Course Content - #3. Renal Disease and Failure. AN OVERVIEW OF RENAL DISEASERenal disease is a serious health issue, affecting an ever- increasing number of patients and resulting in a financial cost in the United States of more than $3. It demands the involvement of many other healthcare personnel, including mental health professionals. Renal disease generally falls into one of two categories: chronic kidney disease (CKD) or acute kidney injury (AKI) . However, CKD should not be viewed in simple mathematic terms. It is an ongoing process of renal injury that causes compensatory hyperfiltration in less- affected glomeruli, which eventually leads to the destruction of those glomeruli as well . Nutrition Guideline For Professional Reference Only Renal Applicable to: Nurses, Physicians and other Health Professionals January 2013 Page 5.5.1.4. Left untreated, this ongoing destruction results in a steady decline in renal function, which eventually affects not just the renal system but almost every organ system in the body . AKI may be classified either by the physiologic cause (i. In the United States, 9. GFR) < 1. 5 m. L/min/1. 7. 3. m. Therefore, the terms ESRD and kidney.
Although ESRD is generally associated with a GFR. L/min/1. 7. 3 m. 2, it is more importantly an. Medicare ESRD program . In some. cases, ESRD is also used rather loosely to refer to patients who are experiencing. CKD and are expected to begin dialysis in a matter of days or weeks. Practice guidelines published by the National Kidney Foundation (NKF) define and classify CKD . The staging system is used to predict associated complications (Table 1), with an emphasis on predicting the development of cardiovascular disease, the leading cause of death in ESRD patients and the cause of dramatically increased mortality rates in patients with even moderate kidney disease. Identifying and staging patients with impaired renal function is important in order to prevent or slow the onset of CKD and its complications. CLASSIFICATION OF CHRONIC KIDNEY DISEASEStage. Description. 1Kidney damage with normal or elevated GFR (. Due. to the difficulty of measuring 2. Other indicators include. About Conference. ConferenceSeries Ltd invites all the participants from all over the world to attend Class Summary. Thiazide diuretics are used as monotherapy, or they can be administered adjunctively with other antihypertensive agents. Thiazide diuretics inhibit. Read the latest Cardiology news, opinion, conference coverage, thought leader perspectives, medical journal articles and more from theheart.org and Medscape. GFR is the best measure of kidney function. Normal adult GFR is 1. L/min/1. 7. 3. m. Definitions of CKD are. CKD increases with age. Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in. 130/80 mm Hg, with an optimal target of below 120/80 mm Hg, especially in patients with proteinuria or renal insufficiency.9,10 Learn about Capoten (Captopril) may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications. True determination of GFR is made by collecting urine for 2. Patient compliance with urine collection can prove quite difficult and 2. GFR (e. GFR), which determines GFR based on numerous biomarkers including serum creatinine. Learn about Diovan (Valsartan) may treat, uses, dosage, side effects, drug interactions, warnings, patient labeling, reviews, and related medications.Although exact statistics regarding the prevalence of mild- to- moderate renal failure are not available, the epidemiology of ESRD has been widely documented by the U. S. Renal Data System (USRDS), which collects statistics on all Medicare patients on dialysis. Since 1. 97. 4, Medicare coverage has been extended to virtually all patients on dialysis in the United States; therefore, these data are highly representative of the current dialysis population. According to the USRDS, the number of patients with ESRD in the United States was 6. The dialysis population increased to 4. New cases of ESRD with diabetes or hypertension listed as the primary. Other less common causes of ESRD include. Due to the prevalence of kidney. ESRD in the United States; however, these patients are reported within their original. New cases of diabetic ESRD are expectedly higher with increasing age in. Statistically, non- whites are four. The prevalence of ESRD per million remains much. African Americans than in other racial groups, at nearly 2 times higher than. Native Americans, 2. Asian Americans, and 4 times higher than whites. The cost of treating ESRD was $2. AKI in the Medicare population has reached an annual average of. AKI rates are significantly associated with aging and with black/African American race. The most common causes of AKI vary. The result is hyperfiltration in the surviving glomeruli (in an attempt by the body to increase GFR), which then causes ongoing glomerular stress, renal injury, and eventually glomerular destruction . This leads to a decrease in GFR and a continuance of the hyperperfusion destruction syndrome. Allowed to continue, the patient will inevitably develop ESRD and require dialysis or transplantation to avoid death from uremia. When treatment to reverse this process is initiated prior to the patient losing more than 4. After a patient has lost more than 5. The pathophysiology of AKI depends on the site of occurrence. Intrarenal or intrinsic. AKI, the result of damage to the renal parenchyma, may be a result of prolonged prerenal AKI. Postrenal. (obstructive) AKI results from physical obstruction of urine outflow and may be caused by. Unfortunately, contrast dye is nephrotoxic and exposes patients to the risk of AKI. It is estimated that cardiac catheterizations alone are responsible for 1. AKI annually . The overall incidence of contrast- induced nephropathy (CIN) is 5% to 3. Contrast dye nephropathy is the third. Risk factors include pre- existing renal disease (i. L or e. GFR less than 6. L/min/1. 7. 3 m. 2), age. CHF, and hypovolemia . Research indicates that furosemide and mannitol do not decrease the incidence of. CIN and in fact may increase the rate by dehydrating patients . Studies involving the prophylactic. N- acetylcysteine (NAC) have produced mixed results, possibly due. In one study, patients received NAC twice. To prevent one case of contrast- induced. NAC was 8. The traditional dose is. In a 2. 00. 4 study. L/kg for one hour prior to their procedure followed by 1 m. L/kg for 6 hours postprocedure. The study was ultimately halted early. Follow- up analysis showed that 8. CIN . Absolute data from the study showed that. A retrospective cohort study conducted. Mayo Clinic assessed the risk of CIN with the use of sodium bicarbonate, NAC, or a. Compared with no. CIN, while NAC. alone or in combination with sodium bicarbonate did not significantly affect the incidence of. CIN . As discussed, nephrogenic systemic fibrosis occurs almost exclusively in patients with advanced renal disease who receive gadolinium- based contrast dye. First identified in 1. California, this disease is systemic, can involve all major organs, and is potentially fatal. The exact mechanism by which gadolinium- based contrast causes nephrogenic systemic fibrosis is poorly understood. Patients can develop the disease at any time postexposure (including after several years), with most patients developing symptoms 2 to 8 weeks after exposure . Patients typically first present with distal extremity swelling followed by skin changes. While nephrogenic systemic fibrosis may not occur for years following exposure, after it develops patients may describe a progression of symptoms that occurs over days to months, with 5% of patients experiencing a rapid course . On clinical exam, the skin may appear . As gadolinium is frequently used in MRI or magnetic resonance angiogram (MRA) procedures, the patient may have a history of one of these procedures and having received an intravenous medication at the time of the study. Biopsy is necessary to confirm diagnosis. Treatment for nephrogenic systemic fibrosis is only symptom based, and there is no known cure. There is also no way of definitively preventing nephrogenic systemic fibrosis when administering gadolinium- based contrast medium to renal failure patients; postexposure dialysis does not appear to decrease the risk. Therefore, the FDA has issued several warnings regarding its administration to patients with renal disease . In 2. 01. 0, a . Most gadolinium- based products should not be used in patients with AKI or severe CKD, including gadopentetate dimeglumine (Magnevist), gadodiamide (Omniscan), and gadoversetamide (Opti. MARK). Clinicians should refer to manufacturers' instructions and FDA warnings prior to the use of gadolinium in all patients, especially those with known renal disease or patients with risk factors for acute and/or chronic kidney disease. PATIENT AND FAMILY EDUCATIONPatient education in renal failure is highly complex. CKD and ESRD require carefully coordinated care. Enrollment in diabetes classes (when appropriate), renal diet cooking classes, and support groups can be of tremendous benefit. By gradually introducing different educational materials and enabling the patient to help control the course of the disease, healthcare providers can help restore a sense of independence and confidence in the patient. It is crucial for healthcare professionals to realize that chronic illness is often a new and unanticipated event to the patient and family. Therefore, concrete information is vital. At the initial diagnosis, the family may be overwhelmed and struggling to come to terms with the illness. They may also be grappling to understand new medical jargon and trying to assimilate a tremendous amount of information in order to make decisions about medical care plans. At this juncture, enhancing communication between the primary physician or nephrology team and the patient/family is the primary goal . Technical information about the illness, prognosis, and care regimen should be conveyed. Healthcare professionals should be sensitive to the fact that this information may need to be relayed on several occasions. During this time, a list of resources and referrals may be helpful . Social isolation may occur. Therefore, it becomes a complicated issue to determine whether a particular behavioral change is the result of normal human development or illness- related. Technical information related to the daily care of the patient should also be relayed. Family members may have to be taught how to lift and move patients without hurting themselves or the patient and how to administer medications or dialysis . Family members should be reminded and educated about the physical consequences of the illness. Patients, for example, may experience fatigue as a result of the medications and/or the illness; however, some family members may become frustrated with the patient and interpret the patient as being lazy and taking advantage of the sick role .
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