Chronically Challenged A Case Study about Chronic Renal Disease by Michelle LeBlanc
Patient History • 27 year old female who presented to the Emergency Room with the following symptoms: • Vomiting for 2 days • Dehydration • Sever migraine headache • Blood pressure 158 / 100 • Patient has a history of Chronic Renal Disease with nephrectomy and transplant one year prior
Questions to Consider • What complications are associated with Chronic Kidney Disease (CKD)? • How does CKD affect kidney function? • What are the symptoms of CKD? • What laboratory results correlate with kidney disease? • What is dialysis?
Diagnosis • Primary: Hypertensive (unspecified) renal disease with renal failure • Secondary: • Post-surgical dialysis • Anemia (based on Hgb and Hct result) • Migraine and fever • Iron metabolism disorder (based on Iron & Saturation results) • Anterior pituitary hyperfunction (based on Prolactin result) • Unspecified hypothyroid (based on TSH result) • Acquired absence of kidney (based on History)
Renal Function • The main function of a healthy kidney is to: • Help remove waste and excess fluid • Filter the blood, keeping some compounds while removing others • Control the production of red blood cells • Make vitamins that control growth • Release hormones that help regulate blood pressure • Help regulate blood pressure, red blood cells, and the amount of certain nutrients in the body, such as calcium and potassium.
Chronic Kidney Disease • Chronic kidney (or renal) disease occurs when the kidneys are no longer able to clean toxins and waste products from the blood and perform their functions to full capacity
Chronic Kidney Disease • Presently there are about 240,000 end stage renal disease patients in the United States with 200 cases per 1 million persons • The number one cause of renal disease is Diabetes Mellitus which is responsible for 40% of all kidney failure • High blood pressure (or hypertension) accounts for about 24% • CKD may be hereditary or likely acquired
What are the warning signs of kidney disease? • Although many forms of kidney disease do not produce symptoms until late into the course of the disease, there are six warning signs of kidney diseases: • High Blood Pressure • Blood and/or protein in the urine. • A creatinine blood test greater than 1.2 for women and 1.4 for men. • A filtration rate (GFR) less than 60 • More frequent urination, particularly at night; difficult or painful urination. Puffiness around eyes, swelling of hands and feet, especially in children.
What are the symptoms of chronic renal disease? • Changes in urination • Swelling of hands and feet • Fatique or weakness • Shortness of breath • Metallic taste in mouth • Back or flank pain • Loss of appetite • Nausea / vomiting
Evaluation of Renal Function • Examine circulating levels of: • Non-protein nitrogenous compounds (e.g, BUN and creatinine) • Glomerular filtration rate • Secretory capacity • Kidney’s reabsorptive capacity for water and electrolytes • Abnormal laboratory results: • Increased serum creatinine / BUN • Increased potassium and phosphorous • Abnormal thyroid and hormone levels secondary to renal insufficiency • Anemia
Treatment • Hemodialysis • Blood is pumped from the body to a special filter (or dialyzer) with two parts, one for blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. • Blood cells, protein and other important things remain in the blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away. • The purified blood is returned to the body.
Dietary Recommendations • Low protein • Low potassium / phosphorous
Kidney Transplant • Renal transplantation is considered an effective form of replacement therapy with a success rate of 80% survival after one year and 60% survival after 4 years. • Evaluation for transplant includes: • Measurement of general operative health • Full human leukocyte antigen tissue typing • Full screen for infectious diseases
Patient Outcome • Tests for Hereditary Hemochromatosis gene were negative and no pituitary tumor was detected • Patient was released after one week in the hospital • Discharged with a battery of 16 different medications!
Summary • Patient with a history of renal disease was admitted with vomiting, headache and high blood pressure • Many secondary complications due to renal disease and nephrectomy • Treatment upon discharge was to continue dialysis, follow a restricted diet, and continue on prescribed medications • Follow up visit scheduled for renal check and evaluation of hyperprolactinemia and hypothyroidism
References • Kidney Disease, Living with One Kidney, Dialysis - National Kidney Foundation, www.kidney.org, Last accessed 11/08/04. • Kidney and Urologic Diseases, National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), http://kidney.niddk.nih.gov/kudiseases/a-z.aspLast accessed 11/08/04.
Credits This case study was prepared by Michelle Leblanc, MT(ASCP) while she was a Medical Technology student in the 2004 MT Class at William Beaumont Hospital, Royal Oak, MI.