Pharmacology; Clinical review assignment: Renal failure
Renal failure is an increasing concern in Australia, with over 54 people dying every day from kidney related disease. The incidence of this pathology has been shown to be growing, with the number of people on dialysis rising by 4% from 2010 to 2011 (National Kidney Foundation, 2013). It is estimated that approximately 1.7 million Australians over the age of 25 show signs of renal failure, either chronic or acute. Indigenous Australians are also four times more likely to die from renal failure than non-indigenous Australians (Australian Bureau of Statistics, 2006). Signs of renal failure often show themselves in the form of reduced kidney function, proteinuria (protein in the urine) or haematuria (blood in the urine). Renal failure is a condition involving the failure of the kidneys, or more precisely the nephrons within the kidneys. The nephron is the functional unit of the kidney, with approximately 1.5 million working to filter blood of wastes and reabsorb water and electrolytes necessary to maintain homeostasis (U.S. Patent No. 5,092,886A, 1992). Renal failure occurs when the kidneys fail to filter blood adequately, it is often undetected until late stage failure has occurred. There are two main forms of renal failure; acute kidney disease and chronic kidney disease, both with underlying pathologies (U.S. National Library of Medicine, 2013). Treatment for renal failure involves either dialysis; filtering of the blood to remove metabolic wastes, or a kidney transplant, which is not a cure and requires permanent care and maintenance post-surgery. As of December 2012, 1080 people are waiting for a kidney transplant in Australia (Better Health Channel, 2013). It is important for paramedics to recognise and understand the underlying pathology behind renal failure as the condition results in a wide range of secondary effects & has many different presentations, with some as simple as headaches and “stomach pain”; pain in the kidney region, and more serious presentations such as metabolic acidosis (National Kidney Foundation, 2013).
All 1.5 million nephrons in the kidney are working constantly to filter blood. The kidneys receive approximately 25% of cardiac output via the afferent arteriole, into the bowman’s capsule which surrounds the glomerulus. The glomerulus is often described as a colander, as it is semi-permeable, only allowing certain things to pass through it. The kidneys main functions are to filter the blood, but they also have many other functions, such as regulating acid/base and fluid/electrolyte balances, reabsorbing water and electrolytes and excreting urine. “In addition, the kidneys excrete metabolic waste products, including urea, creatinine, and uric acid, as well as foreign chemicals” (DeRossi & Cohen, 2008). The kidneys also serve an endocrinological function, “secreting rennin, the active form of vitamin D, and erythropoietin. These hormones are important in maintaining blood pressure, calcium metabolism, and the synthesis of erythrocytes, respectively.” (DeRossi & Cohen, 2008). The progression of renal failure is often undetected, with renal function able to continue until 50% of the nephrons per kidney are destroyed. After nephrons are destroyed they never regenerate (Tilgner, n.d.). Compensatory buffer mechanisms exist in the body to counterbalance the effects of renal disease. As the kidneys are responsible for water and electrolyte balance, shifts in solute concentrations due to nephron destruction can be seen. Isosthenuria, which is excretion of urine that has not been concentrated by the kidneys and therefore has the same osmolality/gravity as plasma, is the first clinical sign of impaired renal function. Water along with sodium is flushed from the body resulting in dehydration & an electrolyte imbalance (DeRossi & Cohen, 2008). “In a healthy...
References: National Kidney Foundation. (2013). Facts on CKD in Australia. Retrieved from http://www.kidney.org.au/Kidneydisease/FastFactsonCKD/tabid/589/Default.aspx
Australian Bureau of Statistics
Dobos-Hardy, M. (1992). U.S Patent No. 5,092,886A. Boston, Massachusetts. Patent Buddy.
Better Health Channel. (2013). Kidney Failure. Retrieved from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Kidney_failure.
National Kidney Foundation
DeRossi, S. & Cohen, D. (2008). Renal disease. Burket’s oral medicine, 11(2), 407- 427.
Creatinine Levels and BUN. (2012). Retrieved from http://www.kidneyfailureweb.com/creatinine/
Blood in the urine (Hematuria)
Klatt, E., Georgia, S. (2013). Urinalysis. Retrieved from: http://library.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html
American Urological Association. (2005) Hematuria. Retrieved from www.urologyhealth.org/content/moreinfo/hematuria.pdf
National Institute of Health
National Institute of Health. (2010). Creatinine Clearance. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003611.htm
The Renal Association
Fry, A., Farrington, K. (2006). Management of acute renal failure. Postgraduate Medical Journal, 82(964), 106-116.
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