The best practice to reduce the incidence of end stage renal disease (ERSD) is participating having a yearly health check on the functioning of the kidneys. The National Kidney Foundation recommends a KEEP check that comprises of a risk survey using the Body Mass Index Measurement and blood pressure levels and urine test for albumin for people at risk (National Kidney Foundation, 2014). I choose this practice because most of the patients presenting with ESRD are normally as a result of late diagnosis. Therefore, taking a KEEP test helps in the identification of individuals at risk and hence the institution of timely interventions to prevent further progression of the disease.
Glomerulonephritis can follow after a streptococcal infection. Such is as a result of an immune complex reaction to the streptococcal infection. The antibodies made to fight the bacteria normally bind to the bacterial antigens to initiate an immune response (NHS, 2016). However, the bacterial antigens then precipitate into the capillary beds of the glomerulus in the nephron. This initiates an inflammatory reaction that destroys the glomerular capillary network and basement membrane leading to glomerulonephritis.
According to J.Hs laboratory findings, he shows signs of worsening. The glomerulonephritis seems to be actively progressing to uremia. The findings show a significant elevation in Blood Urea Nitrogen (BUN) and creatinine. Also, the potassium level is elevated as a compensatory mechanism for metabolic acidosis. The low hematocrit is indicative of reduced erythrocyte production due to a deficiency in the hormone erythropoietin that is normally produced by the kidneys to stimulate the erythropoietic cells in the bone marrow (National Kidney Foundation, 2015). Finally, the low albumin levels and reduced sodium is indicative of progressive nephrosis causing the loss of protein in urine.
Additional laboratory values that would be helpful in the further management of J.H include the creatinine clearance as this provides a rough estimate of the glomerular filtration rate. Also, other tests such as urinalysis would help reveal the presence of protein in urine thus assess the degree of nephrosis (National Kidney Foundation, 2015). Serum calcium levels can help assess for signs of metabolic acidosis. Finally, physical examination can help identify the presence of edema due to low albumin levels and pruritus resulting from the accumulation of urea in the body (National Kidney Foundation, 2015).
The management of J.H would change in case of a deterioration of the condition from nephrosis to uremia. In nephrosis, it is recommended that J.H takes normal fluids as there is no problem with urine output. He also takes a high protein diet to promote healing. However, in uremia, J.H is advised to consume a low protein diet and fluid restriction is undertaken to prevent fluid overload and edema (National Kidney Foundation, 2015). Sodium restriction is also undertaken to prevent increased absorption of water causing fluid overload.
National Kidney Foundation. (2014). Do You Need a Kidney Health Check? The National Kidney Foundation. Retrieved 9 June 2016, from https://www.kidney.org/keephealthy
National Kidney Foundation. (2015). Glomerulonephritis. The National Kidney Foundation. Retrieved 9 June 2016, from https://www.kidney.org/atoz/content/glomerul
NHS,. (2016). Glomerulonephritis - NHS Choices. Nhs.uk. Retrieved 9 June 2016, from http://www.nhs.uk/Conditions/glomerulonephritis/Pages/introduction.aspx
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