NursingCase Study
Disordersof Renal Function
Theformation of renal calculi depended on supersaturating of urine nidusalong with a deficit in stone inhibitors. Calculi are produced byspecific crystals that are not free. These crystals have a highconcentration in the urine. These elements cumulate within a tinynucleus composed of either organic or inorganic matter that serves asan inviting magnitude for stone formation. The specter of nidusreduces the procedure of supersaturating required for the formationof calculi.
Themechanism of stone formation in the kidney is as follows. The initialstage is urinary supersaturation and crystallization. Urinarysupersaturating refers to the driving magnitude following crystalformation in the kidney. Supersaturation is necessary for crystalformation. A patient of stone formation releases urine that isextremely supersaturated in contrary to health individuals.Crystallization process relies on the composition of the solution.Solution supersaturation is affected by various elements such assoluble complexes that lower the free ion action plus thesupersaturation meant for calcium oxalate (Greenberg & Cheung,2015). The next stage is crystal nucleation. In this juncture, thesupersaturation is changed from liquid to solid. It starts withcoalescence for the stone salts in solution. After that, loose bandsare generated these clusters enlarge as new components are added.Crystal growth process then takes place. As soon as crystal nucleusattains a significant size and the supersaturation lingers beyond 1,free energy is reduced through addition of new crystal constituentsto the nucleus. Crystal growth process is a precondition for particledevelopment thus stone formation. Inclusively in the mechanism iscrystal aggregation. Crystal aggregation refers to sticking of thecrystals in the solution to form an enlarged particle. It is also animportant step in the formation of the stone. Crystal aggregation ismajorly in crystal retention around the kidneys. Aggregation ofparticles usually has a significant effect on the size of theparticles. The aggregated particles are customary pointed in urine aswell as renal stones. Viscous binding enhances Crystal aggregationthis shows that crystal foreign elements consisting of double bindingsites for instance Tamm -Horse fall glycoprotein connect to crystalsurfaces and serve as glue (Greenberg & Cheung, 2015). The nextstep is crystal interaction. This mechanism of crystal and cell isextremely complex a lot of them thus remain unexplored.Crystallization occurs due to urinary supersaturation. After that,the formed crystals connect to renal tubular epithelial cells and areconsumed by the cells. Crystal-cell interaction refers to the processof connection of crystals to renal tubular cells. Attachment of COMcrystals happens after an exposure of thirty minutes. This process isalso essential in renal stone formation.
Alow quantity of citrate in the urine is normally referred tohypocitraturia. This situation is a prerequisite for kidney stoneformation. Citrate presence in urine serves as a hindrance to calciumcrystallization. Citrate signifies disassociations of anionsbasically of citric acid. It is a weak acid that is administered inthe diet and created endogenously in the acid cycle calledtricarboxylic. Citrate has a number of significant functions in themechanism of renal stone formation. In the first place, citratecompounds into calcium ions customarily in the urine. This causeslowering of the calcium ion action. Consequently, the urinarysupersaturation will be reduced (Greenberg & Cheung, 2015). Thismeans the calcium phosphate, as well as calcium oxalate amount, willdecline. This process depends on the pH, thus, increase the pH of theurine is essential in the development of this compound compared toincrease in citrate. Secondly, citrate acts as an inhibitor on thecrystallization along with precipitation that occurs in calciumsalts. Thirdly, citrate intensifies the calcium oxalate aggregationdeterring an act of the urine macromolecules, for instance, the TammHors fall protein. It has the capability of lowering the emergence ofurinary osteopontin. This is an essential element in the proteinpattern of the urinary stone. Lastly, the urinary citrate secretionhas the capability of amplifying urinary pH. This is a criticalfactor in uric acid crystallization as well as the uric acid stoneformation. Additionally, it is important in the formation of calciumcitrate phosphate compound.
Administrationof calcium supplements would be useful for a patient suffering fromcalcium oxalate stones because of various reasons. Calciumsupplementary assists in the reduction of urinary oxalate secretionand some patients, it may lower the risks of recurrence of idiopathiccalcium stones. Calcium supplements are advantageous specifically inpatients with hyperoxalurias in whom the urinary calcium is not high.A calcium supplement should be accompanied with meals it may beprudent to start with a small dose such as 100-150mg calcium. Liquidcalcium supplements are effective than calcium in solid or pill form.Liquid form mixes well with food thus letting the calcium bind theoxalate efficiently. On the other hand, milk products reduce oxalateabsorption from tea as well as spinach.
Hydronephrosisrefers to the bulging of the kidney as a result of an upsurge ofurine. This occurs in cases where urine has no capacity to drain outfrom the kidney to the bladder from a blockage or rather anobstruction. It is a phenomenon that can happen in one or bothkidneys. The primary role of the urinary tract is to excrete wastesas well as fluids from the body. Back pressure occurs due to theobstruction which results in pain. The obstruction may stop or ratherreduce the flow of urine if it has effects on both kidneys thuscausing pressure. Individuals with symptoms of Hydronephrosis mayhave discomfort or pain in the back or spine. The presence ofHydronephrosis is the physiological mechanism responsible for nephrondamage when back pressure is present (Sherwood, 2016). Hydronephrosisis likely to be either acute otherwise chronic. Additionally, it maybe unilateral or else bilateral. It can also be a consequence ofobstruction of the urinary tract thought it may occur in the absenceof obstruction. Obstructive uropathy is defined as obstruction of theanatomy of the flow of urine at any point in the urinary tract.Obstructive nephropathy occurs in cases where the obstruction leadsto damage of the renal anatomy. Hydronephrosis occurs due to anatomicprocesses, thereby intruding the urinary flow. This interruption isdeemed to happen anywhere alongside the urinary tract, beginning fromthe kidneys up to urethra. The upsurge in urethral pressure commandschanges in glomerular filtration. Functions of the tubular as well asthe blood flow in the renal (Craver, 2016).
Theglomerular filtration speed decreases within hours due to acuteobstruction. The decrease can persevere for several weeks followingrelief of obstruction. The ability of the renal tubular to conveysodium, magnesium among other things to water down the urine isdeterred. The degree as well as the perseverance of the functionalinsults corresponds to the duration along with the degree ofobstruction. Precise disruptions are bounded to reversible functionaldisruption with minor anatomic changes. Explicitly, chronicdisturbances result to deep-seated tubular atrophy plus permanentloss of nephron.
References
Craver,C. M. (2016). Hydronephrosisand hydroureter in an 8 month old Labrador retriever.Retrieved from https://ecommons.cornell.edu/handle/1813/13293
Greenberg,A., & Cheung, A. K. (2015). Primeron kidney diseases.Philadelphia, PA: Saunders.
Sherwood,L. (2016). Humanphysiology: From cells to systems. New York: Brooks/Cole,Cengage Learning.