Disorders of Renal Function MN551 Case Study.

MN551: Advanced Physiology and Pathophysiology Across the Life Span

Case Study 5: Disorders of Renal Function

Case study number five is focused on a forty-four-year-old man named Fred.  Fred stays healthy and fit by working outside.  After working outside one particularly warm summer day, he returned home only to begin experiencing lower back discomfort and unexplained nausea later that evening.  Having lost his appetite due to the nausea and unable to enjoy the dinner that his wife had prepared, he decided to go to bed early.

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Later that night his symptoms worsened.  He began complaining of excruciating stomach, back and groin pain.  The pain would come in waves that would be followed by diaphoresis and vomiting.  Once his pain eased, his wife rushed him to the hospital to be evaluated. Disorders of Renal Function MN551 Case Study.

After being evaluated and having abdominal scans, emergency room physicians diagnosed him with renal calculi in the right ureter or right urolithiasis.  With a diagnosis the hospital physicians and staff can work with Fred and his wife on a plan of care and begin treatment.  Based on medical literature it is critical that renal disorders are properly diagnosed and treated to prevent further renal injury.

Mechanism of Stone Formation in the Kidney.

There are four different types of kidney stones: calcium, uric acid, struvite, and cystine.  The precise mechanism of forming kidney stones or urolithiasis is not completely understood despite significant research (Evan, Worcester, Coe, Williams & Lingeman, 2015).  Research has shown that a nidus is required along with a urinary environment conducive to the crystallization of components found in kidney stones (Grossman & Porth, 2014).

It has been hypothesized that the kidneys become supersaturated with crystalline liquid structures that they cannot break down.   These crystalline liquid structures begin to precipitate together rapidly to form solid particles. The solid particles begin binding together and arrange into a crystal pattern in a process known as crystal nucleation (Jena, Panigrahi & Dey, 2016).  Varying in size and shape, the crystals adhere to the renal tubular epithelial cells (Chaiyarit & Thongboonkerd, 2017).  Disorders of Renal Function MN551 Case Study  Then the crystals begin to form an adhesive agglomeration within the renal tubules.  It is at this point that the kidney stone causes a restriction or blockage of the renal tubules.

Role of Citrate in the Kidneys.

Citrate is a tricarboxylic acid that is a natural byproduct of the citric acid cycle in renal cells (Grossman & Porth, 2014).  Citrate makes the renal environment unfavorable to stone formation by reducing the supersaturation and increasing the pH of urine (Kaygisiz, 2017).  This effectively inhibits the crystallization of calcium salts thus reducing to probability of forming calcium oxalate stones.

Studies have noted that individuals with a lower urinary citrate excretion or hypocitraturia have higher incidences of kidney stone formation (Coe, Worcester & Evan, 2016).  It has also been shown that citrate therapy inhibits the growth and reduces the reoccurrence of new stone formation in the kidneys (Phillips, Hanchanale, Myatt, Somani, Nabi & Biyani, 2015).  The most effective way to prevent the formation of kidney stones is to maintain the acid-base balance within the bladder. Disorders of Renal Function MN551 Case Study.

Calcium Supplements and Calcium Oxalate Stones.

According to Grossman and Porth (2014), seventy-five to eighty percent of kidney stones are calcium stones.   A differential diagnosis of hypercalciuria is a common indicator of calcium kidney stones.  Patients who have an excessive amount of calcium excreted through the urine may also have a supersaturation of urinary calcium salts (Sorensen, 2014).

Patients are completely dependent on their dietary intake for the absorption of calcium.  If their intake is too low, then there can be in increase of urinary oxalate.  Calcium supplementation helps to bind oxalate in the intestine and effectively reduce its absorption (Grossman & Porth, 2014). Disorders of Renal Function MN551 Case Study.

Hydronephrosis.

Swelling in one or both kidneys resulting from a buildup of urine is hydronephrosis.  This condition can lead to kidney damage and/or failure if not treated.  The amount of damage depends on duration, severity and location of the obstruction (Grossman & Porth, 2014).

One cause for this condition is an obstruction in the ureters preventing the outflow of urine to the bladder.  A second cause of this condition occurs when urine in the bladder refluxes into the kidney causing an enlargement of the renal pelvis (Hydronephrosis, 2017).  Both causes result in renal injury but diagnosed and treated early can reverse the damage.

Relating to this case study the probable location of the kidney stone related blockage would be the ureteropelvic junction.  Fred exhibited symptoms consistent with hydronephrosis which included complaints of pain in his back, abdomen and groin.  He also was suffering from nausea and vomiting. Disorders of Renal Function MN551 Case Study.

Back Pressure in the Kidneys.

For this paper the focus of case study number five is on an obstruction caused by a kidney stone.  Back pressure occurs in the kidneys because of hydronephrosis caused by an obstruction, or reflux.  This condition causes a back or buildup of pressure in the kidneys.  If the condition persists, the kidneys will begin to suffer damage or nephropathy.

Progressive atrophy and damage of the kidney is caused by the dilation of the renal pelvis and calices which occurs because of the continued glomerular filtration.  The back pressure continues to build because of this ongoing filtration and the kidney’s inability to release the urine due to the blockage.  Renal vasculature becomes compressed when the increased pressure in the renal pelvis is forced back through the kidney’s collecting ducts (Grossman & Porth, 2014).

This back pressure causes a restriction in blood flow to the kidneys causing ischemic damage and intrarenal pelvic pressure which combined result in mechanical damage to the nephrons.  This causes the progressive destruction of nephrons.  Disorders of Renal Function MN551 Case Study. Remaining nephrons work to compensate by increasing their function until the assault is halted or the remaining nephrons are destroyed.  According to Grossman and Porth (2014, pg. 1089), “in advanced cases the kidneys can become thin walled cystic structures with parenchymal atrophy, total obliteration of the pyramids and thinning of the cortex.”

Conclusion.

In case study number five, it is clear through medical literature and research that time is of the essence when diagnosing and treating with renal disorders.  In this case study, Fred had worked outside in the heat all day.  His early symptoms could have easily been mistaken for exhaustion, pulling a back muscle or dehydration.

Patients who delay seeking help are at greater risk for renal injury that could result in permanent damage and renal failure.  One specific condition that can devastate a patient’s renal health if left untreated is hydronephrosis.  The damage from this condition can destroy the kidney’s nephrons and lead to renal failure. Disorders of Renal Function MN551 Case Study.

Despite the abundance of research into the formation of renal stone formation, there is still more to be learned.  Health care providers should educate patients about the causes, signs and symptoms of kidney stones.  As evidenced by medical literature, it is clear that early diagnosis and treatment can potentially slow, stop and reverse renal injury.

References

Chaiyarit, S., & Thongboonkerd, V. (2017). Defining and Systematic Analyses of Aggregation Indices to Evaluate Degree of Calcium Oxalate Crystal Aggregation. Frontiers in Chemistry, 5, 113. http://doi.org/10.3389/fchem.2017.00113

Coe, F. L., Worcester, E. M., & Evan, A. P. (2016). Idiopathic hypercalciuria and formation of calcium renal stones. Nature Reviews Nephrology, 12(9), 519-533. doi:10.1038/nrneph.2016.101

Evan, A. P., Worcester, E. M., Coe, F. L., Williams, J., & Lingeman, J. E. (2015). Mechanisms of Human Kidney Stone Formation. Urolithiasis, 43(0 1), 19–32. http://doi.org/10.1007/s00240-014-0701-0

Grossman, S. C., & Porth, C. (2014). Porth’s pathophysiology: Concepts of altered health states (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Hydronephrosis. (2017, February 03). Retrieved from https://www.kidney.org/atoz/content/hydronephrosis

Jena, S. C., Panigrahi, P. N., & Dey, S. (2016). Urolithiasis: Critical Analysis of Mechanism of Renal Stone Formation and Use of Medicinal Plants as Antiurolithiatic Agents. Asian Journal of Animal and Veterinary Advances, 11(1), 9-16. doi:10.3923/ajava.2016.9.16 Disorders of Renal Function MN551 Case Study

Kaygısız, O. (2017). Metaphylaxis in Pediatric Urinary Stone Disease. Updates and Advances in Nephrolithiasis – Pathophysiology, Genetics, and Treatment Modalities. doi:10.5772/intechopen.69982

Phillips, R., Hanchanale, V. S., Myatt, A., Somani, B., Nabi, G., & Biyani, C. S. (2015). Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd010057.pub2

Sorensen, M. D. (2014). Calcium intake and urinary stone disease. Translational Andrology and Urology, 3(3), 235–240. http://doi.org/10.3978/j.issn.2223-4683.2014.06.05

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