Week 7 Renal System Case Study (read instructions below carefully!!!)
Instructions: Upload a word document with answers. Must have APA resource and rationale with each answer for full-credit.
Case #1 (8 Questions Total)
The patient is a 46 year-old male who has a longstanding history of uncontrolled hypertension and diabetes Type II, presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis. He denies any other medical illnesses.
On physical exam the patient is a well-developed, well-nourished male in moderate distress. Blood pressure 180/110, pulse 80, respirations 24 and he was afebrile. Body weight 76.5 kg. Head/Ear/Neck/Throat (HEENT) exam was remarkable for fundoscopic findings of A-V nicking and copper wire changes consistent with hypertensive injury. Cardiac exam had an S1, S2 and S4 heart sounds. The remainder of the exam was remarkable for 2+ lower extremity edema and superficial excoriations of his skin from scratching.
Laboratory Data
Chemistry
Results
Normal Values
Urinalysis
Sodium
133
136-146 mmol/L
pH 6.0
Specific gravity 1.010
Protein 1+
Glucose negative
Acetone negative
Occult blood negative
Bile negative
Waxy casts
Potassium
6.2
3.5-5.3 mmol/L
Chloride
100
98-108 mmol/L
Total CO2
15
23-27 mmol/L
BUN
170
7-22 mg/dl
Creatinine
16.0
0.7-1.5 mg/dl
Glucose
108
70-110 mg/dl
Calcium
7.2
8.9-10.3 mg/dl
Phosphorus
10.5
2.6-6.4 mg/dl
Alkaline Phosphatase
306
30-110 IU/L
Parathyroid Hormone
895
10-65 pg/ml
Hemoglobin
8.6
14-17 gm/dl
Hematocrit
27.4
40-54 %
Mean cell volume (MCV)
88
85-95 FL
24-hour urine protein and creatinine – volume 850 ml, protein 600 mg/dl and creatinine 180 mg/dl
Renal ultrasound- Right kidney 9 x 6.0 cm, Left kidney 9.2 x 5.8 cm
Both kidneys illustrate hyperechogenicity and no hydronephrosis.
Case #1 Questions
1. “Presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis.” what does the symptoms suggest to you?
2. What is the significance of the finding ” superficial excoriations of his skin from scratching.” ?
3. What does S4 signify? What cardiac findings will you expect to find in a hypertensive?
4. What are the possibilities for his 2+ lower extremity edema?
5. What evidence in renal ultrasound, will suggest obstruction?
6. Is the cause of this patient’s renal failure acute or chronic? How did you arrive at that conclusion?
7. Should this patient be started on dialysis? What are the indications for dialysis?
8. What is the most likely diagnosis for his renal disease? How did you arrive at that conclusion?
