Chronic Kidney Disease: Pathology and Biochemistry

Chronic Kidney Disease: Pathology and Biochemistry The kidneys are a pair of organs that function to removing metabolic wastes like urea, carbon dioxide, salts, and chemicals from the blood and excreting these wastes as urine. Kidneys also regulate the concentration of body fluids and electrolyte concentrations, arterial pressure, secretion/excretion of hormones and acid-base balance of body fluids (Guyton Hall, 2005). The main functional filtering unit of the kidney is the nephron. At least 800 thousand nephrons are in one kidney. The initial filtering unit in the nephron is the glomerulus, and the filtrates coming from the glomerulus are formed into urine as it passes the other components in the nephron. Diseases in the kidney cause a significant number of deaths and disabilities worldwide (Coresh, et al., 2007). Acute renal failure is manifested by the kidneys abruptly stopping, although the chance exists that the kidneys could recover, while in chronic kidney disease there is a progressive decline in the function of the nephrons. More specifically, chronic kidney disease is defined as damaged or decreased kidney function measured by a decrease in the glomerular filtration rate (GFR) for a period or three or more months (Levey, et al., 2003). Initial damage to the nephron results in compensatory responses of the remaining nephrons allowing for the continuation of clearance of blood solutes. The compensatory action of the nephrons during early damage is thought to be a major cause of renal damage, because during compensation the glomerular capillary pressure is increased so much that damages are incurred leading to lesions in the glomeruli (Arora Verelli, 2010). Chronic kidney disea se is also caused by hypertension, diabetes, disorders in blood vessels and glomeruli, infections, immune system disorders, congenital disorders, and urinary tract obstructions (Guyton Hall, 2005). Clinical symptoms for chronic kidney disease are not evident until the number of functional nephrons decreases by 70-75% (Guyton Hall, 2005). The progressive deterioration in kidney function could ultimately lead to end-stage renal disease where the patient must undergo dialysis to remove wastes from the blood, or transplanted with a new kidney. Chronic kidney disease has 5 stages based on the GFR (National Kidney Foundation, 2002). Patients with the stage 1-3 of the disease do not show symptoms. At stage 4-5 electrolyte balance and endocrine disorders become evident. It is believed that the uremic disorders observed at stage 5 are due to the accumulation of toxins (Arora Verelli, 2010). Increased retention of potassium (hyperkalemia) occurs due to inability of the kidneys to excrete potassium. Metabolic acidosis results from the inability of the kidneys to produce enough ammonia necessary to react with the endogenous acid and produce ammonium. Phosphates, sulphates, and other organic anions accumulate, causing large anion gaps. Metabolic acidosis increases protein degradation and amino acid oxidation, and reduces albumin synthesis, resulting in protein-energy malnutrition, decreased body mass, and increased muscle weakness. Acidosis also interferes with Vitamin D metabolism and mineral imbalance resulting in renal osteodys trophy or renal bone disease. Renal bone disease can be averted with timely dietary measures and medications like phosphate binders and calcitriol (Renal Resource Center, 2007). Skeletal and extraskeletal complications result from the progression of renal bone disease. In chronic kidney disease, renal bone disease is categorized into four general types: (1) low turnover disease or defective mineralization; (2) high turnover bone disease brought about by high levels of the parathyroid hormone (PTH) levels; (3) beta-2-microglobulin associated bone disease; and (4) mixture of the 3 diseases (Arora Verelli, 2010). Diagnosis and management of chronic kidney disease Chronic kidney disease is diagnosed by laboratory tests on urine and serum. Serum creatinine as an estimate of glomerular filtration rate, albumin-creatinine ratio in the urine, and examination of urine sediment and dipstick test for erythrocytes and leukocytes are recommended (Levey, et al., 2003). Image analysis by ultrasound can be performed for patients with symptoms of stones, infection, obstruction of the urinary tract and having a family medical history of polycystic kidney disease. Serum electrolytes should be measured on patients who are hypertensive, diabetic, and those who have been exposed to drug toxicity. Other tests include urinary concentration or dilution, and acidification for selected patients who present symptoms of polyuria, metabolic acidosis, metabolic alkalosis, hypo- and hyperkalemia (very high levels of potassium). Kidney function is assessed by analyzing serum creatinine along with a blood urea nitrogen test (Lab Tests Online, 2009). Creatinine clearance is an indication of the efficiency of the kidneys in filtering small molecules out of the blood. A traditional and principal marker of kidney damage is persistent or recurring proteinuria (Kean Eknoyan, 1999). Proteins are large molecules, and therefore they cannot pass the membranes of the glomeruli into the urine. Glomeruli, being negatively charged, also repel proteins. Size and charge barriers do not allow the passage of proteins into urine, unless the glomeruli are damaged (Proteinuria and microalbuminuria, 2007). Proteins can be measured using reagent strip tests for point of care detection and laboratory tests, including immunoassays (Carter, Tomson, Stevens, Lamb, 2006). When the protein level is more than 3500 milligrams, extensive glomeruli damage has already occurred. An albumin (or protein)-creatinine ratio higher than 30 mg albumin/g creatinine, is abnormal since the cut-off points are greater than 17 mg/g in males and more than 25 mg/g in females (Warram, Gearin, Laffel, Krolewski, 1996; (Jacobs, Murtaugh, Steffes, Yu, Roseman, Goetz, 2002). Glomerular filtration rate (GFR) is currently the best test for detecting kidney disorders. GFR is estimated using a formula that uses serum creatinine value, and gender, age and weight of individual. The GFR has been recommended to be the main criterion in classifying kidney disease. Five stages of chronic kidney diseases have been identified based on the glomerular filtration rate (GFR) (National Kidney Foundation, 2002). Kidney damage has been proposed with normal or increased GFR of > 90 mL/min per 1.73 m2, while kidneys have already failed when the GFR greatly decreased at Indications of chronic kidney disease are varied and diverse. Increase or decrease in levels of important electrolytes phosphate, potassium and calcium. Other indications are metabolic acidosis, pericarditis, malnutrition, neuropathies and cardiovascular complications (Shlipak, et al., 2005; Tonelli, et al., 2006). The treatment of chronic kidney disease depends on the stage of the disease and should focus on several important factors (Arora Verelli, 2010). The primary objective is to delay and halt the progression of the disease by treating the known underlying condition (e.g. hypertension, diabetes). Systolic blood pressure, hyperlipidemia, and glycemic levels must be controlled, and use of angiotensin receptor blockers is recommended. Pathologic symptoms should be treated as follows: anemia with erythropoietin; high phosphate levels with dietary means for binding and restricting phosphate binders; low calcium levels with supplements and hyperparathyroidism with vitamin D analogs or calcitriol (Arora Verelli, 2010). For uremic manifestations, dialysis and transplantation are recommended depending on the stage of the diseases, and the indications. Timely planning for renal transplantation is also necessary in order to prepare the patient. Reflection on module Chronic kidney disease is prevalent worldwide, with millions of people affected. The review conducted here shows that the disease has been well characterized with respect to the point-of- care and clinical tests for diagnosis. Chronic kidney disease affects the accumulation of ions in the blood therefore leading to a multitude of adverse conditions. The US National Kidney Foundation has spearheaded efforts to standardize and systematize the different stages, diagnostic approaches and treatment modalities. Apparently, chronic kidney disease results from other disorders. Therefore it can be prevented and corrected by first preventing and curing the underlying cause. This makes the nature of the disease complicated, and solutions are also complex. What is clear is that kidney disease is mostly a result of lifestyle, since most underlying causes like diabetes, cardiovascular disease, and hyperlipidemia are mostly due to lifestyles. A limitation in the publications that were reviewed was the lack of clear recommendations on how the onset of chronic kidney disease can be prevented, and what specific medications can lead to repair of the glomeruli and the nephrons after damage has occurred. Clearly, a patient with chronic kidney disease is saddled with the knowledge that a complete cure is not possible; and it only takes a matter of time for one to have the end-stage renal disease. The challenge for the medical community is to come up with a clear preventive strategy against kidney disease, and to have other long-term options aside from dialysis or organ transplantation.

MAR project team Essay

Strength Integrated Health consists a number of hospitals. Has an internal technology department – MIS. Has a large number of staff MAR project team is well rounded with technology. The institutions of Integrated Health are well known by the people in Tempe, Arizona. A non-profit organization, which means all the earned money minus the salary and daily operational costs of the institution, can be used for development. Weaknesses Utilizes manual processing of information. Low investment on automation. Chief Information Officer doesn’t have technical background. Some Directors doesn’t support automation and would rather have the traditional process. A large number of staff doesn’t agree with the change. Due to manual filings, specialists reported that patients endorsed to them doesn’t have files 30% of the time. Doesn’t have a change management process. MIS Staff are underestimated and their relevance is not clear to the whole organization Opportunities Lower of costs by investing on computerizing MAR. Can attract partnerships with insurance companies as they are becoming a trend. By investing in computerized MAR, less information would be missing or incorrect If medical tests would not be repeated unnecessarily, then operational costs can be lessen. Computer management of patient medication profiles offers the opportunity to enhance communication between pharmacists and nurses decrease medication errors and delays in delivery of therapy. enhance medication delivery accuracy and timeliness Threats If the computerized MAR is not implemented, insurance companies would not want to partner with Integrated Health. Increasing incorrect medical profiles of patients. If the computerized MAR is implemented, There will be dependence on its automation in the future and when it fails, operations will stop. Cost for further upgrades to fix bugs and improve services will be considered.

Disc Arthroplasty Essay

Degenerative disc disease have been a problem for many people as this disease brings about low back pain that seems to paralyze the working force,   the middle adulthood population (Smeltzer, 2004). Not only does it bring impaired quality of life to those who suffer from it, but Arvind Kulkarni adds large health care expenses to the list of problems brought about by this disease as seen in his article entitled Prosthetic Lumbar disc replacement for degenerative disc disease. Spinal fusion, which is the medical management for degenerative disc disease, has been criticized by several doctors in the practice due to its untoward effects in the patient’s overall recovery and lifetime improvement. Specialist in the field, Christoph Siepe, identified these unpleasant effects as accelerated adjacent system degeneration, pseudarthrosis, spinal canal stenosis, and donor site morbidity. Adjacent segment degeneration, as mentioned by Peter Ullrich in his article entitled Fusion versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease, stated that this is the major complication of spinal fusion and the reason why most surgeons want this procedure replaced. Adjacent segment degeneration or ASD happens when mechanical stress is transferred to the adjacent segment, also mentioned by Peter Ullrich. But research showed that this procedure can be modified to show more positive results. An anterior lumbar interbody fusion showed a low occurrence of revision surgery needed, which meant low frequency of adjacent segment degeneration, all pointed out in Mr. Ullrich’s paper.   However, to achieve this outcome, Mr. Ullrich declared that there should be an improvement in patient selection and in the procedure. The patients should be those patients having degenerative disc disease in their 5th lumbar to 1st sacral segment, because there is minimal motion at this level. By doing so, he states that fusing these segments do not change the patient’s mobility as much.   But not all are satisfied of this result. Doctors and specialists are continuously making efforts to totally changing the primary medical management for degenerative disc diseases. Studies have been conducted, and several replacement procedures were approved by the FDA. Peter Ullrich stated in his paper that the total disk replacement procedure was approved for medical use by the FDA in the year 2004 using the Charite artificial disc but for only one level of the spinal vertebrae, being the L4 – L5 or the L5 – S1. This is not the first time that a total or partial disc replacement was done. The history of this procedure was mentioned in an article in a website by Spine-Health that disc nucleus replacement was done first in 1955 by David Cleveland by injecting methyl-acrylic. Ever since then, there have two other FDA approved products aside from the Charite, the website Spine-Health states that the Prodisc was approved on August 2006 and the Kineflex lumbar on June 2005.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A total disc replacement is being described by Jose Reyna in his article, Advances in Artificial Disc Technology, as being composed of two pieces of plates made of metal that has teeth to be able to attach itself to the end plates of the vertebral bones above and below it. This means that the particular intervertebral disc that is causing pain has to be removed and replaced by an artificial disc. Several artificial discs have been developed by various manufacturers in the country and they only differ in design and composition. The Charite, as mentioned earlier, is made up of a unique sliding core with two metal alloy end plates. The Prodisc being based on spherical articulations is made up of cobalt chromium molybdenum alloy as stated in the website Spine-Health. Inventors Qi-Bin Bao and Paul Higham developed a hydrogel prosthetic nucleus made up of PVA powder and a solvent mixed together, as seen on the article, Hydrogel intervertebral disc nucleus with diminished lateral bulging. The total disc replacement procedure has its advantages and disadvantages. Even after some models being approved by the FDA, it is still being assessed thoroughly by specialists in the field. Charles Rosen and Douglas Kiester report poor results and complications in the total disc replacement procedure. As it was mentioned in their study, this procedure causes fractures, severe pain, dislocations, extrusion of the implant, facet joint degeneration, and unexplained radiculopathy. They attribute these substandard results to the fact that the center of rotation of segmented motion is erroneous. Jose Reyna Jr. also mentions several disadvantages of the procedure in his study, stating that the anterior approach to the surgery can cause injury to the aorta and the common iliac vessels, can cause retrograde ejaculation in men by injuring the superior hypogastric plexus, hemorrhage can result from the retroperitoneal approach, and infection can occur. However, he also stated some advantages, as this procedure is said to maintain range of motion in majority of the patients as a long-term outcome. There are still a lot of studies to be conducted, and patients to be experimented on. A three year study conducted by Christoph Siepe et al., entitled Clinical Results of Total Lumbar Disc Replacement With ProDisc II: Three-Year Results for Different Indications, intended to assess total disc replacement outcome in patients who actually underwent the operation. Their results showed that not all degenerative disc diseases can be treated with this medical management. The best outcome was seen in patients exhibiting degenerative disc disease condition plus soft disc herniation or nucleus pulposus prolapse. Outcome was measured against the patient’s improvement from their preoperative levels. There were inferior results from the patients who had bisegmental damages, and a higher complication rate. Also it was mentioned that the younger patients, more specifically those aged below forty exhibited better outcome than those older than forty. Technology like this is still being developed, studied and modified as we speak. What is important is that there are people out there who care and who try to make a difference, whether it is by inventing, criticizing or being the experimental person wherein these new devices will be made a reality. References Charles Rosen, Douglas Kiester, Thay Q. Lee: The Potential Biomechanical Etiology for Lumbar Disc Replacement Failures: Review of 24 Patients and the Rationale for Revision . The Internet Journal of Minimally Invasive Spinal Technology. 2007. Volume 1 Number 2. Medscape. (2002). Advance in Artificial Disc Technology. Retrieved January 22, 2008 from http://www.medscape.com/viewarticle/445057 Medscape. (2002). Clinical Results of Total Lumbar Disc Replacement With ProDisc II: Three-Year Results for Different Indications. Retrieved January 22, 2008 from http://www.medscape.com/viewarticle/542479 Neurology India. (2005). Prosthetic Lumbar disc replacement for degenerative disc disease. Retrieved January 22, 2008 from http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2005;volume=53;issue=4;spage=499;epage=505;aulast=Kulkarni Neurospine. (no indicated year). Fusion versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease. Retrieved January 22, 2008 from http://www.neurospinewi.com/newsletters/fusionvsartificial.html Patent Storm. (1996). Hydrogel intervertebral disc nucleus with diminished lateral bulging. Retrieved January 22, 2008 from http://www.patentstorm.us/patents/5534028-fulltext.html Smeltzer, S. and Bare, B. (2004). Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins. Spine-Health. (1997-2007). Lumbar artificial disc surgery for chronic back pain. Retrieved January 22, 2008 from http://www.spine-health.com/research/discupdate/artificial/artificial01.html

Crystal Science Fair Project Tips and Ideas

Crystals can make interesting and fun science fair projects. The type of project depends on your educational level. Here are some examples of crystal science fair projects and ideas to help launch your own creativity in choosing your own project. Make a Collection Younger investigators may want to make a collection of crystals and work out their own method for grouping the crystals into categories.  Common crystals include salt, sugar, snowflakes, and quartz. What other crystals can you find? What are the similarities and differences between these crystals? What materials look like crystals, but really arent? (Hint: Glass doesnt have an ordered internal structure, so it isnt crystal.) Make a Model You can build models of crystal lattices. You can show how lattice subunits can grow into some of the crystal shapes taken by natural minerals. Prevent Crystal Growth Your project can involve ways you might prevent crystals from forming. For example, can you think of a way to keep crystals from forming in ice cream? Does the temperature of the ice cream matter? What happens as a result of freezing and thawing cycles? What effect do different ingredients have on the size and number of crystals that form? Grow Crystals Growing crystals is a fun way to explore your interest in chemistry and geology. In addition to growing crystals from kits, there are lots of types of crystals that can be grown from common household substances, such as sugar (sucrose), salt (sodium chloride), Epsom salts, borax, and alum. Sometimes its interesting to mix different materials to see what types of crystals result. For example, salt crystals look different when they are grown with vinegar. Can you figure out why? If you want a good science fair project, it would be better if you tested some aspect of growing crystals rather than simply growing pretty crystals and explaining the process. Here are some ideas for ways to turn a fun project into a great science fair or research project: How does the rate of evaporation of the crystal-growing medium affect the final size of the crystals? You can change the rate of evaporation by sealing the container (no evaporation at all if there is no air space) or by blowing a fan over the liquid or enclosing the jar of medium with a desiccant. Different places and seasons will have different humidities. The crystals grown in a desert may be different from those grown in a ​rainforest.You will usually heat water or another liquid to dissolve a solid to grow your crystals. Does the rate at which this liquid is cooled affect the way the crystals grow? You can compare crystals allowed to cool at room temperature to those formed from cooling the liquid in a refrigerator.What effect do additives have on the crystals? You could add food coloring, flavorings, or other impurities. How do crystals grown from non-iodized salt compare with those grown from iodized salt?What steps can you take to maximize crystal size? Developing a pr ocedure is a form of experimental science. You can affect parameters such as vibration, humidity, temperature, the rate of evaporation, purity of your growth medium, and time allowed for crystal growth. The type of container used to grow your crystals may make a difference, as could the type of string used to suspend a seed crystal (or other method used to grow a crystal). Are you changing containers when crystals start to grow that could compete with your seed crystal? There are lots of things to think about! Some may have a major effect on crystal growth and others may be negligible. Does light/dark effect growth? Probably not for a salt crystal, but it could for a substance that is degraded by visible radiation.If you are up for a challenge, you can make predictions about the shapes of crystals before you grow them, based on their molecular structures and molecular geometry.