Has chronic kidney disease. Diagnosed with hypertension. Suffer nausea and vomiting. Urine show high protein. Link between the both?

Yn47



RENAL CASE STUDY


XXXXXXX is 70 years old and has chronic kidney disease. He worked as a trade


person as well as manual labourer, often smoking during outdoor work, as he


mainly worked alone. In addition, XXXXXXX drinks heavily and consumes at least 16


cans of beer each night.


XXXXXXX was diagnosed with hypertension 15 years ago and his medication dosage


has increased over that time. More recently, he has been short of breath, has


periods of nausea and vomiting, and has been generally tired.


At a check-up with Nick’s renal specialist, it is found that XXXXXXX has large


concentrations of protein in his urine, his creatinine level is 500 mmol/L and his


estimated GFR is only 11 mL/min. The specialist recommends that XXXXXXX


commences dialysis.


Case questions:


1 Provide a rationale for the strong link between cardiovascular disease and


chronic kidney disease.


2 Discuss the lifestyle choices that XXXXXXX has taken that have contributed to the


development and progression of chronic kidney disease.


3 Describe why Nick’s symptoms (nausea, vomiting, tiredness) have arisen


now.


4 Explain how dialysis performs some of the functions of the kidneys.

Please elaborate in detail.




Brief Answer:
Kindly view the details

Detailed Answer:
Dear XXXXXXX

Thanks for the query.

1. Studies have shown a strong relationship between chronic kidney disease (CKD) and accelerated cardiovascular disease, a condition known as the Cardiorenal syndrome.
Various pathological mechanisms are involved such as accelerated calcific occlusive atheromatosis, diffuse non-occlusive medial wall calcification, endothelial dysfunction, and uremic cardiomyopathy.
Also Kidneys play an important role in regulation of blood pressure through Renin-Angiotensin mechanism which is affected in chronic kidney disease. And the reverse is also true as long standing hypertension is a major risk factor in developing chronic kidney failure and the mechanism is regulated by renin-angiotension mechanism, and decreased renal perfusion due to differential blood flow. Hypertensive nephropathy is a well understood and well studied entity.

2. As revealed from the case history, the lifestyle choices that have contributed to development of and progression of chronic kidney disease includes smoking & alcohol consumption.
Studies have shown increased incidences of chronic kidney disease in individuals with such risk factors.
Nicotine present in tobacco causes constriction of blood vessels in kidneys & also damages the renal parenchyma.
Alcohol has direct effect on renal tubular function & also affects indirectly by interfering with the Lipid levels.

3. Due to failure of function of the kidneys to excrete out the body waste, there is a build up of waste products of metabolism in the body (a condition known as Uremia).
This explains Nick’s present symptoms like nausea, vomiting & tiredness.

4. During Dialysis, we try to artificially remove the waste products of metabolism & excess water from the blood using the principles of the diffusion of solutes and ultra-filtration of fluid across a semi-permeable membrane by passing the blood through the Haemodialysis machine.
In this way dialysis performs some of the functions of the kidneys.

Hope I have been able to answer your queries.
Please let me know if I need to clarify further.
Take care.



Above answer was peer-reviewed by






Dr. Yogesh D











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