PNUR124 Practical Nursing Theory 2

Pathology of ESRD   

End Stage Renal Disease (ESRD) is the final stage of chronic kidney disease (CKD). CKD is a debilitating disease and progression to ESRD occurs when there is gradual loss of kidney function and the kidneys are no longer able to meet body’s need. Glomerular filtration rate is the main clinical market of kidney damage and in case of ESRD, GFR value of less than 15 mL/min is found. High blood pressure and diabetes are the most common cause of CKD and this is responsible for around two-third of the cases. Other risk factors of CKD are smoking, cardiovascular disease, family history of kidney disease, old age, obesity and smoking (Benjamin & Lappin, 2020).

The development of renal failure depends on the etiology of the disease as well as the early homeostatic mechanism linked to the hyperfiltration of nephrons. With the progression of CKD, the nephron gets damaged resulting in the increase in the filtration rate of the kidney. The disease go undetected initially as the patients show normal creatinine value. However, the adaptive mechanism will run its course and gradually lead to damage to the glomeruli. Other factors that further worsens renal injury are nephrotoxins, proteinuria, dehydration, smoking, uncontrolled diabetes and hypertension (Benjamin & Lappin, 2020). Thus, the modulation and adaptation in the functional glomeruli is the main caused behind hyperfiltration and the release of cytokines and growth factors that lead to hypertrophy and hyperplasia. Due to the excess demand on the glomeruli, its function is affected leading to proteinuria. High concentration of protein is detrimental for kidney as it is a direct nephrotoxins and it can impair kidney function (Dai et al., 2017).

Laboratory Value:

Two lab values that are useful in detecting ESRD are estimated GFR value and the serum creatinine value. eGFR is that test that evaluates kidney function. The main rational for this lab value is that it measures the amount of blood passing through the kidney each minute. The normal value of GFR is 90 to 120 ml per minute. This test can help to diagnose ESRD if the GFR value is less than 15 ml per minute. Patients at this stage are in urgent need of renal replacement therapy like dialysis. ESRD is the stage five of CKD. Hence, lower the value of GFR, higher is the rate of kidney function (Porrini et al., 2019).

The second lab value that is of particular importance in diagnosing ESRD is the serum creatinine value. It is a type of blood test that examines whether creatinine is building up in the body or not. Ideally, creatinine is completed filtered by the kidney. Thus, high level of creatinine value in the blood is indicative of kidney problem. Kidney problem can be detected if the creatinine value is higher than 1.2 mg/dL in women and 1.4 mg/dL in men. This difference is seen as the amount of production of creatinine depends on muscle bulk (Gounden & Jialal, 2018). 

It is calculated based on the equation:

C = (U x V) / P

C= Clearance, U=urinary concentration, V=rate of flow of urine

References

Benjamin, O., & Lappin, S. L. (2020). End-stage renal disease. StatPearls [Internet].

Dai, L., Golembiewska, E., Lindholm, B., & Stenvinkel, P. (2017). End-stage renal disease, inflammation and cardiovascular outcomes. Expanded Hemodialysis, 191, 32-43.

Gounden, V., & Jialal, I. (2018). Renal function tests. 

Porrini, E., Ruggenenti, P., Luis-Lima, S., Carrara, F., Jiménez, A., de Vries, A. P., ... & Remuzzi, G. (2019). Estimated GFR: time for a critical appraisal. Nature Reviews Nephrology, 15(3), 177-190.

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