Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts



Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts

QUESTION
A 41-year-old obese male patient is diagnosed with congestive heart failure (CHF). He is told to begin a moderate exercise routine with a healthy diet and is prescribed several medications — including a diuretic.

Based on your knowledge of the kidney and the disease of CHF, what factors would be important in selecting a specific diuretic? How would you explain to this patient how it works?
If this patient developed a disease that caused the renal blood flow to be diminished, how might this impact the medication he is taking for his congestive heart failure? As his health care provider, how would you change his treatment in this situation?
Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts

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Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts

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Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts
What factors would be necessary for selecting a specific diuretic? How would you explain to this patient how it works?
The cardiovascular and renal systems are closely related physiologically, where one system’s functioning affects the other (Ruocco et al., 2020). Congestive heart failure affects the ability of the heart to pump blood to different organs and parts of the body. It, therefore, results in decreased renal blood flow, which leads to stimulation of the sympathetic mechanism as a compensatory measure. The mainstay management for congestive heart failure aims to reduce the body’s fluid buildup by enhancing its excretion, a process facilitated by diuretics (Rossignol et al., 2019). The diuretic choice is influenced by how the patient presents. Loop diuretics are the commonly used diuretics in treating congestive heart failure since they inhibit sodium reabsorption in the thick ascending loop of Henle, enhancing diuresis. The administration of these diuretics has various systemic effects, which vary depending on the route of administration, dosage, and the underlying diseases and treatments. In the case of prescribing the diuretic to the patient, I will explain to him that there is a concern regarding kidney failure and how the use of the loop diuretics could cause hyperuricemia due to enhanced uric acid reabsorption (Kapelios et al., 2018).
How might this impact the medication he is taking for his congestive heart failure? As his health care provider, how would you change his treatment in this situation?
The primary aim of managing patients with congestive heart failure is to relieve them of the various symptoms, promote comfort, and improve their quality of life. The use of loop diuretics is effective in reducing the water retention in the body caused by CHF. However, it is not effective for use in patients with superimposed chronic kidney disease (Rossignol et al., 2019). Adding an ACE inhibitor to the treatment regimen or a thiazide diuretic will help minimize CHF complications, especially in patients with chronic kidney diseases. Thiazide diuretics help sustain a low-level diuresis for a long time, making them effective for patients with chronic kidney diseases (Rossignol et al., 2019).

References
Kapelios, C. J., Malliaras, K., Kaldara, E., Vakrou, S., & Nanas, J. N. (2018). Loop diuretics for chronic heart failure: a foe in disguise of a friend?. European Heart Journal–Cardiovascular Pharmacotherapy, 4(1), 54-63. https://academic.oup.com/ehjcvp/article-abstract/4/1/54/3870393
Rossignol, P., Hernandez, A. F., Solomon, S. D., & Zannad, F. (2019). Heart failure drug treatment. The Lancet, 393(10175), 1034-1044. https://www.sciencedirect.com/science/article/pii/S0140673618318087
Ruocco, G., Palazzuoli, A., & Ter Maaten, J. M. (2020). The role of the kidney in acute and chronic heart failure. Heart failure reviews, 25(1), 107-118. https://link.springer.com/article/10.1007/s10741-019-09870-6

Kidney and Fluid/Electrolyte Disorders and Health/Disease Concepts


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