Comprehensive Report on Renal Failure: Anatomy, Treatment, and Drugs

This report provides a comprehensive overview of renal failure, beginning with an exploration of renal anatomy and physiology, including the kidneys, ureters, bladder, and urethra, and their functions in urine production and waste elimination. It delves into the pathophysiology of renal failure, differentiating between acute and chronic conditions, and detailing the initiating and progressive mechanisms of kidney damage. The report discusses risk factors such as diabetes and hypertension, and outlines treatment strategies including medication and dialysis. Specific drugs like Valsartan and Eprex are examined, including their mechanisms of action, side effects, and nursing considerations. The importance of tests such as Glomerular Filtration Rate (GFR) and hemoglobin tests is highlighted. Finally, the report explains the teach-back method for patient education, focusing on fluid intake restrictions. The report is contributed by a student to be published on the website Desklib. Desklib is a platform which provides all the necessary AI based study tools for students.

Student’s name;
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Part 1
1.1 Renal anatomy and physiology
The renal system is an organ composed of the kidneys, ureters, bladder and urethra for the
production, passage, storage and voiding of urine (Hansen, 2017). The primary function of the
renal is the elimination
Renal has two kidneys which coordinate the electrolyte composition of blood and eliminate
waste products that are dissolved and excess amounts of other substances from the blood
(Beierwaltes et al., 2013). The waste products and excess amounts of other materials from blood
are excreted in urine which passes from kidneys to the bladder by two thin muscular tubes,
ureters. The bladder holds the urine until elimination through the urethra takes place.
The kidneys
The kidneys are bean-shaped, reddish-brown paired organs, convex on one side and concave on
one long side (Mohamed, 2014). The kidneys have a high location in the abdominal cavity. They
are located against its wall lying on each side of the vertebral column. Moreover, between the
levels of the 12th thoracic and third lumbar vertebrae and outside the peritoneum, the membranes
that line the abdomen. The kidney's and the body's long axes are in alignment. However, the
kidney's upper end is tilted slightly inward toward the backbone. Hilus is found in the middle of
the medial concave border is a deep vertical cleft, the hilus which leads to a cavity, the renal
sinus. Renal arteries and veins, lymphatic vessels and nerves enter and exit through the kidney
hilus (Moinuddin, & Dhanda, 2015).
1.2 Pathophysiology
The Gastrointestinal tract absorbs nutrients into the bloodstream and waste materials from
metabolism is deposited back in the bloodstream (Hansen, 2017); the blood is purified by the
kidneys and what is not necessary to the body that is the toxins and water. This waste is filtered
in the form of urine to be excreted. When kidneys are damaged these wastes are retained in the
bloodstream, this causes chronic renal failure. This condition has two sets of mechanisms of
damage

1) Initiating mechanisms which are specific to the underlying etiology, e.g. immunology diseases
and inflammatory mediators in conditions like glomerulonephritis or when renal tubules are
exposed to toxins
2) Progressive mechanisms which include hyperfiltration and hypertrophy of the remaining
healthy nephrons that are a common effect of long-term reduction of renal mass (Helal et al.
2012)
Chronic renal failure is a long-standing, deterioration of renal function that progresses with time
(Webster et al., 2012). Symptoms develop slowly and in advanced stages include; anorexia,
nausea, vomiting, stomatitis, fatigue, muscle twitches and cramps, water retention and seizures
Chronic renal failure is a diminished renal reserve or renal insufficiency, which may progress to
renal failure, as renal failure loses function, there are few noticeable abnormalities because the
remaining tissue increases its performance (Levey, & Coresh, 2012).
Declining renal function leads to interference with the kidneys' ability in maintaining fluid and
electrolyte balance in the body. There is an early declination of the kidney's ability to concentrate
urine. The decline is followed by a decrease in the ability to excrete excess phosphate, acid and
potassium.when renal failure is advanced, the ability to effectively dilute or concentrate urine is
lost thus urine osmolality is usually fixed, and urinary volume does not respond readily to
variations in water intake.
Risk factors
Diabetes
High blood pressure
Cardiovascular disease
Smoking
Obesity
Being African-American, Native Americans or Asian-Americans

Family history of kidney disease
Abnormal kidney structure
Treatment
Controlling underlying disorders-controlling hyperglycemia in patients with diabetic
nephropathy and managing hypertension in all patients
Nutrition-possible restrictions of dietary protein, phosphate and potassium.patients should take a
multivitamin containing water-soluble vitamins .administratration of vitamin A, and E is
unnecessary. vitamins D2 or D3 are not given routinely but are used based on blood levels of
vitamin D 25-OH and PTH
Treatment of contributing comorbidities, e.g. heart failure, diabetes mellitus, nephrolithiasis,
prostatic hypertrophy
Doses of all drugs as needed
Dialysis for severely decreased GFR if symptoms and signs are not managed by medical
interventions adequately.
Maintaining a sodium bicarbonate level at 23 mmol/L
Complications
The gout-kidney disease can lead to gout; however, gout may also lead to kidney disease due to
filtration of uric acid through the kidneys
Anemia; improper kidney functioning may lead to reduced red blood cell count. Reduced blood
cell count can proceed to become anaemia.
Bone disease and high phosphorus-healthy kidneys help keep the bones healthy
Heart disease-It can cause kidney disease. When kidneys are not working well, they cannot
support the other parts of your body as they should leading to heart failure
Hyperkalemia-healthy kidneys filter extra potassium from the blood. If you have a chronic renal
failure, you need to limit your potassium because the kidneys may not be able to filter potassium.

Fluid build-up-healthy kidneys take out extra fluid from the blood. When the kidneys are
working a
bnormally, they cannot take out enough fluid.this can cause the excess fluid in your blood to
build up in your body
1:3 Differences
Acute renal failure occurs suddenly and is often reversibly. it can be caused by an accident,
wound, disease, infection, shock, or ingestion of a poison or a drug
Chronic renal failure develops over a long time and generally not reversibly. Once the disease
has progressed, and kidney function is down dialysis.
Acute renal failure comes on quickly and is often curable while chronic renal failure comes on
slowly and generally leads to long term dialysis
1:4 Renal replacement therapy (hemodialysis)
Hemodialysis is merely using an artificial kidney to filter waste products. Such as creatinine and
urea and excess water from the blood. During this procedure, the patient's blood and dialysis
solution flow in different directions through a dialyzer across a semipermeable membrane
(Daugirdas et al. 2001). The dialyzer is made of thousands of tiny synthetic hollow fibres;
dialysis solution circulates the outside of the tissues. The concentration of solutes like
potassium, urea and creatinine is high in Melanie's blood and low in dialysis solution. The
dialysate has electrolytes and water, which is in balance mix with that of blood plasma. On the
other side, the patient's blood with metabolic waste products, excess water and electrolytes flow
into the dialysate through diffusion due to difference in concentrations. The dialysate solution
carries the waste products away, and the cleansed blood is returned into the patient's body
through another tube. A constant replacement of dialysate ensures that the concentration of
unwanted solutes is kept low. It takes 4 hours, and Melanie should come three times a week for
good results. Melanie will use high flux dialyzer for better removal of water products that is
potassium which is 5.7mmol, urea of 17mmol and creatinine of 90ummol.
Part 2
2:1 Drug used by Melanie

Valsartan
Melanie has hypertension due to high blood pressure of 190/110mmHg. Valsartan is a
nonpeptide drug taken orally. It's an angiotensin receptor antagonist on AT 1 receptor subtype.
Angiotensin II causes vasoconstriction and stimulates the release of aldosterone. Aldosterone
stimulates cardiac muscles and absorption of sodium in the kidney. Valsartan antagonizes the
effects of vasoconstriction and secretion of aldosterone. Valsartan does this by blocking the
binding of angiotensin II to the receptor in smooth muscles and adrenal glands. An oral dose of
80mg acts at about 80 per cent for 24hours. It does this by removing the negative feedback of
angiotensin II causing an increase in angiotensin II and remind in plasma
Side effects
Hypotension
Reduced blood pressure below the normal range due to the antagonistic effect of the drug
Impaired hepatic function. This causes symptoms like headache, light-headedness and dizziness.
Elimination of valsartan occurs in the bike, so the patient using this drug are at high risk of bile
function impairment
Renal function impairment
As an effect of antagonizing angiotensin II, it changes the renal function causing oliguria,
azotemia or renal failure.
Nurse's considerations
In case of hypotension; the nurse should position the patient in supine and also administer
normal saline as he/ she monitors the blood pressure
In case of symptoms of renal function, the dosage can be reduced or discontinued
Labworks to be done weekly to check urea, creatinine and electrolytes level
Monitor the daily patient weight and assess the signs of fluid overload include edema and
angioedema, dyspnea.
Eprex

Melanie is on dialysis and also has chronic renal failure, which means the function of the kidney
to release erythropoietin is impaired. Eprex is a synthetic recombinant human erythropoietin
present in the form of solution for injection, either subcutaneously or intravenously (Jelkmann,
2013). It's a protein hormone produced by the kidney during the hypoxic state, and it regulates
the release of red blood cells. It's also involved in the development of erythroid. This erythroid
has a vital effect on the level of transmitting a signal that prevents apoptosis and stimulates
erythroid cell proliferation. Erythropoietin stimulates the process of erythropoiesis in a patient
with a low hemoglobin level in chronic renal failure because the erythropoietin production is
damaged (Mercadal et al., 2012).
Side effects
Allergic reaction on the injection site
High blood pressure in patients with long term kidney failure due to an increased number of red
blood cells rapidly within the three months
Headache
Nurse's considerations
Monitor the blood pressure 4 hourly and do lab investigations that are reticulocytes count
electrolytes if blood pressure is high discontinue the drug
Rule out other causes of anaemia and administer iron supplements where appropriate
Reassure the patient if there is an allergic reaction on the injection site
2.2: Importance of the tests
Glomerular filtration rate
It's the flow of plasma from the glomerulus into Bowman's capsule over a specific time. Usually,
the kidney receives a quarter of cardiac output. The blood enters glomeruli through afferent
arteriole and comes out via efferent arteriole. The normal glomerular filtration rate is 120ml per
min (Inker et al., 2012). It's the best way to measure the kidney function and determine the stage
of the kidney disease. For Melanie, it's 10ml/min showing stage 5 of kidney failure, which
requires dialysis with high flux dialyzer.

Hemoglobin test
Hemoglobin is a protein in erythrocytes that have oxygen in it. It transports oxygen from the
lungs to other parts of the body. It found in red blood cells. The hemoglobin test measures the
level of hemoglobin in the bloodstream. It's often used to confirm anaemia presence. According
to Silverberg et al. (2014), most patients with chronic renal failure like Melanie have lost one of
the kidney functions. And it is producing erythropoietin which triggers the bone marrow to
produce Red blood cell to carry oxygen throughout the body. Also, these patients are on dialysis
and are at risk of losing iron, vitamin B 12 and folic acid. A hemoglobin test is essential to
Melanie.
Part 3
Teach back method
It's is an exchange of conversation method used by health care professionals to confirm whether
the patient or the caretaker comprehends what is being explained to them. If they understand,
they will have the ability to tach back the information received. Those who use the method is any
health care professional; nurse, or a doctor. What happens is the patient should give return about
their diagnosis, treatment plan information, medications, risks and benefits. They should be
asked early in their care process because many patients have problems in understanding medical
information (Hunink et al. 2014). When a patient is asked to teach back, he or she should have
the ability to describe the information they were given.
Teach back method on fluid intake
Restriction of fluid intake to reduce the risk of fluid overload due to the impaired function of the
kidney of the removal of excess water. Also, take sips of water to minimize dehydration and
formation of stones in the kidney.
Avoid fluids with potassium and acids like coffee and take plenty of milk to replace the lost
calcium
Take orange juice and Ribena for energy replenishment.

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