Stage 5 Kidney Disease

Introduction

The prime purpose of the kidney is to filter excess water and waste from the blood as urine. This function is lost gradually when one is diagnosed with chronic kidney disease. The end-stage renal disease (ESRD) is the final stage of the chronic kidney disease, meaning that the kidneys will no longer function adequately to meet the daily needs of the body. The kidneys of individuals with ESRD function below ten percent of their average ability. For the kidney disease to reach the end stage, it takes ten twenty years after diagnoses depending on how well it is managed (Rahbari‐Oskoui & O'Neill, 2017). The progression of the chronic kidney disease is measured using the glomerular filtration rate (GFR). When GFR falls below fifteen, more than 90 percent of the kidney functions are gone, thus failing to work sufficiently to keep the person alive. The quality of life for patients with kidney disease continues to depreciate even with the advancing technology and science of medicine. The world continues to suffer significant mortality and morbidity despite improvements in the quality of dialysis (Wagner & Fink, 2017). The current statistics released by the American Society of Nephrology indicate that the mortality rate of those diagnosed with ESRD is at 8 percent per year with the leading cause of death being cardiovascular diseases at 22 percent and other infections at 45 percent.

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Etiology and Risk Factors

The chronic kidney disease lack signs or symptoms in its early stages, however, as it progresses to the final stage, some of the commonly seen signs and symptoms include vomiting, loss of appetite, nausea, sleep problems, muscle twitches, and cramps, sleep problems, swelling of feet and ankles and decreased mental sharpness (Ostermann & Joannidis, 2016). Others include persistent itching, high blood pressure, and shortness of breath. It is imperative to note that these signs are nonspecific meaning that other illnesses can cause them.

Causes of ESRD

Conditions and diseases that can lead to kidney failure include type 1 and two diabetes, hypertension, interstitial nephritis, glomerulonephritis, recurrent kidney infection, vesicoureteral, and prolonged obstruction of the urinary tract.

Risk Factors

Some factors increase the risk that chronic kidney disease will progress more quickly to end-stage renal disease. They include polycystic kidney disease, diabetes with poor blood sugar control, kidney disease that affects the glomeruli use of tobacco, male sex, older age, high blood pressure, kidney disease after transplant, and African American descent. In the developed countries, causes of ESRD are related to demographic characteristics including sex, age, and comorbidities such as hypertension and diabetes. Some studies show higher ESRD rates in rural compared to the urban areas with some contradicting this information (Massie et al., 2017). However, it has gained massive support in the research field that people from socio-economically disadvantaged areas are likely to reach ESRD faster compared to those from regions advantaged because of the treatment they receive before the final stage. It is rare to find young people suffer ESRD as a result of chronic kidney disease as opposed to the older people. As people approach old age, the body depreciates, and many organs have functional difficulties which accelerate kidney disease to ESRD (Kallenberg et al., 2016). After the age of 40, kidney filtrations begin to fall at a rate of 15 percent every year. In the United States alone, 0.7 million patients were treated for ESRD and gave a prevalence of 2,206 per million populations with a prevalence of functioning kidney transplant at 653 per million and dialysis treatment at 1,553 per million (Zoccali et al., 2017). The ratio of the male to the female as of December 31, 2016, stands at 1.01, as reported by the United States Renal Data system.

Pathological Processes

The prevalence of the chronic kidney disease is estimated to be 8-16 percent across the world. The rising levels of hypertension, aging population, increased cases of obesity and diabetes, the renal diseases pose a higher threat to the world’s population (Wagner & Fink, 2017). The infections of the kidney affect multiple cell types in the kidney, including tubular cells and endothelial. As the renal function declines, the end product of protein metabolism accumulates in the blood. Uremia develops and affects every system in the body adversely. According to the GFR chart, signs and symptoms become more severe as the buildup of waste products increase. The rate of decline in renal functions and progression of chronic failure relates directly to the underlying disorder, presence of hypertension, and urinary excretion of protein (Massie et al., 2017). In some patients, such as those who have elevated blood pressure and excrete significant amounts of protein, the disease progresses more rapidly.

Clinical Manifestations and Complications
Diagnostics

The first step towards a diagnosis of kidney disease includes a chat with a doctor on the lineage and genetic illnesses. Physical examinations are conducted as well, starting with the condition of the heart, blood vessels, and performs a neurological exam (Zoccali et al., 2017). Other tests and procedures for diagnosing kidney disease include blood tests which indicate the level of waste products such as urea and creatinine in the blood. Urine tests analyze the sample of urine, which reveals abnormalities pointing to chronic kidney failure and help to identify the cause of the illness (Kallenberg et al., 2016). Imaging tests such as ultrasound may be used to assess the kidney structure and size. More advanced analysis is removing a sample of kidney tissue for testing using local anesthesia and a long needle inserted through the skin to the kidney.

Complications

It is impossible to reverse kidney damage with the difficulties affecting almost every part of the body. These complications include fluid retention, which leads to swelling of the arms and legs, fluid in the lungs, and high blood pressure. Weak bones and increased risk of bone fractures, anemia, and blood vessel disease. Some patients experience a sudden rise in potassium levels in the blood, which could impair the heart’s ability to function correctly (Cavanaugh et al., 2016). The final complication is the irreversible damage of the kidneys, thus calling for dialysis or a kidney transplant.

Diagnostics

The standard laboratory and diagnostic tests for chronic kidney disease include the blood tests. The blood tests seek to reveal the Glomerular Filtration Rate, Serum Creatinine, and Blood Urea Nitrogen (BUN). A Creatinine level greater than 1.2 for women and 1.4 for men could be an early sign of kidney problems (Jin et al., 2016). The normal GFR ranges from 90 and above but varies according to age. Imaging tests include Ultrasound, and CT Scan and other imaging techniques such as X-Rays to check for the presence of obstruction. Imaging tests often help the doctor to look at the structure of the kidneys for any structural abnormalities. Kidney Biopsy is a rare test, but it should be done occasionally to identify a specific illness, evaluate the amount of damage caused to the kidney, and to find out the progress of a kidney transplant. Urine tests include urine protein test, urinalysis, microalbuminuria, and Creatinine Clearance test. Urinalysis helps to check for various types of urinary tract disorders, diabetes, bladder infections, kidney stones, and kidney problems (Rahbari‐Oskoui & O'Neill, 2017). The creatinine clearance test indicates how many waste products the kidneys can filter every minute.

References

1. Cavanaugh, P. K., Chen, A. F., Rasouli, M. R., Post, Z. D., Orozco, F. R., and Ong, A. C. (2016). Complications and mortality in chronic renal failure patients undergoing total joint arthroplasty: a comparison between dialysis and renal transplant patients. The Journal of arthroplasty, 31(2), 465-472.
2. Jin, H., Fang, W., Zhu, M., Yu, Z., Fang, Y., Yan, H., ... and Huang, J. (2016). Urgent-start peritoneal dialysis and hemodialysis in ESRD patients: complications and outcomes. PloS one, 11(11), e0166181.
3. Kallenberg, M. H., Kleinveld, H. A., Dekker, F. W., van Munster, B. C., Rabelink, T. J., van Buren, M., and Mooijaart, S. P. (2016). Functional and cognitive impairment, frailty, and adverse health outcomes in older patients reaching ESRD—a systematic review. Clinical Journal of the American Society of Nephrology, 11(9), 1624-1639.
4. Massie, A. B., Muzaale, A. D., Luo, X., Chow, E. K., Locke, J. E., Nguyen, A. Q., ... and Segev, D. L. (2017). Quantifying postdonation risk of ESRD in living kidney donors. Journal of the American Society of Nephrology, 28(9), 2749-2755.
5. Ostermann, M., and Joannidis, M. (2016). Acute kidney injury 2016: diagnosis and diagnostic workup. Critical Care, 20(1), 299.
6. Rahbari?Oskoui, F., and O'Neill, W. C. (2017, July). Diagnosis and management of acquired cystic kidney disease and renal tumors in ESRD patients. In Seminars in dialysis (Vol. 30, No. 4, pp. 373-379).
7. Wagner, L. A., and Fink, J. C. (2017, March). Ensuring patient safety during the transition to ESRD. In Seminars in nephrology (Vol. 37, No. 2, pp. 194-208). WB Saunders.
8. Zoccali, C., Moissl, U., Chazot, C., Mallamaci, F., Tripepi, G., Arkossy, O., ... and Stuard, S. (2017). Chronic fluid overload and mortality in ESRD. Journal of the American Society of Nephrology, 28(8), 2491-2497.

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