NR507 Week 4: Discussion Alterations in Renal and Urinary Function

This week, we are covering Alterations in Renal and Urinary Function. As you reflect on the concepts of fluid and electrolytes and acid/base balance covered in the last two weeks, tell us one alteration that could occur in fluid and electrolyte and acid/base balance due to a renal or urinary disorder.

ORDER COMPREHESIVE SOLUTION PAPERS ON NR507 Week 4: Discussion – Alterations in Renal and Urinary Function

Example approach

Human’s rely on their renal system to filter their blood removing waste in the form of urine while stabilizing electrolytes and maintaining fluid homeostasis. If a complication occurs within the renal system some possible alterations could occur such as limited to no fluid filtering resulting in fluid overload or a shift of metabolic concerns as phosphorous, magnesium, and potassium levels elevate while sodium and calcium levels decrease. Dhondup and Qian (2017, p. 179) noted within a study regarding the prevalence and effects of renal disorders that “the kidneys play a central role in the regulation of body fluids, electrolytes and acid-base balance, chronic kidney disease (CKD) and end-stage renal disease (ESRD) predictably result in multiple derangements including hyperkalemia, metabolic acidosis and hyperphosphatemia which, in turn, lead to serious complications including muscle wasting, bone-mineral disorder, vascular calcification and mortality”.

From an electrolyte perspective, hyperkalemic affects from renal disorders, if left untreated, can result in nausea, muscle weakness, and bradycardia. Bradycardia potentially can lead to fainting episodes due to inadequate blood flow to the brain thus resulting in falls with potential bone fractures especially as calcium continues to be low and bones become brittle. Within the body, the lungs and the kidneys regulate acid/base balance and if this balance is not maintained by the natural course of renal function, an alteration in acid/base balance can result in metabolic acidosis or a build-up in acid in the body as the kidneys fail to “maintain a stable serum bicarbonate concentration by reabsorbing the filtered bicarbonate and synthesizing sufficient bicarbonate to neutralize the net endogenous acid load” (Kraut & Madias, 2016, p.307). Otherwise noted in advancing chronic kidney disease the ability to absorb bicarb is altered and a decline in functioning nephrons affects ammonia excretion as ammonia relies on nephrons in order to be eliminated from the body. This decrease in nephrons interferes with the body’s ability to eliminate acid. An increase in ammonia can cause a decrease in the glomerular filtration rate, indicative of the number of functioning nephrons. As all this continues to cycle, metabolic acidosis occurs increasing the speed at which kidney failure is progressing resulting in death if not managed properly.

References

Dhondup, T., & Qian, Q. (2017). Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure. Blood Purification, 43, 179-188. Doi:10.1159/000452725

Kraut, J. A., & Madias, N. E. (2016). Metabolic acidosis of CKD: An update. American Journal of Kidney Disease, 67(2), 307-317. Retrieved from https://www.ajkd.org/article/S0272-6386(15)01211-1/pdf