Chronic Renal Failure: Pathophysiology, Risk Factors, and Treatment

This article discusses the pathophysiology of chronic renal failure, including renal anatomy and the physiological changes that occur. It also explores the risk factors associated with chronic renal failure and the complications that can arise. The treatment options, including renal replacement therapy and medications, are discussed, along with nursing interventions. The importance of fluid intake in the diet is emphasized, and the teach-back method is explained as a way to ensure patient understanding.

Running Head: CHRONIC RENAL FAILURE
CHRONIC RENAL FAILURE
Name of the student:
Name of the university:
Author note:

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Introduction:
Chronic renal failure is defined as the kidney disorder, where the normal functionality of
the kidney is lost. Initially it does not provide any symptoms, but later it gives rise to certain
symptoms which include fatigue, reduced appetite, confusion, vomiting and leg swelling
(Almutary, Bonner & Douglas, 2016). This discussion primarily focusses on the pathophysiology
of chronic renal failure in Melanie and nursing intervention associated with it.
Part 1:
Renal anatomy and pathophysiology:
Renal or kidney is the major organ of the excretory system. The primary function of the kidney is
to filter fluid and to absorb water. The kidney is present on the both sides between the
retroperitoneal spaces, which are the space between the posterior abdominal wall and that of the
parietal peritoneum (Glassrock & Rule, 2016). By analyzing the anatomy and the physiology of
the kidney, it is observed that the kidney is a bean shaped organ and of brown in color. It is
enclosed within hard capsule named as renal capsule, which is made up of fibrous connective
tissues and prevents the damage from any shock. Along with this, it also comprises two layers of
fats which are used as a cushion. Front section of the kidney comprises renal cortex, the outer
region and medulla at the internal region. The renal columns of the kidney are formed of the
connective tissue, which exude downward from the renal cortex region and through the inner
region, medulla in order to separate the renal papillae and renal pyramids. Renal papillae of the
renal system functions as collecting ducts that helps in the collection of urine. Apart from these,
renal columns also divide into 6-8 different lobes which aim to provide support to the blood
vessels which enter the kidney and exeunt the kidney.

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Pathophysiology of the chronic failure:
Chronic renal failure is also demarcated as the end stage renal disease, which leads to
deterioration of the normal renal functions of the body. The normal renal functions of the body
are to maintain the electrolyte and fluid balance. In the case of renal failure, the organ is not able
to perform ultrafiltration and absorption of water. Along with it, in the case of renal failure, the
renal is not able to maintain the optimum level of the hematocrit, urea, sodium, acid base balance
and the blood pressure. The renal failure is observed either due to dysfunction of tubular or the
glomerular and leads to excess loss of renal tissue. The chronic renal failure if not managed, can
lead to hypoxia due to the thickening of the ascending limbs by the excess absorption of oxygen.
In the case of the renal failure, the delivery of the sodium is gets increased in the macula
densa along with arterial vasoconstriction. The high delivery of sodium in the case of renal
failure can lead to me excess secretion of the prostaglandin, adenosine, cytoskeletal, and NO of
the tubular cells which leads to polarity loss in the tubular cells of the renal system. Due to the
loss of polarity, the adhesion of the cells also gets decreased which leads to damage of the
tubular cells as they become sluggish. As a result of it, the renal started function abnormally and
is not able to properly reabsorb water. Inappropriate absorption of water in the renal system leads
to rejecting of the dilute urine of minimal specific gravity from the system in large amount.
When the level of prostaglandin increases in the renal system it can lead to increase in the
amount of the flow of blood into the inner region of the kidney and also lead to the reduction in
the transport of the body fluid through the ascending limbs, which also leads to renal infiltration.
Renal infiltration if not treated initially can lead to chronic infection due to the high
concentration of the urea and other toxic materials in the blood and also leads to reduction in the
renal mass and nephrons.

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Risk factor of chronic renal failure in Melanie:
The discussion primarily focusses on the case study of Melanie, who has been diagnose
with chronic renal failure. By analyzing the case study of Melanie, certain risk factor have been
identified which might be responsible for the health condition of the patient (Webster et al.,
2017). By assessing the health condition of the Melanie it is observed that the blood pressure of
Melanie has been increased to 190/110 which is more than that of the normal blood pressure
(120/80). According to (Rossignol et al., 2015), high blood pressure is considered as one of the
major risk factor associated to cause renal failure. As in case of patient suffering from high blood
pressure, the flow of blood into the body increases and the kidney of the individual receive less
amount of blood which cause dysfunction into the body of the individual. Lowering blood flow
to the kidney sends signal of dehydration, which consequently reduces the absorptions of the
ions and the water into the body of the patient. As stated above the blood pressure of the patient
is high than the normal blood pressure, hence it can be considered as the risk factor for the renal
failure in case of Melanie.
Another risk factor detected in case of Melanie is the high concentration of serum urea
(17mmol/l) into the body, as it can increase the toxicity level of the blood. The GFR rate of the
patient is also low (10ml/min/1.73m2) in the case of patient, which hinders the effective
absorption of water into the patient and as a result it can lead to accumulation of the waste
material into the body in high concentration (Mula-Abed, Al Rasad & Al-Riyami, 2012).
Complications:
By assessing the physical well-being of the patient, it can be stated that the potassium
level in the blood of the patient has been increased to an extent level and the patient is suffering

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from hyperkalemia (Simon & Farrell, 2018). Due to the high potassium level in the blood the
patient is at the higher risk of getting paralyzed or can also experience muscle weakness and
complications related to cardiovascular. Apart from that the renal failure can also lead to the
other serious complications such as, heart disorder, anemia, bone disorder, gout, edema and fluid
retention (Abdel-Rahman, Turgut, Turkmen & Balogun, 2011).
Treatment:
Chronic kidney failure is an infectious disease and can give rise to other chronic disorder
or can even lead to death. Hence, it is important to provide appropriate treatment in order to
avoid any further complications (Thomas, Kanso & Sedor, 2008). By examining the signs and
symptoms of the renal failure in Melanie, it can be stated that the patient has high potassium
level, low GFR level, and high serum urea level, it can be stated the best treatment that can be
recommended to the patient is the renal replacement therapy (Musso & Macías-Núñez, 2019).
Apart from these, other self-management treatments such as having low fat diet, maintain
the weight, control blood pressure are also available which can prevent the further health
deterioration to some extent (www.niddk.nih.gov, 2019).
Contrasts between the chronic renal failure and the renal failure:
1. Renal failure develops in short time period, whereas in case of chronic renal failure, illness
takes much time to develop.
2. The hemoglobin level in case of Renal failure is normal whereas in case of chronic renal
failure, it is low.

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3. The size of the renal in case of chronic renal failure is reduced whereas; in case of renal failure
it is normal.
4. Renal osteodystrophy is absent in renal failure and present in chronic renal failure.
5. Serum creatinine concentration is reversible in case of renal failure whereas irreversible in
case of chronic renal failure.
6. Peripheral neuropathy is absent in case of renal failure and present in case of renal failure.
Renal replacement therapy:
It is done in the case of chronic renal failure to replace the non-endocrine function of the renal.
By assessing the signs and symptoms of the patient, it can be stated that the patient is suffering
from chronic renal failure and hence required renal replacement. In order to do that, the patient is
provided with hemodialysis, which helps in the purification of the blood and along with that also
helps in the removal of the waste material which is urea and creatinine from the body (as high
level of serum urea and serum craetinine has been observed in Melanie). In this case, the blood is
first passed through dialyzer through the two compartments and then is pumped through semi-
permeable membrane (Pecoits-Filho et al., 2016). As a result the concentration between the
electrolyte solution and the blood is maintained.
Part 2:
valsartan 80 mg: Valsartan 80 mg is an angiotensin receptor blocker, which is prescribed into
the individual suffering from high blood pressure. High blood pressure in the body is caused due
to the enhanced level of angiotensin hormone. The angiotensin receptor blocker reduces the
effect of the hormone and hence the blood comes under control (Crowley & Rudemiller, 2017).

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In the case of Melanie, the blood pressure of the patient is high (190/110), which can pose
negative impact on the kidney. Hence, Valsartan 80 mg is prescribed to reduce the blood
pressure.
Side effects:
1. Headache
2. Upper respiratory infections
3. Diarrhoea
4. Runny nose, sneezing
Nursing intervention:
1. The nurse should administer the recommended dose to the patient, as increased dose in
case of patient suffering from hyperkalemia.
2. The allergy history of the patient is assessed before.
3. Blood pressure is assessed after drug administration.
4. The medication is prescribed as recommended by the patient.
The GFR rate and the haemoglobin rate observed in Melanie is 10ml/min/1.73m2 and 95g/
respectively. It indicates that the GFR rate of the patient is low than the normal GFR rate which is
60ml/min. low GFR rate means the kidney is not able to function properly. The Hb level of
Melanie is also low as compared to the normal Hb level, which means that the patient is
suffering from anaemia (Ou et al., 2016).
Eprex 50 IU/kg: Eprex 50 IU/kg is commonly recommended in case of patient suffering from
chronic kidney failure to manage the hemoglobin level of the patient. Anemia is frequently

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observed in case of patient suffering from chronic kidney failure. Eprex 50 IU/kg increases the
red blood cells inside the body, thereby provide treatment for anemia (www.drugbank.ca, 2019).
The haemoglobin level of Melanie is 90g/l, which is low than that of the normal level, hence to
increase the haemoglobin level of Melanie Eprex 50 IU/kg has been prescribed.
Side effects:
1. Edema
2. Diarrhea
3. Blood clotting at the site of vascular access.
4. Headache
Nursing intervention:
1. The medication should not be administered with benzyl alcohol as it can lead to high blod
pressure.
2. Shaking of the solution is avoided as it can lead to denaturation.
3. Should not provide to patient who are allergic to medication made up of mammalian
cells.
4. Avoided if the patient is allergic to epoetin alfa.
Part 3:
Teach-back method is also termed as the show-me method which is commonly used in
the health care organization to ensure that the patient understands all the information provided to
them related to their treatment. If in method, the person is able to teach back all the information
accurately, the aim of the method is said to be achieved. This method aims to enhance the

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understanding of the patient related to their treatment in order to enhance the health outcome of
the patient. It can only be achieved if the communication between the health care providers and
the patient is effective (www.ahrq.gov, 2019).
In order to provide effective knowledge regarding the fluid intake in diet to Melanie, I
will first discuss about what is fluid intake and its effect into the body. I will explain to her about
the importance of maintaining the fluid intake in the diet. I will also explain to her about the
strategies that can be used to maintain the fluid into the body and will aware about the diets
which will help her in maintain the fluid intake (Popkin, D’Anci & Rosenberg, 2010). I will
explain her about the food which she needs to consume in morning, afternoon and night and will
also acknowledge her about the food which she should avoid. After conveying the knowledge, I
will ask her I explain everything whatever she understood from the communication. If Melanie
would be able to explain the process effectively, it will ensure that the patient has understood the
whole perspective of fluid management with the help of diet.

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