Acute Kidney Injury and Chronic Kidney Disease
Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary (Chapter 34, Learning Objectives 1 to 4).
- What is the difference between azotemia and uremia?
- Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
- Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
- Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?
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Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are two different conditions that affect the kidneys’ ability to function properly. AKI is a sudden and rapid loss of kidney function, while CKD is a gradual loss of kidney function over time. Both conditions can be caused by various factors such as hypertension, diabetes, and medication toxicity.
In Will’s case, he was diagnosed with End-Stage Renal Disease (ESRD), which is a severe form of CKD. He had symptoms such as polyuria, nocturia, difficulty managing his hypertension, loss of appetite, weakness, fatigue, and edema around his ankles. Eventually, he needed to start regular dialysis therapy to manage his symptoms.
Azotemia is an increase in blood urea nitrogen (BUN) and creatinine levels, which are waste products that the kidneys usually excrete. Uremia is a condition where high levels of waste products accumulate in the bloodstream due to decreased kidney function. This accumulation of waste products can lead to various symptoms such as weakness, fatigue, and edema.
Will’s physician warned him about his diet because protein breakdown produces waste products such as BUN and creatinine, which the kidneys usually excrete. High protein intake can increase the workload on the kidneys, leading to further damage and decreased kidney function.
Will’s anemia is likely due to a decrease in erythropoietin production by the kidneys. Erythropoietin is a hormone produced by the kidneys that stimulates the bone marrow to produce red blood cells. In CKD, there is a decrease in erythropoietin production, leading to anemia.
Left ventricular dysfunction is a concern for Will’s physician because CKD can lead to fluid overload, which can put a strain on the heart. This strain can lead to left ventricular dysfunction, which can further exacerbate the fluid overload and lead to heart failure.
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2022). Pathophysiology: The biologic basis for disease in adults and children (9th ed.). Elsevier.