Question

Case Scenario Juan is a 67 year old male with chronic kidney disease (CKD) stage 4 secondary to hypertension, which was undiagnosed for many years since he had not had regular checks with a medical provider. Family history includes father who died of stroke, and mother with type 2 diabetes currently on oral meds. He was referred for Medical Nutrition Therapy by his nephrologist who has seen him twice so far. The MNT service was approved for coverage based on Medicare guidelines. Patient is married with 1 adult child and 2 grandchildren in the home. Wife prepares most meals, traditional Mexican cuisine and he takes a prepared lunch when on the job as a construction worker. He is struggling to complete his tasks at work due to fatigue. He has not noticed a change in appetite, although some foods don't taste as good. Although he has some missing teeth, he reports that this does not affect his choice of foods or ability to eat. He does experience constipation more frequently. His diet is low in fiber and he indicates that he is more inactive or sedentary now then what just a year ago. Although he had not been accustomed to taking medications, his list now includes a diuretic, anti- hypertensives, statin, and sodium bicarbonate. He says he was advised by his primary care physician to decrease salt in his diet but his wife has struggled to adjust her cooking to restrict use of salt.

a) Using lay language (non-scientific), describe in a short statement (2-3 sentence) what is CKD to Juan and his family; b) From the lab values provided, calculate Juan’s glomerular filtration rate (GFR) and justify the need for dialysis; c) Explain to the patient and family what is dialysis and why it may be important to consider dialysis

Answer 1

a) kidney disease is one of the illnesses whereby the kidney is unable to filter the waste products from the blood. The word chronic means kidney damage starts slowly but prolongs over a long period of time. The main function of the kidney is to excrete the waste products and water from the body to balance the salts and minerals. The kidney is also responsible for regulating blood pressure.

b) calculating GFR

By cockgraft formula,

GFR = [(140 - age) x Weight in Kg] / Sr. creatinine x 72

GFR = [(140 - 67) x 70] / 2.4 x 72

GFR = 73 x 70 / 172.8

= 5110 / 172.8

GFR = 29.5mL/min.

GFR < 30mL/hr is considered as Stage 4 kidney disease. Dialysis or kidney transplant is the only option to prevent further complications.

C) If the kidney fails to function properly for a long period results in kidney failure. So the blood has to be purified using dialysis. Dialysis is a machine that will do the work of the kidney. It is necessary to maintain the health of the body and control blood pressure.