Risk factors and etiology of the patient Case Study 2022

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

NURSING ASSIGNMENT1
WRITTEN EXPLANATION
RISK FACTORS AND ETIOLOGY OF THE PATIENT
The case study stays that Mr. Steve McManus has been diagnosed with chronic kidney
disease. Two of the main risk factors for chronic kidney diseases are diabetes and hypertension.
Diabetes mellitus is one of the leading cause of chronic kidney disease. According to
Kazancioğlu (2013), the mechanisms that can cause kidney disease due to diabetes includes
injury due to hyper filtration, advanced glycosylation end products and reactive species of
oxygen. At the molecular level, growth factors, numerous cytokines and various hormones like
transforming growth factors like factor –beta and Angiostenin II. RAAS is activated early in
diabetic nephropathy. This decreases the concentration of the H+ ions in the body causing a
decrease in the sodium concentration the body (DeMarco, Aroor & Sowers, 2014). The renin-
angiotensin-aldosterone system is highly activated in obesity. Another risk factor is hypertension
(Kazancioğlu, 2013). Loss of kidney function and systemic hypertension is transferred to the
intraglomerular capillary pressure causing glomerulosclerosis and loss of kidney functions. In
glomeruloscerosis, the timey blood vessels stops functioning, eventually causing proteinuria.
Again obesity has been recognised as a risk factor for chronic kidney das well as proteinuria
(Hall et al., 2014). The proximal tubule takes up the protein and initiates the process of
inflammation, giving rise to tubulointerstitial fibrosis. This occurs in the later stage of the CKD,
with a reduction in the glomerular filtration rate. Inflammation is against caused by the
activation of RAAS (Hall et al., 2014). Obesity induced hemodynamic changes and glomerular
deposition of the lipids (DeMarco, Aroor & Sowers, 2014). Variable risk of the impaired
functions has been reported in patients suffering from hypertension. Hyperkalemia has been

NURSING ASSIGNMENT2
noticed in a patient with systemic arterial hypertension (Lakkis & Weir, 2018). The hypertension
was liked with retention of the sodium ions, increasing the plasma volume, supresses plasma
renin activity and decreased secretion of aldosterone (Judd & Calhoun, 2015).
According to an experimental study, it has been proved that the metabolic acidosis
exacerbates ischemia induced acute kidney injury. The case study reveals that Steve McManus
was an obese person. Obesity is one of the strongest risk factor of chronic kidney diseases.
Glomerular hypertrophy and the hyperfiltration has been found to be responsible for chronic
kidney disease by increasing the tension of the capillary wall of the glomerular tubule. This
increase in the intraglomerular pressure can cause damage in kidneys and increases the chance of
chronic kidney disease (Kovesdy et al., 2017).
PATHOPHYSIOLOGY OF THE DISORDER
Metabolic acidosis is commonly related to chronic kidney diseases. As the kidney
functioning decrease in chronic kidney disease, the acid secretion is initially maintained by an
increase in the ammonium secreted by the body (Hu et al., 2016). Maintenance of the acid base
homeostasis is important for all the aspects of health. Hyperkalemic Metabolic acidosis can be
considered as the worsened control of hyperglycemia and an increased risk of CKD. Diabetic
ketoacidosis occurs due to excessive deficit of sodium bicarbonate in the body. Diabetes induced
hyperglycemia leads to dehydration, electrolyte loss, hyperosmilarity and decrease in the
glomerular filtration rate (Hu et al., 2016). Metabolic acidosis shares many symptoms like
fatigue and itchy skin. Due to the decreased glomerular filtration rate, uremia is caused. Itchy
skin can be because of uremia (Hall et al., 2014). High metabolic acidosis is related to reduce
skin turger causing itchy skin. In a chronic kidney disease, the building up of metabolic wastes
in the blood can cause severe itching. Again, it has been found that excessive levels of