Renal Case Study

A 51 year old Caucasian-American female present to the emergency department with a headache of 8 of 10 on a pain scale. She reported the headache as a pulsation in her ear that is typical when her blood pressure rises. She also reported accompanying visual blurring, intermittent chest pressure, non-exertional shortness of breath, and episodic abdominal pain with nausea. She reports not taking her Labetalol.

PMH: Type I DM since age 8 with history of impaired renal function that has continued to progress to a chronic stage and hypertension.
Family history: Positive for DM, hypertension, CAD and Cancer.
SH: Quit tobacco 5 years ago
Meds: Labetalol, Lasix 20mg qd prn, Lantus 20 units at hs, Protonix 40mg qd, ASA 81mg qd, and Tylenol prn

ROS:

• Constitutional: Denies fever or chills
• Eyes: Reports blurred vision, no floaters
• ENT: Denies sinus pressure or congestion, denies sore throat
• Respiratory: Denies cough, non-exertional dyspnea reported
• Cardiovascular: Admits intermittent chest pressure, denies palpitations

Physical Exam:

• General: Alert and oriented in no acute distress
• Vitals: T 36.7C, BP 193/98, HR-88, Weight 87.5kg
• Eyes: PERRLA, EOMI, moist mucus membranes
• Neck: supple, No JVD
• Lungs: CTA A&P
• Heart: RRR without MGR
• Abdomen: soft, non-distended, nromoactive bowel sounds
• LE: edema to mid-thigh
• Skin/Integument: no cyanosis or clubbing

The patient was admitted for hemodialysis due to her progression of renal functioning but also admitted to control the hypertensive urgency and headache.

Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information

Discussion Questions:

1. Explain what happens physiologically with chronic renal failure and the GFR. Support with evidence. Include important labs that are monitored in the process.
2. Explain the role of Angiotensin II and proteinuria as they relate to advancing renal disease.
3. List at least three other body systems that are impacted by chronic kidney disease and why.