Case Study 6
Acute Renal Injury and Chronic Kidney Disease
Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary.
- What is the difference between azotemia and uremia?
- Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
- Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
- 4 – 5 pages with reference page
- Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?
Requirements
- Make sure all of the topics in the case study have been addressed.
- Cite at least three sources; journal articles, textbooks or evidenced-based websites to support the content.
- All sources must be within five years.
- Do not use .com, Wikipedia, or up-to-date, etc., for your sources.
Expert Solution Preview
Introduction:
This case study focuses on a 68-year-old male with a history of hypertension and ESRD who is undergoing regular dialysis therapy. The patient presents with symptoms such as polyuria, nocturia, hypertension, loss of appetite, weakness, fatigue, and edema around his ankles. This case study poses some questions that need to be addressed to understand the patient’s condition and develop an effective treatment plan.
1. What is the difference between azotemia and uremia?
Azotemia and uremia are two related but separate concepts. Azotemia refers to the accumulation of nitrogenous waste products in the blood due to impaired kidney function. It is characterized by elevated levels of urea and creatinine. Uremia, on the other hand, is a clinical syndrome that occurs when azotemia becomes severe enough to cause a range of symptoms such as fatigue, nausea, vomiting, and pruritus. Uremia is an indication for renal replacement therapy such as dialysis.
2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
When the kidneys are impaired, they are unable to excrete nitrogenous waste products effectively. Protein metabolism produces a significant amount of these waste products, and a high protein diet can exacerbate azotemia in patients with kidney disease. Therefore, a low protein diet is often recommended for patients with kidney disease to reduce the accumulation of nitrogenous waste products in the body and slow the progression of kidney damage.
3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
Anemia is a common complication of kidney disease. In the kidneys, erythropoietin is produced, which stimulates the production of red blood cells in the bone marrow. However, in patients with kidney disease, the production of erythropoietin is reduced, leading to decreased red blood cell production and anemia. Dialysis itself can also contribute to anemia due to blood loss during the procedure.
4. 4 – 5 pages with reference page.
This requirement asks for a 4-5 page paper addressing all the topics presented in the case study. The paper must include a reference page citing at least three sources such as journal articles, textbooks, or evidenced-based websites. All sources must be within five years, and it is expected that the paper will not use unreliable sources such as up-to-date.com, Wikipedia, or .com sources.
5. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?
Patients with ESRD are at an increased risk of cardiovascular disease due to a variety of factors, including hypertension and electrolyte imbalances. Left ventricular dysfunction is a common complication of cardiovascular disease that can occur in patients with kidney disease. It is characterized by a decrease in the ejection fraction of the left ventricle and can lead to heart failure. Left ventricular dysfunction is a concern for Will’s physician because it could exacerbate his symptoms of fatigue, weakness, and edema and could potentially lead to more severe complications such as myocardial infarction or stroke.
