A 23-year-old male felt “puffy”, weak, and tired for several months. He suddenly

Question

A 23-year-old male felt “puffy”, weak, and tired for several months. He suddenly noticed his urine had a red to brown discoloration and the volume was minimal. He went to the emergency room of a nearby hospital and the following data were obtained upon examination and testing: Hematology Serum Sodium 125 mEq/L 136 – 145 Serum Potassium 6 mEq/L 3.6 – 5.1 Serum Creatinine 2.6 mg/dL 0.7 – 1.3 BUN 24.0 mg/dL 7 – 18 pH (arterial) 7.32 7.35 – 7.45 Hematocrit 25% 40 – 54% Urinalysis Appearance Red to Brown Specific Gravity 1.025 1.023 – 1.029 Blood Positive Negative Glucose Negative Negative Protein Mild Mild Renal Function Tests Glomerular Filtration Rate (GFR) 40 mL/min 125 mL/min Renal Blood Flow (RBF) 280 mL/min 1,200 ml/min 1. What is the disorder of this individual? 2. What situation(s) predispose an individual to this disorder? 3. Define hyponatremia and hyperkalemia. Hyperkalemia is a higher than normal Potassium (K) level found in the blood Hyponatremia is lower the normal levels of sodium in the blood 4. What is the cause of the hyponatremia and hyperkalemia? 5. Why is there blood in the urine? 6. How do the renal function tests for this individual compare to normal? 7. What has causes the “puffy” feeling this individual describes? 8. What type of treatment does this individual need? 9. Is this person a candidate for kidney dialysis or kidney transplantation? Explain your answer.

Explanation / Answer

This individual has chronic kidney failure disease

The chronic kidney failure is possibly due to an obstruction of the ureter or the renal arteries or due to the kidney infection or renal tumors.

Hyponatremia is defined as a serum sodium <135 meq/l.

Hyperkalemia is a serum potassium concentration > 5.5 mEq/L, usually resulting from decreased renal potassium excretion or abnormal movement of potassium out of cells. There are usually several simultaneous contributing factors, including increased potassium intake, drugs that impair renal potassium excretion, and acute kidney injury or chronic kidney disease. Hyperkalemia can also occur in metabolic acidosis as in diabetic ketoacidosis. Clinical manifestations are generally neuromuscular, resulting in muscle weakness and cardiac toxicity that, when severe, can degenerate to ventricular fibrillation or asystole. Diagnosis is by measuring serum potassium. Treatment may involve decreasing potassium intake, adjusting drugs, giving a cation exchange resin and, in emergencies, giving calcium gluconate, insulin, and dialysis.

Hyperkalemia is a higher than normal Potassium (K) level found in the blood Hyponatremia is lower the normal levels of sodium in the blood

The hyponatremia is caused by the volume dilution. The hyperkalemia may be caused by the cellular breakdown or may be due to dietary sources of potassium ( meat vegetables fruits). there may also be tubular dysfunction especially at the aldosterone site of the distal tubule of nephron.

The blood in the urine may be because of the glomerular disease ( altered porosity of the glomerular membrane ; damage to the glomerular tuft) or may occur from the ction of tubular enzyme that degrade red blood cells.

The renal function tests for this individual revealed significant reduction in the renal blood flow (23% of normal) and marked reduction in GFR (33%) of normal.

The puffy feeling to this individual is because of the fluid retention from the decreased RBF and GFR.

The treatment plan for this individual should be decide only after determining the cause of chronic renal failure in this individual. Until determining the cause of the renal failure this individual should be monitor for the dietary and fluid intake need.Reduced dietary protein (to reduced nitrogenous waste production) with sufficient carbohydrate and fat to meet energy and requirements and prevent ketosis or muscle wasting is recommended. Water intake should be controlled to maintain to serum of 135-145 mEq/L. sodium should be restricted or permitted depending on whether the individual is accumulating or losing the sodium.

The cause of the renal failure need to be determined first and then only should be treated specifically. Until determining the cause of the renal failure this individual should be monitor for the dietary and fluid intake need.Reduced dietary protein (to reduced nitrogenous waste production) with sufficient carbohydrate and fat to meet energy and requirements and prevent ketosis or muscle wasting is recommended. Water intake should be controlled to maintain to serum of 135-145 mEq/L. sodium should be restricted or permitted depending on whether the individual is accumulating or losing the sodium. Fluid and dietary may be enough to support this individual through the diagnosis and treatment. or else intermittent dialysis may be necessary.

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