Introduction
Chronic kidney disease refers to the “progressive loss of kidney function over time” (National Kidney Foundation, 2015). It is a potentiate for global disease burden, and more than 26 million adults in the U.S. have the disease, and million others are at risk. Diabetes and high blood pressure are the main causes of chronic kidney disease, contributing to two-thirds of chronic kidney disease cases. Hence, this paper will aim at discussing the pathogenesis of chronic kidney disease in relation to clinical presentation, diagnosis and treatment.
Clinical Presentation
Symptoms of chronic kidney disease are not noticeable when one has a glomerular filtration rate (GFR) of more than 35%. This being the case, it is necessary to recognize primary pathologic mechanisms that result in renal injury, and especially for patients with diabetes mellitus and hypertension. A GFR of less than 35% is associated with various psychiatric, metabolic, cardiovascular, metabolic, and acid-base regulatory issues. Thus, clinical presentation relies on the complication and underlying cause of renal failure (Buttaro, Trybulski, Polgar Bailey & Sandberg-Cook, 2013, p. 766).
Diagnosis and Role of Patient History, Physical Exams, and Diagnostics Play in Diagnosis
Patient history is very important in the diagnosis of chronic kidney disease because of personal factors such as genes and lifestyle, which are associated with the disease. Physical examination is important because it helps to identify the pathologic processes attributed to primary disease entity, such as, hypertension or diabetes mellitus (Buttaro, 2013, p. 766). In addition, it entails a broader examination that aims at identifying changes associated with progressive renal failure. Areas of priority during physical examination of chronic kidney disease include an assessment of the vital signs, for example, orthostatic blood pressure. In addition, there is also the funduscopic evaluation for signs of arteriovenous nicking, diabetic retinopathy and papilledema.
The main diagnostic tool for patients with chronic kidney disease is dipstick urinalysis. Presence of proteins in urine (proteinuria) prompts the need for an entire 24-hour urine analysis to assess the clearance of protein and creatinine.Negative results for protein using a dipstick requires further investigation through laboratory procedures that require microalbuminuria testing. This is a very important test that is useful in the early detection of kidney disease when an individual is diagnosed with type 2 diabetes, and 2 years after one if diagnosed with type 1 diabetes (Buttaro et al., 2013, p. 766).
A study by Adams, de Jonge, van der Cammen, Zietse, Hoorn (2011) established an association between hyponatremia. The study showed a high incidence of prerenal acute kidney injury in patients who had hyponatremia (Adams et al., 2011, p.751-752). Hypomagnesemia can also be used to diagnose kidney disease because it is an indicator of renal insufficiency, and this is important to prevent progression to chronic kidney disease (Assadi, 2010).
Treatment
ACE inhibitors and angiotensin receptor blockers (ARBs) are used, and they may even be prescribed concurrently. These aim at lowering protein levels in urine.
Personal Factors
Ethnicity
Certain populations are predisposed to metabolic diseases, such as diabetes, more than others. As a result, such populations influence diagnosis by prompting regular screening and a change in lifestyle to slow progression of getting these metabolic diseases. Subsequently, this results in timely intervention.
Age
The same happens with age. Chronic kidney disease has a higher prevalence among the elderly than among any other population. Therefore, screening for kidney at a particular age is necessitated, and this leads to timely diagnosis in case of a problem, and subsequently, timely treatment.
Conclusion
Kidney disease is a serious illness that gravely affects a country’s economic burden, and familial expenditure. This disease affects people with a higher affinity for it based on identifiable risk factors. Chronic kidney disease is a severe manifestation of kidney disease, but with early diagnosis using frequent urine tests to test the kidneys’ ability to filter out wastes.
References
Adams, D., de Jonge, R., van der Cammen, T., Zietse, R., & Hoorn, E. (2011). Acute kidney injury and hyponatremia. JNEPHROL, 24(6), 749-755.
Assadi, F. (2010). Hypomagnesemia: An Evidence-Based Approach to Clinical Cases. Iranian Journal of Kidney Diseases, 4(1), 13-19.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.
National Kidney Foundation. (2015). About chronic Kidney Disease. Web.