Chronic Renal Failure: Pathophysiology, Risk Factors, and Treatment

Running Head: CHRONIC RENAL FAILURE
CHRONIC RENAL FAILURE
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CHRONIC RENAL FAILURE
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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