2808NRS Assessment 2: Analysis of Chronic Kidney Disease Case Study

This nursing assignment analyzes a case study of a patient diagnosed with chronic kidney disease (CKD). The assignment begins by identifying the patient's risk factors, including diabetes, hypertension, and obesity, and explains how these factors contribute to the development of CKD. It then delves into the pathophysiology of CKD, detailing the mechanisms of metabolic acidosis, hyperkalemia, and the impact on kidney function. The clinical manifestations, such as fatigue, itchy skin, and pitting edema, are discussed in relation to the underlying pathophysiology. The assignment also justifies the diagnostic investigations, including blood tests, urine analysis, and imaging tests, and outlines evidence-based treatment modalities, such as diuretics, potassium-removing agents, and dialysis. References from current literature are provided to support the analysis. The assignment aims to demonstrate clinical reasoning skills and an understanding of CKD management.

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

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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

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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

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phosphorus in the blood can contribute to itching. Uremic frost is a type of crystalline uremic
crust that is formed in the body of patients, causing itching in those affected by chronic kidney
diseases (Belmar et al., 2016).
Steve McManus is associated with pitting oedema. Swelling of legs has been caused by
oedema. In chronic kidney diseases, extra fluid retention and sodium in the circulation can cause
oedema. Damage to the filtering blood vessels in the kidney can lead to nephrotic symptoms. In
nephrotic symptoms, the lowered level of proteins in the blood can lead to accumulation of body
fluid and oedema. A decreased glomerular rate might decrease he urine output, which can
increase the retention of sodium and water causing swelling of the body. Again, there are certain
diabetic medicines like thiazolidinediones can lead to formation of pitting oedema (Harris et al.,
2016). With the progression of uremia, the production of the erythropoietin hormone decreases,
causing anemia, which can be the cause of fatigue in Steve McManus.
JUSTIFICATION OF THE DIAGNOSTIC INVESTIGATION AND THE
TREATMENT MODALITIES
Hyperkalaemia and metabolic acidosis can be determined by testing the ABG and the
serum electrolytes. Analysis of the urine sample for revealing the abnormalities, imaging tests
for assessing the size and the structure of the kidney. In severe cases a kidney biopsy can be
used. A blood test will check the glomerular filtration rate of the blood or how well can the
kidney filter the blood (Dabelea et al., 2016). A urine test will be done for measuring the albumin
level. A healthy kidney will never let albumin to mass through urine. The less albumin in the
blood, better is the condition of the kidney.

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Intravenous therapies counteracts the effects of the high potassium levels, that it has on
the cell membrane and stabilises the electrical system of the heart, muscles and nerves ( Rocha
& Pecoits-Filho,2019). In case the kidney is severely damaged especially, when the potassium is
at the emergency levels. Haemodialysis is one of the preferred method of dialysis, which can be
done at the late stage of the disease (Gosmanov, Gosmanova & Dillard-Cannon, 2014).
Water pills like diuretics work by increasing the amount of potassium excreted by the
body. Some of the loop diuretics like Bumex, Edecrin or Lasix. Some of the potassium removing
agents work by binding potassium and exchanging it to the other minerals like sodium or
calcium (Kim, 2019).

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REFERENCES
Belmar Vega, L., Galabia, E. R., Bada da Silva, J., Bentanachs González, M., Fernández
Fresnedo, G., Piñera Haces, C., ... & de Francisco, Á. L. M. (2019). Epidemiology of
hyperkalemia in chronic kidney disease. Nefrología (English Edition). doi:
10.1016/j.nefro.2018.11.011
Dabelea, D., Rewers, A., Stafford, J. M., Standiford, D. A., Lawrence, J. M., Saydah, S., ... &
Pihoker, C. (2014). Trends in the prevalence of ketoacidosis at diabetes diagnosis: the
SEARCH for diabetes in youth study. Pediatrics, 133(4), e938-e945.
DeMarco, V. G., Aroor, A. R., & Sowers, J. R. (2014). The pathophysiology of hypertension in
patients with obesity. Nature Reviews Endocrinology, 10(6), 364.Retrieved from:
https://www.nature.com/articles/nrendo.2014.44
Gosmanov, A. R., Gosmanova, E. O., & Dillard-Cannon, E. (2014). Management of adult
diabetic ketoacidosis. Diabetes, metabolic syndrome and obesity: targets and therapy, 7,
255.
Hall, M. E., do Carmo, J. M., da Silva, A. A., Juncos, L. A., Wang, Z., & Hall, J. E. (2014).
Obesity, hypertension, and chronic kidney disease. International journal of nephrology
and renovascular disease, 7, 75. doi: 10.2147/IJNRD.S39739
Harris, A. N., Grimm, P. R., Lee, H. W., Delpire, E., Fang, L., Verlander, J. W., ... & Weiner, I.
D. (2018). Mechanism of hyperkalemia-induced metabolic acidosis. Journal of the

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American Society of Nephrology, 29(5), 1411-1425. DOI:
https://doi.org/10.1681/ASN.2017111163
Hu, J., Wang, Y., Geng, X., Chen, R., Xu, X., Zhang, X., … Ding, X. (2017). Metabolic acidosis
as a risk factor for the development of acute kidney injury and hospital mortality.
Experimental and therapeutic medicine, 13(5), 2362–2374. doi:10.3892/etm.2017.4292
Judd, E., & Calhoun, D. A. (2015). Management of hypertension in CKD: beyond the guidelines.
Advances in chronic kidney disease, 22(2), 116–122. doi:10.1053/j.ackd.2014.12.001
Kazancioğlu R. (2013). Risk factors for chronic kidney disease: an update. Kidney international
supplements, 3(4), 368–371. doi:10.1038/kisup.2013.79
Kim, G. H. (2019). Pharmacologic Treatment of Chronic Hyperkalemia in Patients with Chronic
Kidney Disease. Electrolytes & Blood Pressure, 17(1), 1-6.
https://doi.org/10.5049/EBP.2019.17.1.1
Kovesdy, C. P., Furth, S. L., Zoccali, C., & World Kidney Day Steering Committee (2017).
Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Canadian journal
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Lakkis, J. I., & Weir, M. R. (2018). Hyperkalemia in the Hypertensive Patient. Current
cardiology reports, 20(2), 12.
Lopes, M. B., Rocha, P. N., & Pecoits-Filho, R. (2019). Updates on medical management of
hyperkalemia. Current opinion in nephrology and hypertension, 28(5), 417-423. doi:
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