Introduction to Advanced Pathophysiology and Pharmacology
The knowledge of advanced pathophysiology is concerned with the comprehensive evaluation of an individual’s health status, identifying the early stage of disease throughout a patient’s life. Pharmacology entails the study of how medications impact biological systems, determining how the body responds to prescribed drugs. Across the lifespan, pharmacology will consider the relationships between the stages of life and the particular pharmacokinetic and pharmacodynamic characteristics that dictate considerations for disease management (Luu, Kayingo, & Hass, 2021). For each set of lifespan development, specific elements must be included in the decision-making process to identify appropriate pharmacologic therapy methods. When it comes to diseases characterized by altered cells and tissues, both advanced pathophysiology and pharmacology across the lifespan are essential because they will allow for adjusting treatment to the unique characteristics of the patient.
Analysis of a Chronic Disease Across the Lifespan
While many chronic diseases affecting cells and tissues develop as people age, chronic kidney disease could affect individuals of all ages. Kidney disease represents the loss of functioning of the organ, which can exacerbate chronic kidney disease (CKD), which worsens over time. It should be noted that such prerequisite factors as high blood pressure and diabetes increase the risks of CKD development. While there is no cure to eliminate CKD, some steps can be taken to preserve kidney function for as long as possible. Kidney disease that reaches the late stages of its progression tends to require dialysis or an organ transplant, which allows for improved well-being.
Pharmacological Treatment of the Chronic Disease
In contrast to diseases such as acute kidney injury (AKI), in which the process of healing is completed with the total functional recovery of the kidneys, chronic and sustained damage caused to the tissue and cells of the kidney combines over time. The progressive nephropathies progress into kidney fibrosis and the destruction of the kidneys’ normal architecture. The effects occur in all organ compartments, such as glomeruli, tubules, interstitium, and vessels (Mayo Clinic Staff, 2023).
Histologically, the destruction of the kidneys shows as “glomerulosclerosis, tubulointerstitial fibrosis, and vascular sclerosis” (Mayo Clinic Staff, 2023, para. 4). Therefore, the cells and tissues that form kidneys are unable to sustain their functions, which leads to the deterioration of the organ.
It should be noted that the sequence of events that result in scarring and fibrosis of the kidneys is complicated due to overlapping processes and multistage phenomena. It is common for damaged kidneys to experience infiltration with the subsequent extrinsic inflammation of the cells. Later, the activation, proliferation, and loss of intrinsic renal cells occur due to such processes as apoptosis, necrosis, mesangiolysis, and podocytopenia (Mayo Clinic Staff, 2023). The next series of events includes the proliferation and activation of the organ’s extracellular matrix that produces cells such as fibroblasts and myofibroblasts (Mayo Clinic Staff, 2023). Finally, extracellular matrix deposition occurs, thus replacing the organ’s normal architecture and functioning.
Finally, it is important to mention the mechanisms that accelerate the development of CKD. Specifically, it changes prostanoid metabolism, intrarenal precipitation of calcium phosphate, glomerular hypertrophy, and systematic and intraglomerular hypertension (Mayo Clinic Staff, 2023). All of the mentioned mechanisms result in the critical acceleration of CKD. In addition, environmental influences ranging from lead exposure to the taking of analgesic agents can all contribute to the progression of the disease.
Impact of Age on Disease Pathophysiology and Treatment
Differences in Disease Pathophysiology by Age Group
For children, the diagnosis of chronic kidney disease leads to further concerns such as controlling blood pressure, eating a healthy diet, and preventing anemia while also sustaining adequate growth. The treatment starts with medication and dietary changes, as well as supplementation with vitamins. It should be noted that in children, the symptoms of chronic kidney failure may not manifest until 80% of the organ’s function is lost (KidsHealth Medical Experts, 2023).
After the disease has progressed, the symptoms in children can include extreme fatigue, nausea and vomiting, difficulty concentrating, and confusion. Besides, the build-up of fluid in the body as a result of poor kidney functioning causes swelling in the skin, congestion of fluid in the lungs, and higher blood pressure. At such a severe stage of kidney failure, the methods of treatment are the same as in adults and include either dialysis or transplantation.
Across the lifespan, CKD progresses to worse outcomes, especially as individuals get older. However, due to the different stages of chronic disease development and the ranging possibilities for treatment and well-being maintenance, the prognosis for patients of varied ages will be different. The excess mortality that has been linked to the failure of the organ as a result of CKD is due mainly to the rising risks of cardiovascular disease (Vallianou et al., 2019). Therefore, sustaining well-being before the possibility of an organ transplant is concerned with the management of blood pressure and sustaining all vital processes at optimal levels. If dialysis is performed, the expected remaining lifetime can also increase both for the adult and pediatric segments of the population; however, if transplantation is not performed, the projections on life expectancy tend to err on the side of pessimism (Neild, 2017).
Nevertheless, with the combination of available treatments and methods of sustaining CKD patients’ well-being, the trends in disease outcomes may improve slowly, which points to the possibility of making more optimistic projections on the disease.
Adapting Pharmacological Interventions for Children, Adults, and Older Adults
The treatment of chronic kidney diseases will vary depending on the age of the patient and the progression of the illness. Specifically, at late stages characterized by kidney failure, both children and adults will have to undergo dialysis and will be included on a waiting list for organ transplants. However, when the destruction of the organ has not reached critical stages, treatments may differ. For instance, some children, adolescents, and teenagers will be prescribed injectable medication intended for the treatment of anemia and growth failure.
Specifically, erythropoietin can increase the count of red blood cells, thus helping improve energy and activity in kids with chronic kidney disease. Moreover, with the help of treatment with human growth hormone injections, it is possible to sustain the normal growth of children with chronic kidney disease. In addition, helping children maintain an active lifestyle and ensuring they eat a nutritious diet can harm their well-being.
For adults, the combination of lifestyle changes and pharmaceutical treatment is administered before the implementation of dialysis. Importantly, it is necessary to address the causes of CKD in adults, such as high cholesterol, high blood pressure, and diabetes mellitus. Therefore, adults will be prescribed angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers to lower blood pressure and preserve the function of kidneys at the optimal level.
In addition, adults may be prone to swelling due to poor kidney functioning. Diuretics are usually prescribed to relieve swelling as they help balance out the fluids in the body. Moreover, medication for lowering cholesterol and supplementation with vitamin D and calcium are necessary for balancing cholesterol levels and protecting bones that can weaken due to calcification (Mayo Clinic Staff, 2023). Finally, similar to recommendations made for younger people, a lower-protein diet is recommended for minimizing waste products in the blood, thus reducing the amount of work that kidneys must perform.
Dialysis and transplantation can be done in all patients who require them regardless of their age or stage of lifespan development. While dialysis in both children and adults enhances the work of the kidneys to clean the blood, it will not cure or fix the failure of the kidneys. In the majority of patients, the treatment through dialysis is considered a “bridge” to a kidney transplant (KT). The organ is being transplanted from a healthy person who has just died. In children, the procedure can harm their growth, bone strength, and nerves. However, due to differences in children’s and adults’ characteristics, pediatric KT requires further considerations, such as post-procedure complications, organ size mismatch, growth problems, and non-adherence to therapy (Cho, 2018).
In adults, there is no need to transfer post-KT care to caretakers, there are no challenges with growth, and the chances of non-adherence are lower. Chronic kidney disease is a comprehensive disorder affecting multiple processes in the body. If it occurs early in life, it can stunt human development and lead to adverse complications. However, many treatments align with younger and mature patients, and the implications can vary.
References
Cho M. H. (2018). Pediatric kidney transplantation is different from adult kidney transplantation. Korean Journal of Pediatrics, 61(7), 205–209. Web.
KidsHealth Medical Experts. (2023). Chronic kidney disease. Web.
Luu, B., Kayingo, G., & Hass, V. (2021). Advanced pharmacology for prescribers. Springer Publishing.
Mayo Clinic Staff. (2023). Chronic kidney disease. Web.
Neild G. H. (2017). Life expectancy with chronic kidney disease: An educational review. Pediatric Nephrology (Berlin, Germany), 32(2), 243–248. Web.
Vallianou, N. G., Mitesh, S., Gkogkou, A., & Geladari, E. (2019). Chronic kidney disease and cardiovascular disease: Is there any relationship?. Current Cardiology Reviews, 15(1), 55–63. Web.