DE JESUS, Flor Anne D.

BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

Renal insufficiency, also called renal failure, is when your kidneys no longer have enough
kidney function to maintain a normal state of health. Note that the term renal failure is beginning to be
replaced by renal insufficiency when in the context of chronic kidney disease. There are two kinds.

Acute renal failure (ARF). This is kidney failure that happens rather suddenly, where something
has caused the kidneys to shutdown. This may be due to infection, drugs (prescription, over-the-
counter, recreational), traumatic injury, major surgery, nephrotoxic poisons, etc. Emergency dialysis
may be needed until the situation resolves and the kidneys begin functioning again (this might take
a short time, or months, or it might be permanent). While more acute episodes are possible in the
case of IgAN (we often refer to them as "flare-ups"), IgA nephropathy is a condition that mainly
causes chronic renal insufficiency (CRI), not usually acute renal failure (ARF). However, some people
may experience spontaneously-reversing acute renal failure as well. The latter are cases where
serum creatinine goes up dramatically but later returns to a more normal baseline. In such cases,
dialysis may be needed until the condition improves. ARF in the context of IgAN is usually more
associated with the person developing a flare-up of HSP.

Chronic renal insufficiency (CRI). This is when a disease such as IgA nephropathy slowly and
gradually destroys the filtering capacity of the kidneys. It is sometimes referred to as progressive
renal insufficiency, chronic kidney disease or chronic renal failure (CRF). This kind of damage cannot
currently be repaired, and as such, it is irreversible. A person may have chronic renal failure for
many years, even decades, before dialysis or a kidney transplant become necessary. Chronic renal
insufficiency does not, by itself, mean complete shutdown of the kidneys, and a person with chronic
renal insufficiency may still pass urine normally, and may have more than enough kidney function
left for normal functioning of the body. Note that you cannot judge the efficiency of your kidneys by
the amount of urine you produce. People with quite advanced renal insufficiency, and even people
on dialysis may still produce a fair amount of urine. But this does not mean that the kidneys are
filtering waste nor regulating serum electrolyte levels efficiently.
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

Stages of Chronic Kidney Disease

These guidelines are adapted from the National Kidney Foundation's

Kidney Disease Outcomes Quality Initiative (KDOQI)

Stage Description GFR*

1 Signs of mild kidney disease but with normal or better GFR greater than 90%

2 Mild kidney disease with reduced GFR 60-89%

3 Moderate chronic renal insufficiency 30-59%

4 Severe chronic renal insufficiency 15-29%

5 End-stage renal failure less than 15%

Early chronic renal insufficiency (Stages 1 to 2)

Physical symptoms. Usually few or no physical symptoms that you can feel (other than those
you may experience if you have heavy proteinuria).
Blood work. Blood work results will show abnormalities - mainly a slightly elevated serum
creatinine. Note that there is often a time lag between elevations of serum creatinine, and some
progression of the IgAN. By the time serum creatinine is elevated, the person may already have
lost 50% of kidney function.
Urinalysis. Urine will show abnormalities. Urine can be checked by dipstick in the doctor's office
(as an initial check), and followed up with a more complete urinalysis. The main urine
abnormality that will suggest a kidney disease is the presence of protein and/or blood. Either
will usually trigger further investigation. However, blood and/or protein in the urine doesn't say
anything about actual kidney function.
Treatment. Treatment may involve some mild dietary changes (a lower protein diet may in
some cases be recommended), and a blood pressure medication  may be prescribed (usually of
the ACE inhibitor class, the angiotensin II receptor class, or both, even if blood pressure is not
really elevated much).
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

Blood pressure. Some people start having high blood pressure even in early chronic renal
failure. IgAN is one kidney disease that can do this.
Anemia.  Anemia may rarely occur at this stage. In this case, it is most often caused by having
heavy proteinuria rather than actual chronic renal insufficiency.

Advanced chronic renal insufficiency (Stages 3 to 4)

 Physical symptoms

You may still feel completely normal at this stage, or you may begin to experience one or more of the
following symptoms:

Serum creatinine. Serum creatinine will be higher (indicating less than 30% kidney
function)
Tiredness or fatigue
Puffiness or swelling (obvious in the hands or feet and ankles, but the puffiness will
often first be seen around the eyes). 
Back pain. Usually felt as a dull ache anywhere in the mid-to-lower portion of the back,
on one side or the other - this is sometimes referred to as flank pain, or loin pain)
Appetite. Changes in appetite or eating pattern. Foods may start tasting "funny".
Urine. Changes in urination (amount, colour, frequency). Urine may in fact look
exceptionally clear at this point, rather than abnormal. This is because little is actually
being filtered into it by your kidneys. Previously high proteinuria and/or hematuria may
actually improve.
Blood pressure. High blood pressure (also referred to as hypertension)
Digestion. Poor digestion (varying degrees of gastroparesis, which means that digestion
is slowed).

 Treatment

Diet. Dietary changes may be ordered (renal diet: low protein, low potassium, low
phosphorus, low sodium, higher calorie)
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

Medication

 High blood pressure medications. It's common to need more than one at this
stage, and often 3 or more.
 Other drugs/supplements. May be prescribed if needed, such as vitamin D analog
(calcitriol is a common one), renal vitamins (not a regular multi-vitamin, as these
contain too much vitamin A for the typical advanced renal insufficiency patient).
Drugs for controlling heavy proteinuria if necessary (note that heavier proteinuria
does not automatically follow with more advanced chronic renal insufficiency).
 Phosphorus binder. You may be asked to begin taking a calcium supplement with
meals as a phosphorus binder (or a medication may be prescribed instead of or in
addition to calcium).

End-stage renal failure (or late chronic renal insufficiency)

The terms end-stage renal failure and end-stage renal disease are used interchangeably, and the
abbreviation ESRD is commonly used. Typically, patients will have kidney function in the area of 10-15%
or so. These are the common symptoms you may experience at this stage (and some people may start
experiencing some of these earlier):

 Symptoms

anemia (may begin earlier than this)

easy bleeding and bruising
headache
fatigue and drowsy feeling (more than normal or usual for you)
weakness
mental symptoms such as lowered mental alertness, trouble concentrating, confusion,
seizures
nausea, vomiting, and generally less desire to eat
thirst
muscle cramps, muscle twitching
nocturia (night-time urination)
numb sensation in the extremities
diarrhea
itchy skin, itchy eyes
skin colour changes (grayish complexion, sometimes yellowish-brownish tone)
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

swelling and puffiness (more than you had while in advanced renal failure, and most
likely in the feet and/or ankles)
difficulty breathing (due to fluid in the lungs, anemia)
high blood pressure (with IgAN, you may already have had this since the early stages)
decreased sexual interest
changes in menstrual cycle (and difficulty getting pregnant)
decreased urine output (however, you should be aware that some people with ESRD will
continue to get rid of water as urine, but not wastes - therefore, the urine may be very
clear and normal-looking, and some may have increased urine output rather than
decreased).
poor digestion (varying degrees of gastroparesis).

 Treatment

Dialysis
Kidney transplant

COPD, or chronic obstructive pulmonary disease, is a progressive disease that

makes it hard to breathe. "Progressive" means the disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus (a slimy substance), wheezing,
shortness of breath, chest tightness, and other symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have COPD smoke or used to smoke.
Long-term exposure to other lung irritants, such as air pollution, chemical fumes, or dust, also may
contribute to COPD.

Signs and Symptoms

An ongoing cough or a cough that produces large amounts of mucus (often called "smoker's
cough")
Shortness of breath, especially with physical activity
Wheezing (a whistling or squeaky sound when you breathe)
Chest tightness
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

Treatment

Quit smoking

Medicines

Bronchodilators

Bronchodilators relax the muscles around your airways. This helps open your airways and makes
breathing easier.

Inhaled Glucocorticosteroids (Steroids)

Inhaled steroids are used to treat people whose COPD symptoms flare up or worsen. These
medicines may reduce airway inflammation. Your doctor may ask you to try inhaled steroids for a
trial period of 6 weeks to 3 months to see whether the medicine helps relieve your breathing
problems.

Vaccines

 Flu Shots

The flu (influenza) can cause serious problems for people who have COPD. Flu shots can
reduce your risk of the flu. Talk with your doctor about getting a yearly flu shot.

 Pneumococcal Vaccine

This vaccine lowers your risk of pneumococcal pneumonia  and its complications. People
who have COPD are at higher risk of pneumonia than people who don't have COPD. Talk with
your doctor about whether you should get this vaccine.

Pulmonary Rehabilitation

Pulmonary rehabilitation, or rehab, is a medically supervised program that helps improve the health
and well-being of people who have lung problems.

Oxygen Therapy

If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe
better. For this treatment, you're given oxygen through nasal prongs or a mask.
DE JESUS, Flor Anne D.
BSN 112/ Group 46

C.A.
92y/o
T/C RENAL INSUFFICIENCY, COPD WITH ACUTE EXACERBATION

You may need extra oxygen all the time or just sometimes. For some people who have severe COPD,
using extra oxygen for most of the day can help them:

 Do tasks or activities, while having fewer symptoms

 Protect their hearts and other organs from damage
 Sleep more during the night and improve alertness during the day
 Live longer

Surgery

In rare cases, surgery may benefit some people who have COPD. Surgery usually is a last resort for
people who have severe symptoms that have not improved from taking medicines.

Surgeries for people who have COPD that's mainly related to emphysema include bullectomy and lung
volume reduction surgery (LVRS). A lung transplant may be done for people who have very severe COPD.

Bullectomy

When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces
can become so large that they interfere with breathing. In a bullectomy, doctors remove one or
more very large bullae from the lungs.

Lung Volume Reduction Surgery

In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In
carefully selected patients, LVRS can improve breathing and quality of life.