pathophysiological basis of renal changes | My Assignment Tutor

Assessment 2: Case Study1. What is the pathophysiological basis of renal changes in long-standing hypertension?(350-400 words)Pathophysiological effects of long-standing hypertension (HBP) include narrowing,hardening and weakening of blood vessels, kidney atrophy (shrinkage of kidney size) anddamaged nephrons (McCollister, Deborah, Shaffer, Shannon, Badesch, David B, Filusch,Arthur, Hunsche, Elke, Schüler, René, Wiklund, Ingela, & Peacock, Andrew, 2016).Due to the extreme pressure at which blood travels through the arteries, over time theinner cell linings of the blood vessels are damaged (Yang, Ning, & Vafai, Kambiz, 2006). Thedamaged arteries collect dietary fats and become less elastic, essentially, limiting blood flowto vital organs such as the kidneys in the renal system. The deposition of fatty materials inthe arteries can develop into Atherosclerosis, which causes arteries to further deteriorateand hypertension to escalate exponentially (Lonardo, Amedeo, Nascimbeni, Fabio,Mantovani, Alessandro, & Targher, Giovanni, 2018). The built-up resistance in the arterieslimits blood flow to the kidneys, resulting in several changes in the renal system which mayfurther result in Chronic Kidney Disease (CKD).One of the most common change in the renal system is kidney atrophy (Marboeuf, Philippe,Delsart, Pascal, Hurt, Christopher, Villers, Arnaud, Hossein-Foucher, Claude, Beregi, JeanPaul, Deklunder, Ghislaine, Noel, Christian, & Mounier-Vehier, Claire, 2010). This is causedby the lack of blood supply to the organs as a result of the built-up resistance in the bloodvessels (Lee, Siew Yi, & Lau, Howard, 2008). The average kidneys size is 10-12cm (5 inches)but due to the inadequate blood flow to the vital organs, the kidneys shrink down to half ofits original size (KARIYANNA, Shathabish S, LIGHT, Robert P, & AGARWAL, Rajiv, 2010). Thekidneys also play an integral role in regulating blood pressure, so kidney atrophy can alsoworsen hypertension as it becomes less effective (Tian, Zhongmin, & Liang, Mingyu, 2021).Kidney atrophy may further develop into CKD, which can be detected by urinalysis andblood tests. Urinalysis provides an analysis on whether there is a high protein and bloodcontent in urine. Blood tests monitor whether there is a build-up of toxins in the blood dueto the inability of nephrons in the kidneys to filter blood (Zoccali, Carmine, Vanholder,Assessment 2: Case StudyRaymond, Massy, Ziad A, Ortiz, Alberto, Sarafidis, Pantelis, Dekker, Friedo W, Fliser, Danilo,Fouque, Denis, Heine, Gunnar H, Jager, Kitty J, Kanbay, Mehmet, Mallamaci, Francesca,Parati, Gianfranco, Rossignol, Patrick, Wiecek, Anzej, & London, Gerard, 2017). In thepresence of hypertension, over time nephrons are damaged and become less effective inthe process of filtering blood (Rothermund, Lars, Lorenz, Marcus, Schnieber, Anne, Eberson,Jan, Bauhaus, Iris, Haug, Marcel Bernhard, Schulz, Angela, Keller, Frieder, Vetter, Roland, &Kreutz, Reinhold, 2011). Since the key role of the kidneys are to filter blood of toxins andreturn important nutrients such as protein back into the blood, it’s ineffectiveness due tolong-standing hypertension poses even greater health risks.2. Based on the clinical picture and laboratory investigations provided, what stage ofchronic kidney disease this patient is in and what will be the main managementapproach at this stage? (100-150 words)Observing the provided blood test of the patient, it is evident that the patient has enteredstage 5 of Chronic Kidney Disease. The blood report states that the creatinine content in thepatient’s blood is 6 times high than the average adult male, meaning the GRF number isexceedingly low. Considering the fact that patient has reported symptoms such as nauseaand vomiting, dyspnoea on exertion, and dizziness the best management approach wouldbe to consider dialysis and referral to kidney transplantation (Johnston, Sheila, 2016).Symptoms are usually silent until the disease has progressed past stage 5 and since thepatient is experiencing common stage 5 CKD symptoms the risks are extremely high andthey should be referred to a nephrologist urgently.Assessment 2: Case StudyBibliography:Johnston, Sheila. (2016). Symptom Management in Patients with Stage 5 CKD Opting forConservative Management. Healthcare (Basel), 4(4), 72.https://doi.org/10.3390/healthcare4040072KARIYANNA, Shathabish S, LIGHT, Robert P, & AGARWAL, Rajiv. (2010). A longitudinal studyof kidney structure and function in adults. Nephrology, Dialysis, Transplantation, 25(4),1120–1126. https://doi.org/10.1093/ndt/gfp654Lee, Siew Yi, & Lau, Howard. (2008). Effectiveness of Unilateral Nephrectomy for RenalHypertension in Adults. Asian Journal of Surgery, 31(4), 185–190.https://doi.org/10.1016/S1015-9584(08)60083-4Lonardo, Amedeo, Nascimbeni, Fabio, Mantovani, Alessandro, & Targher, Giovanni. (2018).Hypertension, diabetes, atherosclerosis and NASH: Cause or consequence? Journal ofHepatology, 68(2), 335–352. https://doi.org/10.1016/j.jhep.2017.09.021Marboeuf, Philippe, Delsart, Pascal, Hurt, Christopher, Villers, Arnaud, Hossein-Foucher,Claude, Beregi, Jean-Paul, Deklunder, Ghislaine, Noel, Christian, & Mounier-Vehier, Claire.(2010). Management of renal atrophy in hypertensive patients: experience in Lille. La Pressemédicale (1983), 39(4), e67–e76. https://doi.org/10.1016/j.lpm.2009.07.020McCollister, Deborah, Shaffer, Shannon, Badesch, David B, Filusch, Arthur, Hunsche, Elke,Schüler, René, Wiklund, Ingela, & Peacock, Andrew. (2016). Development of the PulmonaryArterial Hypertension-Symptoms and Impact (PAH-SYMPACT®) questionnaire: a newpatient-reported outcome instrument for PAH. Respiratory Research, 17(1), 72–72.https://doi.org/10.1186/s12931-016-0388-6Rothermund, Lars, Lorenz, Marcus, Schnieber, Anne, Eberson, Jan, Bauhaus, Iris, Haug,Marcel Bernhard, Schulz, Angela, Keller, Frieder, Vetter, Roland, & Kreutz, Reinhold. (2011).Assessment 2: Case StudyImpact of Nephron Number Dosing on Cardiorenal Damage and Effects of ACE Inhibition.American Journal of Hypertension, 24(4), 474–481. https://doi.org/10.1038/ajh.2010.206Tian, Zhongmin, & Liang, Mingyu. (2021). Renal metabolism and hypertension. NatureCommunications, 12(1), 963–963. https://doi.org/10.1038/s41467-021-21301-5Yang, Ning, & Vafai, Kambiz. (2006). Modeling of low-density lipoprotein (LDL) transport inthe artery—effects of hypertension. International Journal of Heat and Mass Transfer, 49(5),850–867. https://doi.org/10.1016/j.ijheatmasstransfer.2005.09.019Zoccali, Carmine, Vanholder, Raymond, Massy, Ziad A, Ortiz, Alberto, Sarafidis, Pantelis,Dekker, Friedo W, Fliser, Danilo, Fouque, Denis, Heine, Gunnar H, Jager, Kitty J, Kanbay,Mehmet, Mallamaci, Francesca, Parati, Gianfranco, Rossignol, Patrick, Wiecek, Anzej, &London, Gerard. (2017). The systemic nature of CKD. Nature Reviews. Nephrology, 13(6),344–358. https://doi.org/10.1038/nrneph.2017.52

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