NSG2HPB Nursing Health Priorities B


Use current literature to discuss the pathophysiology of chronic renal failure and its management, with particular reference to Mr Goodpasture’s clinic presentation.

Explain the relationship between Mr Goodpasture’s presentation (i.e.

his symptoms and pathology results, and the pathophysiology of kidney disease.

Define the relationship between Mr Goodpasture’s renal disease and his medical history.

Explain the management of end-stage renal disease.

Compare and contrast two management options.


The Pathophysiology and Presentation of Mr. Goodpasture’s Kidney Disease

My Goodpasture describes end stage renal disease (ESRD), which is characterized as irreversible deterioration and a loss of metabolic and fluid balance.

This disease is multi-systemic and manifests across a variety of interrelated systems including neurologic, cardiovascular, pulmonary, integumentary to reproductive.

End-stage kidney disease patients are often diagnosed with neurologic complications like Mr. Goodpasture’s condition of agitation.

Cognitive dysfunction, stroke, peripheral and autonomic neuropathies, as well as cognitive dysfunction, are common neurological complications in end stage renal failure (Arnold. Issar. Krishnan. Pussell, 2016.).

CNS injury in ESRD can be caused by many factors.

It includes neurodegenerative as well as vascular mechanisms.

Neben irritability can also be caused by disorientation, weakness, fatigue, and inability to focus.

Mr. Goodpasture’s respiratory examination revealed scattered crackles on the bases. This is also common in end-stage kidney disease.

ESRD may present with pulmonary symptoms including shortness, crackles, Kussmaul type respirations, thick, tenacious sputum and tachypnoea (Smeltzer Bare, Hinkle & Cheever 2010, 2010).

The intimate relationship between the kidney and lung functions is what causes pulmonary symptoms.

Reduced systemic effects from renal acid-base disturbances can be mitigated by changes to respiratory function (Cury Brunetto & Aydos 2010, 2010).

There may be cardiovascular system problems.

Smeltzer Bare and Hinkle (2010) suggest that the most common signs and symptoms of chronic heart failure are hypertension, hyperlipidemia, pericarditis and hyperkalaemia.

The patient in question has both hypertension as well as oedema.

Due to shared risk factors for ESRD, and cardiovascular disease, cardiovascular disease is the most common cause of death among patients on dialysis (Sweety Arzu., Rahman. Salim. & Mahmood. 2014).

Some of the common gastrointestinal manifestations include constipation or diarrhea, anorexia and mouth ulcerations.

The accumulation of proteins from protein metabolism in blood is a result of declining renal function.

The rate at which the kidneys function is declining is directly related to the urinary excretion.

Patients with ESRD have higher creatinine and urea levels than others (Khalidah & Suhad (2015)).

Paige & Nagami (2009) found that patients suffering from ESRD experience an increase in serum phosphorous levels and potassium levels, as demonstrated in My Goodpasture.

On hematology Mr. Goodpasture presented with haemoglobin, red cells count, haematocrit and white cell count levels below the normal range.

This is in agreement to Suresh, Mallikarjuna Sharan and Hari Krishna (2012) who concluded chronic renal failure patients exhibit abnormal haematological characteristics.

According to the authors, the main cause of the decline in haemoglobin and red blood cell counts, platelet count, and haematocrit is the reduced production of erythropoietin. Other factors include increased haematuria and haemolysis.

Mr. Goodpasture’s Kidney Disease and His Medical History

The underlying disorder of protein excretion in the kidneys, as well as hypertension, are responsible for the rapid decline in kidney function and progression of CKD.

The presence of hypertension, which is a risk factor in chronic kidney disease and ESRD, is also a concern for Mr. Goodpasture.

Hypertension is the second most common cause of kidney failure after diabetes (Tomiyama, Yamashina (2014).

Yamashina (2014) reported that both hypertension (and ESRD) have been increasing over the past two decades.

Hypertension is both a consequence and a cause of ESRD, as shown by the high prevalence of the condition among patients undergoing haemodialysis.

A high level of blood pressure, as indicated in the vital signs of the patient, can lead to kidney dysfunction within a short period of time.

If left untreated, milder forms of high pressure can cause kidney damage.

A patient with uncontrolled hypertension is at greater risk of developing end-stage kidney disease.

Hypertension combined with other risk factors such as smoking, obesity, and drinking (as demonstrated in this case) can increase the risk of developing ESRD. (Rumeyza 2013, 2013).

Unmanaged hypertension can cause damage to blood vessels throughout your body.

The most vulnerable to damage are the venules and arterioles.

High pressure can cause damage to many vessels in the kidneys.

Hypertension can be transmitted to the glomerulus via the capillary pressure. This causes glomerulosclerosis as well as loss of kidney function. (Lastra. Syed. Kurukulasuriya. Manrique. Sowers, 2014.

Hypertension is more dangerous for patients with chronic kidney disease.

End?Stage Kidney Disease Management

Patients like Mr. Goodpasture have two options. They are haemodialysis (blood transfusion) and kidney transplant.

For most patients with ESRD, kidney transplantation is the preferred treatment.

This is because of the significant increase in survival and quality of life compared with patients receiving dialysis (Berns 2016).

The average life expectancy for transplant patients is 8-12 years.

Living donors have been shown to be more effective than kidneys taken from deceased donors.

The transplantation of kidneys from living donors is also more beneficial to younger patients than for those who are older.

But, there are certain factors that could prevent a patient being eligible for transplantation.

These could include extreme obesity, chronic illness that could cause death in a few years or active or recent cancer, current drug and alcohol abuse, dementia and inability remember to take medications (Berns 2016).

Transplantation has the main drawback of the need to take medications and to be closely monitored to avoid organ rejection.

Haemodialysis is a procedure that involves pumping blood through a dialysis machine to remove fluids and waste products.

Haemodialysis can be contraindicated in the following situations: unstable cardiac rhythm, hemodynamic instability and hypotension.

Studies on transplantation have shown that although there are some positive outcomes (in terms of psychosocial and risks), most recipients experience a higher quality of their lives, while the overall improvement in their physical and emotional well-being is not as dramatic (Lopes and colleagues, 2011).

Anxiety and depression are the most frequent negative effects on psychosocial functioning.

Studies have shown that recipients and donors are more likely to have healthy relationships after positive outcomes.

Transplantation has risks. There is the chance of rejection, side effects of immunosuppressants, and surgery risk.

The psychosocial impact includes depression, anxiety and fatigue due to anemia, malnutrition, and sleep disorders. It also reduces the quality of one’s life due to uncertainty about the future, lack of energy, and anxiety.


Neurological complications of chronic kidney disease.

Patient education: Dialysis or transplantation — which one is right for you?

(Beyond Basics).

End Stage Renal Disease: Treatment Options

Prim Care Clin Office Pract.

Chronic kidney disease can cause negative side effects.

The Biochemical Changes in Chronic Renal Failure Patients.

International Journal of Pharma Medicine and Biological Sciences. 75 to 79.

Type 2 diabetes mellitus, hypertension: A review.

Evaluation of donors, recipients and depression in living kidney donation.

Neuropsychiatric complications in chronic kidney disease.

The Top 10 Things Nephrologists Wish All Primary Care Physicians Knew.

Mayo Clin Proc. 180-186.

Psychopathological aspects in kidney transplantation: The effectiveness of a multidisciplinary group.

World J Transplant, 267-275.

Update on the risk factors of chronic kidney disease.

Kidney Int Suppl (2011). 368-371.

Diagnosis and Treatment of Hemodialysis Emergencies.

Clin J Am Soc Nephrol, 1-13.

Brunner & Suddarth’s Textbook for Medical-surgical Nurses,.

Hematological Changes in Chronic Reproductive Failure.

International Journal of Scientific and Research Publications.

Cardiovascular complications in end-stage renal disease patients receiving maintenance haemodialysis.

Mymensingh Medical J, 329-334.

Beta-Blockers in Hypertension Management and/or Chronic Kidney Disease Management

Hemodialysis and its psychological impact.

M. Polenakovic, Renal Failure – The Facts (pp.

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