Glendas Chronic Kidney Failure Diagnosis and Treatment Options - Essay Example

Title: Glenda’s Chronic Kidney Failure Diagnosis and Treatment Options Name: Registration No: Course Code: Institution: Date of Submission: TABLE OF CONTENTS TABLE OF CONTENTS 2 1.Introduction 3 2.Discussion 3 2.1.Relationship between Glenda’s symptom and the above data 3 2.2.Diagnostic results that explain why Glenda has developed each of the clinical manifestations 4 2.3.Further investigations and assessments based on the findings 4 2.4.Contributing factors to Glenda’s kidney failure 5 2.5.Incidence, prevalence and causes of kidney renal failure in Australia 5 2.6.Treatment options to end stage renal failure and their implications 7 2.7.Difference between implied consent and compliance and their relationship to Glenda’s case 8 2.8.Legal and ethical considerations for withdrawing Glenda’s treatment 9 3.Conclusion 9 References 11 1. Introduction It has been observed that kidney failure is a condition that has affected people in various parts of the world. An example of a place where kidney failure has greatly affected the population is Australia where the aboriginal groups of people have experienced a number of kidney problems (Aparicio, Chauveau, & Combe, 2001). Consequently, diagnosis for kidney failure is a practice that is considered important in the care for patients who suffer from complications of kidney diseases. It involves studying the symptoms demonstrated by the patient, followed by conducting a number of tests to determine the possibility of the patient being affected by kidney failure. It some of the tests that need to be performed include determining whether the concentration of urine is that or a normal person or the heart beat is normal Di (Cerbo, Pezzuto, Palmieri & Palmieri, 2012). When a clinician has identified the symptoms and conducted the tests, it is required that a clinician must determine the technique of treatment of kidney failure so that the patients kidney can function effectively and the patient can live normally. This paper presents an analysis of methods of determining symptoms for kidney infections, measurement strategies for characteristics of kidney failure as well as treatment strategies. It also provides the status of kidney failure in Australia by investigating the prevalence, incidences and causes of kidney failure among aboriginal groups of people in Australia. 2. Discussion 2.1. Relationship between Glenda’s symptom and the above data It can be explained that creatinine clearance rate of 8.5 ml/min is lower than the normal rate of 125 ml/min. thus; there is a high concentration of creatinine in Glenda’s blood which can be a contributing factor to high toxicity of her blood which could be the contributing factor to conditions such as feeling of fatigue, difficulties in breathing and confusion as well as other conditions such as feeling of nausea. The laboratory results also showed that creatinine level was 1132/umol/L which is higher than the normal value of 0.5 to 1.1 milligrams per deciliter (Elliott & Brown, 2007). As a result of high amount of creatinine in her blood, toxicity was increased which resulted into conditions such as nausea, anorexia and feeling of itches in the face. The value of the blood PH was 6.1 which are slightly lower than the normal blood PH of 7.4. Thus, there was a high acidity of blood which resulted into conditions such as itching, feeling nausea and anorexia. The value of po4 was 5.4 which are higher than the normal value of 2.4 to 4.1 mg/dL. This can be a contributing factor to toxicity of blood which resulted into itching of the body. The anion gap is 20 which are higher than the normal value of 12. This shows that there was an increase in acidosis condition in the blood which resulted into the feeling of itches in the skin and nausea (Janicic, 2003). 2.2. Diagnostic results that explain why Glenda has developed each of the clinical manifestations Diagnostic results that explain the above conditions experienced by Glenda is that as a result of the inability of the kidney to filter wastes such as creatinine, urea and sodium in blood, there is a high concentration of these waste materials in blood. This results into inability of the body to get clean blood to perform its metabolic functions. As a result, the affected person feels nausea, fatigue, anorexia and itches in the skin (Jörres, Ronco & Kellum, 2010). This is contributed by toxicity resulting from increased amount of waste materials in blood. Excess calcium has also been found to contribute to the destruction of distal tubules which facilitate filtering processes in kidneys. This results into inability of the kidney to filter blood well and the result is an increase in amount of wastes in blood. 2.3. Further investigations and assessments based on the findings The main investigations that will enable understanding of the above clinical manifestations will include an analysis of urine sample. This is where a sample of urine will be tested for abnormalities (McMahon et al. 2012). The doctor may perform urinary sediment examination, which involves measuring the quantity of red and white blood cells, determining high quantities of bacteria and determining the number of cellular casts. Another examination will involve measuring urine output so that a diagnosis of kidney failure can be determined. When there is a low urinary output, it would be assumed that there is a urinary blockage, which can be contributed by a series of illnesses or injuries (Monteiro et al. 2013). In addition sampling of blood should be done by taking blood from the patient’s kidney such as urea and creatinine. When there is a rise in levels of urea and creatinine in the sample, it may be an indication of a kidney failure. In addition, the method of imaging can be used to diagnose kidneys for failure (Morris, Na & Johnson, 2008). This can be achieved by conducting analyses such as ultrasounds, MRIs, magnetic scanning, computerized tomography visual observation of the kidneys so that the doctor can look for blockages and determine whether there are any abnormalities. Another method of examination can involve obtaining kidney tissue sample and examining whether there are deposits, scarring or infections. In order to take a sample, kidney biopsy technique is used (Mycyk, 2003). 2.4. Contributing factors to Glenda’s kidney failure The main factors that may contribute to Glenda’s kidney failure include: loss of blood flow to the kidneys. There may be other diseases that may affect the flow of blood to the kidneys search as heart attacks, diseases of the heart, liver cirrhosis, high levels of dehydration, severe burns, high cholesterol levels, reactions from allergic conditions and infections (Newman, Fleisher & Fink, 2007). In addition, other conditions that may result into kidney diseases include high blood pressure and inflammatory medications which have an impact on blood flow. Other conditions that could lead to kidney failures include blood clots in various sections of the kidneys, infections, increased amount of toxins in blood, increased use of alcohol, inflammation of blood vessels and inflammation of blood vessels that transport blood to the kidneys (Peixoto, 2003). Other possible causes can include; cancer of the plasma cells in the bone marrow, hemolytic uremic syndrome and dyes used in a number of imaging tests. 2.5. Incidence, prevalence and causes of kidney renal failure in Australia The main contributing factors to kidney renal failure include diabetes, glomerulonephritis which results into inflammation of the glomeruli and hypertension (Thorpe & Walser, 2013). The main complications that result from impairment of kidney function include mineral and bone disorders, anorexia, uremia, acidosis, restless legs, anaemia and depression. A survey conducted in Australia showed that 2544 were involved in kidney replacement therapy in 2013, 21% of the people who were involved in kidney replacement therapy were referred to a nephrologist and late referrals were observed among people of Pacific islanders origin who composed 29%, Indigenous Australians who comprised 28% and those of Maori origin who comprised 26% (Vaziri, Yuan & Norris, 2013). It was also found that 11774 people were being provided with dialysis treatment by the end of 2013, where 29% received the dialysis at home and the remaining received dialysis in health institutions. Kidney transplant operations show that 905 operations were performed in 2014 and 1160 were waiting to be subjected to kidney transplant process. Studies by Australian Bureau of Statistics also show that 56 people die every day as a result of kidney related illnesses and the number of deaths as a result of kidney-related illnesses has increased by 17% since 2002 (Whittier, 2004).The main contributing factors to kidney diseases among Indigenous Australians are complex. They are illustrations of a combination of historical, social, economic and biomedical risk conditions. The significance of historical, psychological and economic conditions has been established. The present health disadvantages experienced by Indigenous people can be associated with social disadvantages and should be considered in the historical context. A kidney failure among Indigenous Australians has mainly been affected by changes in active roles as a result of displacement of people and colonization by European settlers (Uribarri et al. 2003). Due to a reduction in activity levels of the Indigenous people as well as a reduction in nutrition levels due to displacement by the Europeans, social status of Indigenous Australians has been greatly affected. This has contributed towards kidney disease development as well as the development of other chronic conditions such as diabetes with the greater impact experienced in the 20th century (Aparicio, Chauveau & Combe, 2001). It has also been established that the Indigenous Australians have been subjected to inadequate economic and social conditions which result into a poor health status of a number of people and results into a high rate of kidney and urinary tract failures among most Indigenous Australians. Other conditions that have been associated with increased incidences of kidney failure among Indigenous Australians include substandard living conditions, poor sanitation in the environment and poverty (Di Cerbo, Pezzuto, Palmieri & Palmieri, 2012). In order to prevent, control and manage kidney diseases among indigenous Australians, it will be required that preventive actions aimed at addressing poor socioeconomic conditions are taken. The main biomedical factors that have been associated with kidney diseases among Indigenous Australians include a number of risk factors such as repeated infections, hypertension, obesity, low birth weight and increased use of alcohol and tobacco (Elliott & Brown, 2007). Since a large number of Indigenous Australians suffer from these conditions, there is high risk of kidney diseases among them especially women. 2.6. Treatment options to end stage renal failure and their implications An example of a treatment option for a renal failure is peritoneal dialysis. This is where a surgical operation is performed by placing a soft, hollow tube in the lower section of the abdomen closer to the navel. When the tube has been placed, a solution called dialysate is instilled in the peritoneal tube. The peritoneal cavity is the section of the abdomen that contains organs and it is composed of two special layers referred to as peritoneum (Goraya, Simoni, Jo & Wesson, 2013). After the dialysate is injected into the abdomen, it is left for a particular period of time based on the decision of the doctor. Waste products and toxins are absorbed by the dialysate through the peritoneum. This is followed by draining the fluid from the abdomen, measuring and discarding the fluid. The main types of peritoneal dialysis used include continuous cyclic peritoneal dialysis (CCPD), continuous ambulatory peritoneal dialysis (CAPD) and intermittent peritoneal dialysis (IPD) (Janicic, 2003). The main implications of this form of dialysis is that the person may have special protein or salt requirements, the intake of potassium may be restricted and calorie intake may also need to be reduced since there may be weight gain as a result of sugar that exists in the dialysate. Another option for end stage renal failure is hemodialysis. This is where a special type of access referred to as arteriovenous fistula (AV) is inserted surgically in the arm of a person. The artery and the vein are joined together. There may be an insertion of an external, central intravenous (IV) catheter but it is not frequently used for long-term dialysis (Jörres, Ronco & Kellum, 2010). When access has been established, the body of the patient is connected to a large hemodialysis machine that serves the function of removing wastes and fluids and the returns the fluid to the blood stream. This is a process that takes place several times in a week and takes duration of four to five hours. Due to the duration of time taken in the hemodialysis process, it is recommended that a person should find something to do such as reading a book while the process is continuing. During the treatment process, a person can watch television, read a newspaper or talk (McMahon et al. 2012). It is recommended that when hemodialysis is done at home, it should involve another person such as a partner. The main complications of this form of hemodialysis may include muscle cramps and a drop in blood pressure. Consequently, the affected person may feel weak or sick in the stomach. In order to avoid side effects, it is recommended that the patient should follow a proper diet as well as take the right medications according to the doctor’s prescriptions. Another treatment option is kidney transplant. This is where the body of a sick person is operated to replace the infected kidney (Monteiro et al. 2013). The sick person may be referred to a transplant center. There evaluation will be done by the transplant team and the patient will be examined to ascertain the need for the transplant process. After the transplant, a person may be required to adhere to the right diet that is low in proteins and contains little fluid, adequate amounts of salt, potassium and phosphorus. Other treatment options for a person with end stage renal failure is extra calcium and vitamin D, medicine called phosphate binders that assist in prevention of the amounts of phosphorus from becoming too high and provision of extra diet rich in iron, iron pills or shots and blood transfusion. 2.7. Difference between implied consent and compliance and their relationship to Glenda’s case Implied consent is a situation where the behavior of the patient demonstrates the willingness of the patient to participate on a treatment process as well as cooperate with the doctor during the process of provision of the medical attention. It is demonstrated by the willingness of the patient to disclose information that would enable treatment of an illness such as the symptoms among clinical professionals. In the case of Glenda, it implies the willingness to allow health professionals at the health center to provide her with the medication without being forced to do so. Compliance, on the other hand involves obeying the decisions made by the health professional without necessarily being involved in the decision making process. It also involves following the instructions of the doctor despite having the feeling that they are not right for the patient. In the case of Glenda’s condition, compliance will involve ensuring she takes the medication as prescribed by the doctor and she will also make appointments with the physician whether she is willing or not so that her condition can be managed. While outright compliance should not be forced on Glenda, if she assents to being treated by the medical practitioners in this case, she will have to comply to subsequent treatment requirements such as appointments with the clinicians and taking the drugs according to prescriptions. 2.8. Legal and ethical considerations for withdrawing Glenda’s treatment Ethical and legal considerations in medical practice require that the physician has the responsibility to provide care to patients in accordance with their prerogative decision to enter into a treatment relationship with the patient (Morris, Na & Johnson, 2008). A physician is also required to respond to the best of his or her ability in cases where there is the need for a medical emergency. Failure to do so, a legal action can be taken against the clinician for neglect of duty. The act of withdrawing from provision of care to Glenda’s illness without providing a reasonable explanation amounts to violation of this ethical opinion and the clinician is subject to prosecution. Another ethical requirement is that a physician should not refuse to care for a patient on the basis of race, gender, sexual orientation or any behavior which is a demonstration of discrimination. It is also stated that a physician must observe human rights while providing medical care to a patient by observing law that dictate the manner in which medical practice should be performed (Mycyk, 2003). If the clinician in this case refuses to provide care to Glenda on the basis of the above conditions, such a clinician is subject to prosecution. However, it is ethically permissible for a physician to decline providing treatment to a patient when the treatment request is beyond the capability of the clinician. Consequently, the clinician in this case has a right to decline to treat Glenda if the condition of the patient is beyond his ability. 3. Conclusion This study focuses mainly on diagnosis strategies that need to be followed when determining the occurrence of kidney failure in a person. This is achieved by use of a case study in which Glenda is diagnosed with kidney failure and various processes are followed in order to treat her condition. It also explains treatment strategies that can be used to treat a patient who has been diagnosed with kidney failure. These include the options of hemodialysis, peritoneal dialysis and kidney transplant. It is recommended that clinicians must possess the right skills in order to perform these treatment strategies. An investigation is carries out on the aboriginal people of Australia and it is found that the population is greatly impacted by kidney failure problems. Thus, t is recommended that health practices should be aimed at assisting the affected people such as the aboriginal groups of people. Finally, this document illustrates legal and ethical considerations that a doctor must observe so that he conducts his medical practices according to these requirements. References Aparicio, M., Chauveau, P., & Combe, C. (2001). Low protein diets and outcome of renal patients. Journal of nephrology, 14(6), 433–439. Di Cerbo, A., Pezzuto, F., Palmieri, L., & Palmieri, B. (2012). The use of probiotics in the end- stage renal disease management. Minerva Biotecnologica, 24, 155–170. Elliott, P., & Brown, I. J. (2007). Sodium intakes around the world. Geneva: World Health Organisation. Goraya, N., Simoni, J., Jo, C. H., & Wesson, D. E. (2013). A comparison of treating metabolic acidosis in CKD stage 4 hypertensive kidney disease with fruits and vegetables or sodium bicarbonate. Clinical Journal of the American Society of Nephrology, 8(3), 371–381. Janicic N. (2003).Evaluation and management of hypo-osmolality in hospitalized patients. Endocrinol Metab Clin North Am; 32(2): 459-81. Jörres, A., Ronco, C., & Kellum, J. A. (2010). Management of acute kidney problems. Heidelberg: Springer. McMahon, E. J., Campbell, K. L., Mudge, D. W., & Bauer, J. D. (2012). Achieving salt restriction in chronic kidney disease. International Journal of Nephrology, 2012, 720429. Monteiro, C. A., Moubarac, J. C., Cannon, G., Ng, S. W., & Popkin, B. (2013). Ultra-processed products are becoming dominant in the global food system. Obesity Reviews, 14, 21–28. Morris, M. J., Na, E. S., & Johnson, A. K. (2008). Salt craving: the psychobiology of pathogenic sodium intake. Physiology & behavior, 94(5), 709–721. Mycyk MB. (2003).A visual schematic for clarifying the temporal relationship between the anion and osmol gaps in toxic alcohol poisoning. Am J Emerg Med; 21(4): 333-5. Newman, M. F., Fleisher, L. A., & Fink, M. P. (2007). Perioperative medicine: Managing for outcomes. Philadelphia, Pa: Elsevier Saunders. Peixoto AJ. (2003) Critical issues in nephrology. Clin Chest Med; 24(4): 561-81. Rocktaeschel J. (2003). Unmeasured anions in critically ill patients: can they predict mortality? Crit Care Med. 31(8): 2131-6.  Thorpe, B., & Walser, M. (2013). Coping with kidney disease: A 12-step treatment program to help you avoid dialysis. Hoboken, N.J: Wiley. Uribarri, J., Peppa, M., Cai, W., Goldberg, T., Lu, M., He, C. et al. (2003). Restriction of Dietary Glycotoxins Reduces Excessive Advanced Glycation End Products in Renal Failure Patients. Journal of the American Society of Nephrology, 14(3), 728–731. Vaziri, N. D., Yuan, J., & Norris, K. (2013). Role of urea in intestinal barrier dysfunction and disruption of epithelial tight junction in chronic kidney disease. American Journal of Nephrology, 37(1), 1–6. Whittier WL. (2004).Primer on clinical acid-base problem solving. Dis Mon; 50(3): 122-62. Read More