comprises of two ureters, a pair of kidneys, a urinary bladder, two sphincter
muscles as well as the urethra. The main functional organs of the renal system are the
kidneys, which are bean shaped organs situated behind the peritoneum, responsible for
filtering the blood to help eliminate waste products from the blood. The kidney is bounded by
3 tissue layers- the outer layer is the renal fascia, which is a thin connective tissue layer that
helps in anchoring the kidney to its position; the next layer is the adipose tissue layer
responsible for shielding the kidney from trauma or excess force; the third layer is the renal
capsule, which is a smooth, transparent dense connective tissue layer which is responsible for
the bean shaped structure of the kidney. There are two zones inside the kidney- an outer
cortical zone and the inner medullary zone. The renal cortex consists of blood vessels which
are connected nephrons, which are present in the medulla. The hilum in the kidney acts as the
entry and exit of the ureters and the arteries, veins and nerves from the kidney. The ureters
are narrow and muscular tubes that act as passage ways from the kidney to the bladder and
are about 24-30cm long. The renal arteries ascend from the aorta and the renal veins channel
from the inferior vena cava. The urinary bladder is a muscular sac situated in the pelvic
region. The sphincter muscles help the keep the urine in the bladder and the urethra is the
tube responsible for aiding in the process of excretion of the urine (Koushanpour & Kriz,
2013).

Part 1.2
Chronic kidney disease can be characterised by the gradual decrease in the functionality of
the kidneys leading to several associated medical complications. The reduced functionality of
the renal organs results in the inability of the kidney to retain homeostasis between the fluid
and the electrolyte concentration in the body (Levey & Coresh, 2012).
Melanie Johnson, the case subject is diagnosed with chronic renal failure after developing an
arteriovenous fistula. According to her medical history, she has been suffering from
palpitations and severe headaches for over 5 years for which she did not seek any medical
help but took ibuprofen and naproxen. These were responsible for her increased blood
pressure. Prolonged high blood pressure have been known to deteriorate the functionality of
the kidneys especially the glomerulus, as this increase in blood pressure tends to damage the
arteries rendering them unable to deliver enough blood for the kidneys to filter (Ortiz et al.,
2014).
According to her blood tests, she has a GFR (glomerular filtration rate) of 10ml/min/1.73m2 ,
which is very low compared to the normal range of about 60 ml/min/1.73 m2. The evident
decline of the glomerular filtration rate indicates the presence of an underlying kidney
disease; a sit effectively implies the ability of the kidney to filter the blood effectively
(Skupien et al., 2016). The haemoglobin was 95g/L which is also lower than the normal range
of 121 g/L to 151 g/L. This indicates that Melanie is anaemic. An individual developing a
kidney disease is most likely to suffer from anaemia, as the kidney is known to produce
Erythropoietin alfa, which is responsible for the stimulation of the production of red blood
cells (Sinha et al., 2019). At the end stage of any renal disease, the individual often suffers
from palpitations and headaches as well as symptoms like pruritus, which occurs due to the

decreased nephron functionality that in turn reduces the rate of removal of the waste products
like urea from the blood stream.
Her Serum Potassium was found to be 5.7 mmol/L, which indicated the condition of
Hyperkalaemia. This inability of the kidneys to aid in the secretion of potassium in the urine
can cause arrhythmia, for which she might have faced symptoms like increased tiredness as
well as palpitations and headaches (Hoss et al., 2016).
In Melanie’s case, her age, prolonged untreated hypertension, symptoms like palpitations, use
of non-steroidal anti-inflammatory drug Ibuprofen, arrhythmia, anaemia, hyperkalemia, and
improper diet are some of the risk factors which might have aided in the incidence of this
disease. Other than these, her occupational factors like exposure to different chemicals while
farming as well as her socio-economic status to not being able to afford her medical expenses
and her ignorance which can be due to her lack of knowledge and awareness of the severity
of her condition might have also helped in the progression of the disease to the end stage.
The main aim of the treatment process is to regain the effective functionality of her kidneys.
Thus the nephrologist can recommend some long term as well as some instant and short term
interventions which will help her condition. The long term goals may include a balanced diet
with different variations to help encourage her to venture out of her farm for food, as well as
lifestyle modifications which might help her be more exposed to sunlight in order to help
regain her vitamin D levels that can aid her in improving her kidney’s health (Jean,
Souberbielle & Chazot, 2017). She can also be advised to not be over exposed to the farming
chemicals which might aggravate her skin itching. She can also be given vitamin supplements
and advised against sodium and protein intake. She will require dialysis to help filter her
blood from waste products. She can also be given short term interventions like drugs – anti

seizure agents like diazepam, antihypertensive drugs like diuretics and inotropic agents. She
can also be administered recombinant human erythropoietin (Cherng et al., 2018).
Part 1.3
ARF CRF
Sudden reduction in the functionality of the
kidney.
Slow and progressive reduction in the
functionality of the kidney.
This disease is curable. This disease is not completely curable.
Risk factors include infection, accidents,
wound, drug side effects, and dehydration
Risk factors include prolonged hypertension,
arrhythmia, anaemia, diabetes, hyperkalaemia,
and improper diet, and lifestyles as well as
occupational factors (Chawla et al., 2014).
It has a total of 4 stages of deterioration. It has a total of 5 stages of deterioration.
Interventions of this disease include – diet
modifications, fluid restrictions and dialysis
(Bellom, Kellum & Ronco, 2012).
Interventions of this disease include mainly
dialysis and in extreme cases kidney
transplant.
This can last up to days to weeks. This can last up to years, until the person
undergoes a kidney transplant.

Part 1.4
Renal replacement therapy is used to replace functionality of the kidneys and is usually
recommended to individuals suffering from chronic renal failure. This process is often
referred to as haemodialysis (Parasrampuria, et al., 2015). Considering the case of Melanie,
who has been clinically proved to be suffering from chronic kidney failure, has been
recommended by her nephrologist to undergo this process.
This medical procedure employs the principles of processes like osmosis, filtration, diffusion
as well as ultra-filtration. This will thus help restore the functionality of the kidneys and help
in the fluid filtration as well as flow. Thus will help ensure that homeostasis is maintained
between the fluid and the electrolyte concentration in the body. Melanie’s blood will be
pumped into one chamber of the dialyzer, in order to facilitate the exchange of salts and
waste products. The dialysate, which is present in the other chamber of the dialyzer, has a
negative pressure with respect to blood, which creates a difference in the concentrations and
the pressure, enabling the initiation of the filtration process. Melanie then receives the
dialyzed blood through the arteriovenous fistula. The blood is then treated with an
anticoagulant to prevent the formation of blood clots which might cause medical
complications in the patient and render the process ineffective and even fatal. She would
require to continue with this process 3-4 times in a week in order to not suffer from different
associated symptoms and medical complications of the disease. Considering that Melanie is
suffering from chronic kidney failure, this process cannot cure her condition but can help aid
her kidneys filter her blood until she undergoes a kidney transplant.

Part 2.1
Valsartan:
Valsartan is used to treat heart diseases, kidney diseases as well as high blood pressure. It is
an orally active, angiotensin II receptor blocker which is known to hinder the functionality of
vasoconstrictors and aldosterone secretin (Yasuda et al., 2013).
Melanie, the case subject is known to have both hypertension due to her drug abuse of
ibuprofen as well as the resulting kidney failure due to her lifestyle, ignorance and drug
abuse. Thus, prescribing this can help in the preventing the overall deterioration of the kidney
function as well as help reduce her blood pressure (Yasuda et al., 2013).
4 major side effects:
The drug has many side effects like- fatigue, dizziness, diarrhea as well as insomnia (Yano et
al., 2012).
4 nursing considerations:
The nurses ought to undertake the assessment of her vitals like blood pressure, pulse rate and
more, as this drug is known to decrease blood pressure and even cause arrhythmia. Thus
considering Melanie’s medical history of palpitations and arrhythmia, this assessment is
crucial to understand the effects of the drug.
Considering her increased serum potassium and urea level in the previous blood test, they
nurses would require to continue taking more blood tests after the administration of the drug
to understand the effective dosage for Melanie (Hoss et al., 2016).

Melanie has been seen to suffer from skin itching or pruritus. Thus after the administration of
the drug, which helps in improving the efficacy of the kidney functions, the nurses ought to
conduct a skin assessment, to check the incidence of any skin lesions or skin rashes.
Nurses should undertake an assessment to help determine whether the patient is suffering
from oedema and look for signs for any difficulty in breathing.
Eprex:
Synthetic erythropoietin like Eprex can be used to facilitate and stimulate the production of
red blood cells. Kidneys are responsible for the production of natural Epoetin alfa. Thus this
medication is often prescribed to people suffering from severe anemia or from chronic or
acute renal diseases (Hörl, 2013).
In case of Melanie, the blood report suggests that she is highly anemic and her reduced
potassium and creatinine levels along with other objective assessments, it can be implied that
she has chronic renal failure. Thus, to help increase her red blood cell count and to help in the
regaining the functionality of her kidneys, this medication can be suggested (Hörl, 2013).
4 major side effects:
The drug has many side effects like- headaches, dizziness, myocardial infarction, as well as
stroke, and deep venous thrombosis (Gansevoort et al., 2013).
4 nursing considerations:
The nurses ought to undertake the assessment of her vitals like blood pressure, pulse rate and
more, as this drug is known to increase red blood cell count and cause different
cardiovascular diseases (Gansevoort et al., 2013). Thus considering Melanie’s medical

history of palpitations and arrhythmia, this assessment is crucial to understand the effects of
the drug.
Considering the said side effects, she needs to be monitored in order to observe whether she
contracts any seizures from this medication.
Considering her GRF value from the previous test, it is evident that she has contracted
chronic kidney failure. Thus after administering this drug for a given amount of time, she
would have to undergo these tests to find out whether this drug is working for her or not.
Educate her and her family on the signs of a stroke, in order for the early identification of the
signs and symptoms.

Part 2.2
According to her blood tests, she has a GFR (glomerular filtration rate) of 10ml/min/1.73m2 ,
which is very low compared to the normal range of about 60 ml/min/1.73 m2. The evident
decline of the glomerular filtration rate indicates the presence of an underlying kidney
disease; a sit effectively implies the ability of the kidney to filter the blood effectively. The
haemoglobin was 95g/L which is also lower than the normal range of 121 g/L to 151 g/L.
This indicates that Melanie is anaemic. An individual developing a kidney disease is most
likely to suffer from anaemia, as the kidney is known to produce Erythropoietin alfa, which is
responsible for the stimulation of the production of red blood cells. At the end stage of any
renal disease, the individual often suffers from palpitations and headaches as well as
symptoms like pruritus, which occurs due to the decreased nephron functionality that in turn
reduces the rate of removal of the waste products like urea from the blood stream.

Part 3
Teach-back method : The teach back method can help the healthcare providers assess the
cognitive response of their patients- whether they can understand and comprehend the things
that are being taught to them. This also helps the healthcare providers understand the ability
of the patient to retain the newly taught knowledge as well as whether they are able to use
this information to help other patients , suffering from similar medical complications. This
process also helps in identifying the gaps or limitations of the teaching process. Thus, this
method helps facilitate the improvement in the efficacy of the teaching process (Tamura-Lis,
2013).
I would recommend Melanie to incorporate varieties of fresh and organic food items and
encourage her to venture outside her farm for food options. This will help her maintain a
balanced diet. Given her age and medical history, she would require to incorporate dairy
products and lean meats in her diet along with beans, and poultry. She would require to be
very cautious about her calorie intake and make sure she incorporates the only the required
amount of fat in her diet, as this might facilitate the contraction of heart diseases. Her diet
plan should mainly incorporate low fat food options like vegetables. She would require
having less sodium and phosphorus intake as well as monitoring her potassium levels. After
explaining this to her, I would let her explain which food items I told that she could eat and
what items she should restrict from eating. The patient will then proceed to explain that high
calorie food items, junk foods and high-protein content meats are some of the items she
should avoid eating.
After this, if I detect any gaps or misunderstanding in her understanding, I would proceed to
help her understand the necessary details. I will also encourage her to educate not only her

family but also friends and anyone she sees exhibiting symptoms like her to not ignore the
symptoms and go to a healthcare provider to get medical help.
I will also help her understand how the kidney works and how these food items can either
improve or deteriorate the health of her kidney.

References
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