Chronic Kidney Disease Stage 3, Pathophysiology: Long-Term Effects of CKD to the Social Determinants Section (Term Paper Sample)

Chronic Kidney Disease Stage 3
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Abstract
Chronic kidney disease has become a major health concern across the globe. The disease is grouped into five stages depending on the rate at which glomerular filtration takes place. The estimated glomerular filtration rate decreases as the disease develops from stage 1 to 5. In 2014, the United States Renal Data System reported that twenty million of its population is affected by CKD. The major etiology of this disease is hypertension and diabetes. Hypertension causes high blood within the arteries leading to rupture of the arteries or restriction of blood flow into the kidney. The management of patients with CKD has been made easier through the staging system that provides specific care according to the severity of the disease. Some of the long-term effects of CKD include dyslipidemia, anemia, mineral and bone disorders, and other cardiovascular threatening conditions. Stage 3 patients suffering from CKD have elevated levels of phosphorus element in their system. The disease affects all races. However, the rate at which it affects varies from race to race. For example, African Americans have a higher percentage of the disease of 3.6% higher when compared to the whites. Diet and nutrition guidance should be provided to CKD stage 3 patients as a measure to manage the disease. To sum up, a better understanding of the mechanism of the disease provides promising treatment and measures that can be used to control the disease in the present and the future.
Definition
Chronic Kidney Disease is defined as a gradual loss of kidney function >90 days, due to structural abnormalities or other health complications affecting the kidneys. It is important to consider the duration of impairment when differentiating acute versus chronic disease (Murphree & Thelen, 2010). Glomerular Filtration Rate (GFR) assessment is essential when staging CKD and determining how well the kidneys are functioning. A decreased GFR of <60 ml/min/1.73m2 implicates CKD stages G3a-G5. Stage 3 specifically; "which is a GFR between 45-59 (mildly to moderately decreased) and, G3b, which has a GFR range of 30-44 (moderately to severely decreased)" (Greco & Mahon, 2015, p. 74).
Patients with this stage of chronic kidney disease have kidney damage that is moderate. The damaged kidney loses almost half its functions and therefore there is an accumulation of unwanted products in the body. This causes a condition referred as uremia. Some of the complications of stage 3 include; diseases of the bone, elevated blood pressure, and anemia (Greco & Mahon, 2015.
Pathophysiology
CKD is a slowly progressive disease without other comorbidities, "the human body has an impressive ability to compensate for decreased kidney function" (Greco & Mahon, 2015, p. 119). A pair of healthy functioning kidneys contains over 2 million nephrons filtering non-stop around the clock. When the nephrons are damaged the filtration area decreases which increases the glomerular capillary pressure, causing glomerular hypertension, leading to systemic hypertension (Greco & Mahon, 2015). Nephrons have the ability to expand and compensate to maintain GFR while underlying issues continue destroying healthy nephrons.
Diabetic nephropathy occurs due to the accumulation of massive protein matrix in the glomerular. This leads to thickened lining of the glomerular which in turn leads to chronic kidney disease. The protein matrix is due to an irreversible reaction that occurs between glucose molecules and protein. Accumulations of these proteins also known as advanced glycosylated end products (AGEs) hasten vascular complications (Stam et al., 2006). Over time, patients with hypertension experience dyslipidemia and hyperglycemia which promote the accumulation of AGEs. These events affect the endothelium layer by thickening it causing what is known as endothelial dysfunction. Since the function of the kidney depends on the full functionality of micro-vasculature of the glomerular, the thickened endothelial layer impairs its proper functioning. The increased level of accumulated AGEs is greater than the rate at which the glomerular filtration takes place.
Diabetic patients experience accumulation, deposition and production of AGEs that causes injury to the vascular and decreased excretion of waste products by the kidney. The thickening causes decreased oxygenated blood flow, impairment of vascular layer, vasodilatory capabilities, and damaged glomerular leads to kidney failure (Palmer, 2002). Due to impaired afferent arteriole, there is increased pressure of the glomerular filtration. This elevated pressure also causes thickening of the endothelia layer. Coupled with the continuous accumulation of AGEs, the integrity of glomerular membrane becomes compromised losing its selective nature. This damages the kidney by allowing unwanted materials in the kidney. However, research shows that reduced levels of AGEs could reduce the risk of kidney disease by 37-40% (Palmer, 2002).
There is a strong relationship between chronic kidney disease and hypertension though the damage level is low when compared to other complication of the cardiovascular (Mennuni et al., 2014). The damage caused by hypertension condition to the kidney has been divided into malignant and benign nephrosclerosis. The damage level of the kidney as a result of hypertension is related to the level of arterial pressure the kidney is exposed to. Usually, the kidney is protected from increased level of blood pressure by the mechanism of afferent arteriole of the glomerular. This mechanism is regulated automatically by tubuloglomerular and myogenic responses (Mennuni et al., 2014). In hypertension patients, increased blood pressure causes elevated levels of pressure of renal artery which becomes uncontrollable. The uncontrolled pressure is then transmitted to the capillaries of the glomerular leading to rupture of the vascular wall and injuries to the glomerular. Hypertension patients experience reduced blood flow through the renal artery to the kidney resulting in a decreased blood flow to the kidney which impairs it from carrying its functions. The increased level of chronic kidney disease has been attributed to conditions such as obesity, injury to the artery of the kidney as a result of glomerular hypertension and aging (Mennuni et al., 2014).
Epidemiology
According to United States Renal Data System (2015), 14 percent of the general population has CKD. Stages 1-5 have increased from years 1988-1994 and have remained steady at 13.6 percent from the years 2007 to 2012. During this time frame, stage 3 has had the largest increase from 4.5 to 6.0 percent (USRDS, 2015). Stage 3 is broken down into a 3a and 3b sub category. There are lifetime risks starting at birth: there is a 59.1 percent for CKD in stage 3a and a 33.6 percent in stage 3b (Grams, Chow, Segev, & Coresh, 2013). People with CKD usually have one or a combination of the following: diabetes, hypertension, cardiovascular disease, and an increase in weight, which contributes to the progression of the CKD stages. Adults’ ages 60 and older have the highest rates of CKD, which is at 33.2 percent as of 2012 (USRDS, 2015). Women experience CKD at a slighter higher rate (15.1%) than men at (12.1%) (USRDS, 2015). According to Greco & Mahon (2015), CKD affects all racial and ethnic groups. However, African Americans are 3.6 times higher, and Asians are 1.4 times higher than compared with European Whites. Hispanics are 1.5 times higher when compared to non-Hispanics (Grams et al., 2013).
Etiology
The two main causes of CKD are diabetes and hypertension (HTN), which are responsible for up to two-thirds of the cases (Baumgarten & Gehr, 2011). Diabetes is diagnosed when your blood glucose levels are too high. High glucose levels damage organs in the body such as the kidneys and heart, as well as blood vessels, nerves, and eyes. Diabetes (type 2) is said to be the most common cause of CKD, attributing to 32.5 percent of the adult cases, which eventually will lead to the development of diabetic nephropathy (Baumgarten & Gehr, 2011). Hypertension occurs when blood vessels are subjected to high pressure from blood. According to Murphy & Thelen (2010), 21 percent of CKD cases are caused by hypertension, which is the second most common cause. Several months and years of uncontrolled hypertension can lead to kidney damage (stages 1-3) and eventually kidney failure, if not caught and aggressively managed. Other conditions that affect the kidneys are; glomerulonephritis, polycystic kidney disease, malformations (blockages), and lupus (nephritis). In 2014, National Institute of Diabetes and Digestive and Kidney Disease concluded that polycystic kidney disease is a genetic disease that leads to CKD due to numerous cysts in and around the kidneys that cause decreased kidney function, eventually progressing through the stages of CKD.
According to Garcia & Jha (2015), it is believed that the cause of CKD has several social determinants. Underserved urban areas and its residences are at increased risk for undiagnosed CKD. The unemployed or underinsured minorities (African Americans, Hispanics, and Native Americans), especially African Americans have the highest rates of CKD diagnosis (Garcia & Jha, 2015). Low to no income patients are at increased risk for inadequate nutrition. These patients are usually unable to seek medical attention when symptoms present leading to uncontrolled hypertension and diabetes which quickly progresses through the stages of CKD (Garcia & Jha, 2015). This is a challenge for the patients who have limited funds and healthcare service, and are most likely to show up to hospitals once the disease has caused deterioration in their overall health (Morton et al., 2015). According to Morton et al., (2015) lac...