Question

Case study:

Mr. H., age 68 years, has a long history of hypertension. He has had more headaches recently, his legs and feet are swollen, and he has noticed that more frequent voiding, both during the day and at night, is necessary. He constantly feels tired and does not feel hungry. Mr. H.'s blood pressure is 170/110, his pulse is 94, and he has gained 12 pounds in the last 2 months. Diagnostic test findings related to the blood and urine include elevated serum creatinine and urea levels, low serum bicarbonate, low hemoglobin and hematocrit, and low serum sodium. The urine contains protein and has a very low specific gravity. The diagnosis is renal insufficiency, or chronic renal failure, due to nephrosclerosis.

1. Describe how nephrosclerosis leads to chronic renal failure.

2. Explain the cause of the edema and the weight gain.

3. State three factors contributing to fatigue.

4. Explain why Mr. H.:

a. is voiding frequently.

b. has a very dilute urine.

5. Explain why Mr. H. has:

a. high blood pressure.

b. anemia.

c. metabolic acidosis.

6. List the signs indicating that Mr. H. has progressed into uremia, or end-stage renal failure.

7. List three reasons why development of pneumonia is a high risk in Mr. H.

Answer 1

1) Nephrosclerosis leads to chronic renal failure as it caused the development of fibrosis which make the hardening of the kidney.It leads to chronic renal failure by two more way .

1. It causes by the diseases of the renal ateries that supply blood to the kidney .So affecting kidney continuously leads to chronic renal failure
2. In Nephrosclerosis main prevalence is hypertension and for longer duration of hypertension causes chronic renal failure.

2)Causes of edema and weight gain-

• Sodium retention in the body .
• Oliguria -urine output less than 300ml per day leads to hypervolemia .
• Overexpansion of the vasular compartment responsible for hemodynamic
• Glomerular damage leads to protein loss and increase resorption of sodium and water retention
• Hypoalbuminemia
• Increase venous pressure can progress to edema and weight gain.

3)Three factors contributing the fatigue:

1. Anemia
2. Disturbance in the levels of electrolytes in the blood
3. Chronic inflammation

4)-a- voiding more because of osmotic diuresis which is seen in diuretic phase as renal functioning getting deteriorate and kidney also unable to absorb water. B- urine is dilute because of hyponatremia and fluid retention.Also decrease the ability to concentrate urine.It can be because of osmotic diuresis also .

5)A-kidney unable to filter fluid and waste from the body,leading hypervolemia which cause hypertension.

B-formation of red blood cells by bone marrow decrease due to imbalance in the formation of erythropoietin (helps bone marrow in rbc) by the failure kidney cause anemia.

C-insufficient production of bicarbonate according to the acid present in our body leads to metabolic acidosis . As acidosis level increases in blood.

6) sign of end stage renal disease-

• Hypertension
• Weight gain
• Elevated creatinine level
• Low serum bicarbonate and sodium level
• Proteinuria
• Low specific gravity of urine
• Anaemia
• Increased heart rate

7) Reason which show pneumonia has a greater risk for Mr H

1. Infection which trigger the abnormalities of kidney
2. Fast heart rate