ELECTROLYTE IMBALANCE AND RENAL FAILURE

By Ali raza ( BS Biochemistry)

ELECTROLYTE IMBALANCE AND RENAL FAILURE

https://www.google.com/search?q=kidney&sxsrf=ALeKk00XppOpYo5lXSBPyPsTlgNkeCmbNg:1594284500920&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjXj-TK5L_qAhU_A2MBHYAxCG8Q_AUoAXoECBAQAw#imgrc=BztLMugT9BNRCM

Abstract

The kidney is responsible for electrolyte balancing by filtering blood and excreting components to keep homeostasis in the body. kidney failure and derangements of electrolytes lead to worse conditions for patients. Chronic kidney disease (CKD) has become a worldwide problem. Electrolyte derangements are a significant cause of morbidity and mortality in renal disease patients. Proper diagnosis and treatment will minimize complications.

Introduction

The role of the kidneys in maintaining the balance of fluid and electrolytes in the blood becomes clear when considering the outcomes on electrolytes in patients with acute renal failure.CKD has become a global problem with an estimated prevalence increased from 12 % to 14 % throughout the world. It leads to end-stage kidney disease and decreased the survival rate by increasing cardiovascular risks. CKD predictably results in sodium, magnesium, potassium imbalance which results in severe consequences. Patients with CKD present in miserable conditions and need to manage the electrolyte imbalance for the recovery of the patient. The electrolyte imbalance is corrected by dialysis. About 30 % of patients who experience CKD will require renal replacement therapy which includes dialysis and kidney transplant.

ELECTROLYTES	NORMAL VALUES
Sodium	136-146 mmol/L
Magnesium	1.5-2.5 mmol/L
Potassium	3.5-4.5 mmol/L

 

Electrolytes Imbalance

Main electrolytes which are the reason for renal failure are sodium, magnesium and potassium imbalances or derangements.

Sodium Imbalance

Hyponatremia (Na < 136 mmol/L) is a more common electrolyte disorder which affects up to 30 % of patients. Hypernatremia (Na > 146 mmol/L) is less common which affects only up to 4 % of patients. CKD patients are at risk of hyponatremia due to dilute urine. The limited nutritional intake leads to Na imbalance.

Hyponatremia is dilution due to excess water intake in a dialysis patient. Hyponatremia indicates Na excess loss which represents dilutional hyponatremia after administration of mannitol and colloidal solutions. Hyponatremia patients rely on the use of intravenous sodium-containing fluids (normal saline or hypertonic saline) and fluid restriction.

Hypernatremia is due to a lack of access to water. Administration of hypertonic saline and sodium bicarbonate contribute to hypernatremia. Patients should be given intravenous 5% dextrose for acute hypernatremia or half-normal saline (0.45% sodium chloride) for chronic hypernatremia if unable to tolerate oral water.

Magnesium Imbalance

Serum magnesium may increase in severe renal failure. Because the kidney is involved in magnesium excretion. Hypomagnesemia and hypermagnesemia are occurring in patients with reduced glomerular filtration rate (GFR). Supplemental magnesium should be avoided in this condition. Hypokalemia may be refractory to therapy if hypomagnesemia is present. Mg containing medications contribute to hypermagnesemia in kidney dysfunction. In dialysis patients, serum Mg is often affected by Mg content. Hypo and hypermagnesemia exert mortality in CKD patients. Proper care helps in the correction of Mg imbalance. Treatment includes IV administration of calcium gluconate and possibly furosemide; hemodialysis can be helpful in severe cases.

Potassium Imbalance

CKD leads to K imbalance which increased risks to cardiovascular risks and mortality. The excess of potassium is hyperkalemia. Hyperkalemia should be differentiated from pseudo-hyperkalemia which is caused by hemolysis. High intake of K and induced defects in K excretion cause hyperkalemia which is the reason for renal failure. In patients with implanting cardioverter with severe hyperkalemia leads to triggering of serious shock. Hyperkalemia leads to stop the use of lifesaving therapies for CKD i.e. renin-aldosterone-angiotensin inhibitor. Therapeutic options for hyperkalemia are low K diet, beta-agonist albuterol, patiromer, and thiazide diuretics.

The shortage of K is hypokalemia. Excessive renal wasting associated with polyuria, alkalemia which causes the excretion of K out of cells in response to H⁺ translocation, gastrointestinal K loss from diarrhea and vomiting, etc. are causes of hypokalemia. Hypokalemia leads to CKD and cardiovascular complications. Hypokalemia leads to renal failure and ventricular arrhythmias which increase the mortality rate. Judicious K supplementation requires for hypokalemia treatment. Hospitalized cannot take orally K so via dialysis this process can manage.

Conclusion

Electrolyte imbalance or derangements cause kidney dysfunction which leads to morbidity or mortality. Sodium imbalance is with diluted and concentrated urine. Magnesium imbalance occurs mainly due to reduced GRF. Potassium imbalance is linked to cardiac failure in CKD patients. Normal usage of electrolytes is important because excess and insufficient amounts both cause diseases. Careful fluid therapy and dialysis are a careful treatment which prevents from CKD or renal failure. New effective agents such as patiromer have the potential to improve patient outcomes.

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 Author's Details

Ali Raza
BS (Hons.)
Department of Biochemistry, GC University, Faisalabad.

Reviewed & Edited by

M.Ahsan ul haq 1, Munazza Ijaz 2

1,2 M.Phil Scholar

1Department of Biochemistry, GC University, Faisalabad.

2Department of biotechnology and bioinformatics,GC University, Faisalabad.