Chronic Renal Failure: Pathophysiology, Treatment Options, and Medications

This article discusses chronic renal failure, its pathophysiology, risk factors, complications, and treatment options. It also covers the medications used to manage the condition and their side effects. Additionally, it explains the teach-back method for patient education on managing chronic renal failure.

Running head: CASE STUDY TWO
Case Study Two
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CASE STUDY TWO 2
Case Study Two
Part I.
Renal anatomy and physiology
Renal anatomy refers to the structure of the kidney. The renal system is made of the
kidney, ureters, urinary bladder, and the urethra. Each of the parts of the renal system has
specific functions that define how it works. The kidneys are bean-shaped structures positioned on
each side of the lower abdomen and they have the function of collecting wastes from the body.
The collected waste products are then transferred to the urinary bladder through muscular tubes
called the ureters. The urinary bladder that is located at the end of each ureter is a sac-like
structure that holds urine coming from the kidney to the ureters. Once the urinary bladder is full,
urine is then passed out of the body through a pathway called the urethra (Robson, 2014).
According to Lumen (2017), the kidney has renal filtration units in it called the nephrons. Each
kidney contains millions of nephrons that perform the role of purifying the blood and removing
the acids, bases, electrolytes, and other wastes. The nephron consists of renal artery that collects
blood with wastes and brings it to the kidney for filtration. Once filtration is complete, the
purified blood leaves the kidney to the body through the renal vein.
Pathophysiology of chronic renal failure, risk factors, possible complications, and treatment
options
The term “chronic” means that the disease is gradual and progressive. In most cases, the
disease may be triggered by other causes but the symptoms may not be noticeable until a
significant damage has been done to the body. Chronic renal failure is an umbrella term for
several diseases that trigger destruction of nephrons in the kidney and continue damaging the
remaining ones to the point where the kidney cannot perform its role of purifying the blood

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(Sands, 2015). The damage is gradual and progressive, and it may take time before noticeable
symptoms are observed. The kidney possesses limited ability of degeneration, implying that
repeated or minor injuries to the nephron trigger multiple responses that interfere with its
structure. If the damage reaches a point where the kidneys cannot perform their functions, the
condition is irreversible and it is called end-stage renal disease (ESRD). Patients in this stage
cannot be cured of the disease and the only treatment option available is the dialysis and kidney
transplant. These treatments do not cure the disease, but they help the patient to live longer. The
possible risk factors for this disease are hypertension and diabetes. During dialysis, the blood is
cleaned manually by running it through the machine to remove wastes. This process has to
continue throughout the lifetime of the patient. In case of kidney replacement, Melanie will need
a new kidney from donors. In case of kidney transplant, Melanie will not need dialysis to clean
her blood. She will however, need to be careful to avoid damage to the new kidneys.
Additionally, even though hemodialysis can help in purification of blood, the patient will still
need to stay careful through diet management to avoid other complications that may affect her
health.
In the case scenario of Melanie, the high blood pressure could have led to the chronic
kidney failure. According to the case scenario, Melanie’s BP was 190/110. Chronic kidney
failure occurs when the nephrons in the kidney are damaged slowly without necessarily
observable changes in the body. According to the case scenario, Melanie could experience
symptoms of hypertension but she had been taking ibuprofen whenever she felt palpitations.
According to Dalal, Bruss, and Sehdev (2019), renal kidney failure results from progressive
damage to the nephrons that lead to their reduction in number. For the case of Melanie,
progressive damage that occurred to her nephrons attracted the symptoms of the renal kidney

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failure. Dialysis removes only some of the wastes, but diet management could help improve the
quality of life.
In this case scenario, the causes of the chronic renal failure may be attributed to high
blood pressure, taking the over-the-counter medications for a long time, and possibly diabetes
due to high blood sugar. According to Webster and Nagler (2017), patients with renal kidney
failure are likely to develop complications such as tiredness, headache, shortness of breath,
swelling in legs and in the eyes, nausea. Melanie has already exhibited some of these symptoms,
indicating that her nephrons have been damaged and she is it the end stage of chronic renal
failure.
Differences between acute and chronic renal failure
There exist significant differences between acute and renal failure. While acute renal failure may
result from short-term damages to the kidney such as physical injuries, chronic kidney failure is
caused by long-term diseases such as diabetes and hypertension. Acute renal failure is reversible
through treatments, but CKD cannot be cured. AKD results from abrupt damage to the kidney,
but CKD may take time as it is gradual and progressive. The signs and symptoms of AKD are
sudden, but the signs of CKD may take time before being noticed. AKD does not need dialysis
or kidney transplant, but a person with CKD requires dialysis or kidney transplant to resume
some normal functioning (National Institute of Diabetes and Digestive and Kidney Diseases,
2019). AKD is not fatal, but CKD can be fatal if all the nephrons have lost their ability to
function.
Renal replacement therapy (Hemodialysis)
Hemodialysis is a therapy performed to clean blood using artificial machines that
function like kidneys (Ricci, Romagnoli, & Ronco, 2016).). The process if performed to filter

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wastes from the blood in the same manner the kidneys functioned when they were normal.
During hemodialysis, the dialysis machine pumps blood through external filters to remove
wastes and pumps purified blood back to the body.
In the case of Melanie, she will need to undergo renal replacement therapy
(hemodialysis) to purify her blood because her kidneys can no longer do the work automatically.
According to Vinsonneau (2015), Melanie can make an arrangement with the nephrologist to
agree when she can be undergoing hemodialysis. While hemodialysis is the preferred method of
managing this condition, Melanie should be aware of some complications that may arise due to
this process. Some of the complications that may arise include anemia, hypertension, fluid build-
up in the body, and heart diseases (Spectrum Health, 2019). The hemodialysis therapy does not
replace the functions of the kidney, but it only helps in cleaning blood by removing some wastes
(Malkina 2019).. Melanie should, therefore take caution to make sure that she does not consume
foods rich in potassium and phosphorus that could lead to high intake of these mineral elements,
creating a need for high frequent artificial purification of her blood.
Part II
Discussion of medications and their side effects
According to the case scenario, Melanie had a high blood pressure that could affect the
functioning of her kidneys. This is the reason she has been commenced on valsartan 80 mg OD
to help manage the disease. It is taken orally as per instructions from the physician. The drug
works by relaxing the blood vessels to make sure that blood with minimal resistance. In the case
of Melanie, the drug will help in lowering her blood pressure to make sure that blood is not
forced into the kidneys. High blood pressure overworks the kidneys, the heart, and the liver.
When kidneys receive blood that is under high pressure when they are damaged, they undergo

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further damage. The reason Melanie has been commenced on valsartan is to lower the pressure
of blood as it flows into the kidneys for purification.
In spite of its use in managing the blood pressure, valsartan has side effects that may
affect the patient. According to Vadakedath and Kandy (2017), valsartan causes dizziness when
the patient is first exposed to the drug. Dizziness and headache occurs due to the fact that the
drug lowers the blood pressure once it is taken. The other limitation of this drug is that it may
cause kidney problems to make them worse. As a result, the physician has to check with the
status of the kidneys before commencing the use of these drugs. Other side effects include low
blood pressure due to relaxation of blood vessel, joint and back pain, vomiting, diarrhea, and
pain in legs and joints.
Eprex is another drug prescribed for Melanie. The purpose of this drug is to treat anemia
that Melanie may suffer from because of her failed kidneys. It is injected into the body to
stimulate bone marrow to produce enough red blood cells to prevent the patient from suffering
from anemia. Even though Eprex is recommended for treatment of kidney diseases, it has been
linked to some side effects which include dizziness, headache, diarrhea, and pain in legs and
joints (Schoenfelder, Chen, & Bleb, 2017).). Other side effects of eprex are effects include low
blood pressure due to relaxation of blood vessel, joint and back pain, vomiting, diarrhea, and
pain in legs and joints (WebMD, 2019). These side effects are not common for all patients, but
Melanie could consider contacting her physician immediately she notices some changes after
taking the drug.
Discussion of GFR and Hb performed and the indication of the results
The GFR performed on Melanie was to determine how her kidneys were performing their
function of purifying blood. According to Dalal, Bruss, and Sehdev, (2019), GFR higher than 30

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ml/min indicate that the patient is asymptomatic. On the other hand, GFR less that 30 indicates
that the patient is in stages 4-5 of the disturbances. Since Melanie had a GFR of 10ml/min, she is
in stage four or five.
The Hb test was performed to determine the amount of hemoglobin in the body of
Melanie. According to Healthdirect (2019), kidneys do not produce hemoglobin, but they
produce a hormone called EPO that triggers the bone marrow to produce hemoglobin. Damaged
or diseased kidneys do not produce enough EPO hormone, hence it is easy to detect if the
kidneys are the problem when the hemoglobin level is low. Melanie had a hemoglobin level of
95g/L, indicating that the kidneys were not producing enough EPO for production of hemoglobin
from the bone marrow.
Part III
The teach-back method in managing chronic renal failure
The teach-back method, also called the show-method will be used by the physician to
determine whether she has learned how to manage the condition by herself (Mollazadeh &
Hemmati, 2018).). The purpose of this method is to determine whether Melanie has understood
how to manage the condition in absence of the physician. It is called teach-back method because
the physician will play the role of the patient and Melanie will explain back to the physician
what she has learned. In the process of teaching back what she has captured, she will be learning
of what she is supposed to do. When using this method, the physician may tell Melanie that “We
learned today about managing renal kidney failure, can you mention some of the methods?”
Patient education on managing chronic renal failure (teach back method)
The purpose of this method will be to help Melanie understand how to manage her
kidneys. According to Yen and Leasure (2019), teach back method is mainly used to help

CASE STUDY TWO 8
patients in self-management programs. As a physician, I will first explain to Melanie about fluid
therapy and what she is supposed to do when undergoing hemodialysis. I will explain how fluid
intake will affect her kidneys and why she will need to restrict fluid intake when undergoing
hemodialysis. Additionally, too much intake of water dilutes the sodium content in the blood and
this can lead to a condition called hypoglycemia which may be fatal. I will explain that when
undergoing hemodialysis, she will need to restrict fluid intake because this could increase blood
pressure and overwork the kidneys, making her to feel pain and irreparable damage to her
kidneys.
Once the patient has understood how she is supposed to monitor fluid intake, I will sit
back and ask her to explain what we have learned. I will also ask her to propose some other ways
that she thinks one could use to manage fluid intake when the person has renal kidney failure.
Once she has finished explaining what I have taught her on the self-management of her kidney
problem, I will highlight some changes in areas I realize that she did not capture. I will then ask
her to make some recommendations as I sit back to learn from what she has captured from the
session.

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References
Dalal, R., Bruss, S., Z., & Sehdev, K. (2019). Physiology, Renal blood flow, and filtration.
Startpeals. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482248/
Healthdirect (2019). Chronic kidney failure. Retrieved from
https://www.spectrumhealth.org/patient-care/services-and-treatment-detail-pages/
hemodialysis
Lumen (2017). Physiology of the kidneys. Retrieved from
https://courses.lumenlearning.com/boundless-ap/chapter/physiology-of-the-kidneys/
Malkina, V. (2019). Chronic kidney disease. MSD Manuals. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695466/
Mollazadeh, F., MS, & Hemmati Maslakpak, M., PhD (2018). The Effect of teach-back training
on self-management in kidney transplant recipients: a clinical trial. International Journal
of Community Based Nursing and Midwifery, 6(2), 146–155. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845118/.
National Institute of Diabetes and Digestive and Kidney Diseases (2019). What is Chronic
Kidney Disease? Retrieved from https://www.niddk.nih.gov/health-information/kidney-
disease/chronic-kidney-disease-ckd/what-is-chronic-kidney-disease
Robson L. (2014). The kidney--an organ of critical importance in physiology. The Journal of
Physiology, 592(18), 3953–3954. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198006/
Ricci, Z., Romagnoli, S., & Ronco, C. (2016). Renal replacement therapy. F1000Research, 5.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755402/

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Sands, J., M. (2015). Understanding renal physiology leads to therapeutic advances in renal
disease. Physiology, 30(3). Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4422976/
Spectrum Health (2019). Kidney dialysis. Retrieved from
https://www.spectrumhealth.org/patient-care/services-and-treatment-detail-pages/
hemodialysis
Schoenfelder, T., Chen, X., & Bleb, H. (2017). Effects of continuous and intermittent renal
replacement therapies among adult patients with acute kidney injury. GMS Health
Technology Assessment. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332811/
Vinsonneau, J. (2015). Renal replacement therapy in adult and pediatric intensive care. Annals of
Intensive Care. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695466/
Vadakedath, S., & Kandi, V. (2017). Dialysis: A Review of the Mechanisms Underlying
Complications in the Management of Chronic Renal Failure. Cureus, 9(8), e1603.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654453/
WebMD. (2019). Valsartan: Uses and side effects. Retrieved from
https://www.webmd.com/drugs/2/drug-849/valsartan-oral/details
Webster, A., C. & Nagler, E., V. (2017). Chronic kidney disease. Lancet. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695466/

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Yen, P. & Leasure, Z. (2019). Use and effectiveness of the teach-back method in patient
education and health outcomes. Federal Practitioner. Retrieved from
https://europepmc.org/articles/pmc6590951