Answers to Case Questions

1. Filter harmful waste products from the blood and drain them out via the urine, balance the levels of fluids and salt in the body, produce hormones.

2. Infection, damage, tumor, side effects of certain medications.

3. Fatigue, nausea, loss of appetite, skin itching, high blood pressure, difficulty concentrating, difficulty sleeping or excessive sleep, shortness of breath.

4. Dialysis

5. A rapid breakdown of renal function that occurs when high levels of uremic toxins (waste products) accumulate in the blood. Acute renal failure occurs when the kidneys are unable to excrete toxins.

6. Oliguric: Patients who excrete less than 500 ml/day of urine (less than 16 oz).
Nonoliguric: Patients who excrete more than 500 ml/day of urine (more than 16 oz).

7. Inadequate blood circulation to the kidneys. Atherosclerosis or dehydration.

8. Obstruction that blocks the normal flow of urine. Kidney stones are an example of a cause of postrenal acute renal failure.

9. Damage or injury within the kidney.

10. Death of renal tubular cells from either lack of oxygen or exposure to a toxic drug or molecule.

11. Hypotension, obstetric complications, obstructive jaundice, sepsis, surgery, some medications.

12.  BUN and Creatinine.

13.  The patient is unable to filter the waste products from the blood because of damage to the tubules of the kidneys.

14.  pH, CO2, and electrolytes (Na+, K+, CL-).

15.  Can disrupt the heart's rhythm.

16.  Elevated Na+ in the extracellular fluid.

17.  The patient could be diabetic but the glucose in the urine could also be from the inability of the kidneys to properly filter the blood glucose. 

18.  Damage to the tubules of the kidney.

19.  The presence of protein, cells, and casts in the urine.

20.  Medical laboratory scientist.

21.  Diuresis reduces the blood volume which is increased due to edema.  The increased blood volume causes an increased circulatory load which can lead to heart failure.  The diuretic also dilutes the elevated sodium level in the blood.

22.  The damaged kidneys are unable to filter protein from the blood.  Decreasing protein intake decreases possible further damage to the kidneys.

23.  Renal dialysis filters waste products from the blood that are not effectively filtered when the kidneys are malfunctioning.

24.  Hemodialysis:  Blood is pumped from body to a filter where it is purified and returned to the body.

Advantages: No patient training is required. Disadvantages: Dialysis graft failure, cannot be performed at home-lack of freedom

Peritoneal dialysis:  Bodies peritoneal membrane is used as a filter.  Fluid is drained in and out of abdomen.

Advantages:  It can be done at home--more freedom.
Disadvantages:  Patient training, possible peritonitis and membrane failure.