Posted: November 20th, 2023

PATHOPHYSIOLOGY IN PEOPLE WITH CHRONIC RENAL FAILURE

Discuss the Pathophysiology basis of electrolyte and acid base alterations in people with chronic renal failure

Most individuals produce about 15,000 mmol of carbon dioxide (CO2) and 50-100 meq of nonvolatile acid daily. Acid-base balance remains maintained by standard removal of CO2 by the lungs and normal nonvolatile acid excretion by the kidneys. Acid-base balance is usually maintained by the kidney excretion of the everyday acid load (about one meq/kg daily, derived typically from the sulfuric acid generation during the metabolism of amino acids with sulfur.  However, the removal of this acid load is attained by the urinary hydrogen ions excretion, both as titratable acidity as well as ammonium. Near-normal equilibrium can be maintained even in case the acid load is self-effacingly raised since net acid excretion increases appropriately, mainly through increased production ammonium and its excretion (Levey & Coresh, 2012).

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The renal maintain body homeostasis by avoiding major alterations concerning the fluid electrolyte balance or acid-base balance until the GFR (Glomerular filtration rates) goes to below 25 ml per min because of an adaptive changes sequence, both Renal as well as extrarenal. However, with progressive reduction in the function, these mechanisms are overcome leading to disturbances in the metabolism of water contributing to hypernatremia and hyponatremia. The altered sodium transport regulation leads to the disturbed status of fluid volume including volume depletion and overload. This incidence of metabolic acidosis and Hyperkalemia is what is seen in CKD (Chronic Kidney Disease) with GFR less than 10 milliliters per minute (Levey & Coresh, 2012).

 Differentiate between respiratory acid-base alterations

According to Levey and Coresh (2012), acidosis and alkalosis are medical terms, which are used to explain the pH, or acid and base balance, of the blood. Acidosis occurs when the height of acidic factors in the blood is very high. On the other hand, when the quantity of bases in the blood increases, alkalosis takes place. Ideally, alkalosis and acidosis are categorized into metabolic or respiratory concerning the physiologic process, which forms the abnormality. Respiratory acid is where CO2 represent a potential of creating an equal quantity of carbonic acid. Respiratory acid-base alterations are where the response of the body to a change in acid-base condition: Buffering; arterial pCO2alteration; and HCO3- excretion change (Levey & Coresh, 2012).

Clinical manifestations and treatments

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The early disease symptoms are very similar as for many other diseases. Symptoms include but not limited to appetite loss; general malaise and fatigue; headaches; pruritus (Itching) and dry skin; nausea; weight loss; abnormally darkening or lighting of skin; and bone pain. Other symptoms include drowsiness; swelling or numbness in the limbs; muscle cramps or twitching; excessive thirst; frequent hiccups; dyspnea; and sleep problems (Levey & Coresh, 2012).

The control of hypertension will worsen the situation. ACE (Angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) are the drugs to be administered to keep bp at or below normal. Lifestyle changes, for instance, quitting smoking is also important. Other intervention includes low in cholesterol and fat foods; regular exercise; medication to lower cholesterol levels; blood sugar control; and low salt or potassium diet. Phosphate binders may be prescribed to prevent high levels of phosphorous. Calcium and Iron rich-foods are also important (Levey & Coresh, 2012).

Reference

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Levey, A. S., & Coresh, J. (2012). Chronic kidney disease. The Lancet, 379(9811), 165-180.

 

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