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Case
Summary
1.
A young woman presented with classical symptoms of early renal
insufficiency. She also had a been a diagnosed diabetic since her
late teens. In this case study, the patient had received
two antibiotics for a recurring urinary tract infection. As
we have seen, many of the cases of renal failure are due to toxic
substances which accumulate in the renal cortex causing
tubular necrosis and/or ischemia (temporary deficiency in the
blood supply). The effects of tubular necrosis vary widely from
one patient to the next and depend on the substance or condition
causing this pathologic condition.
In effect, the renal
tubules are damaged and cannot fulfill their normal activities of
tubular excretion, secretion and reabsorption. Hypervolemia, the
body's retention of water which in turn increases the blood
volume, is one of the more serious effects, leading to increased
blood pressure and cardiac overload. The exchange of
potassium from intracelluar fluid to the plasma poses the
potential for disruption of the heart's conduction mechanism.
Waste products such as urea and creatinine cannot be excreted.
Hydrogen ion balances are disrupted leading to metabolic
acidosis.
2.
Symptoms of renal failure depend widely on the underlying
cause(s). In this case, the disease was in it's early
stages. Edema (retention of fluid in tissues), oliguria
(decreased urinary output), and increased blood pressure (due to
increased fluid retention) were seen.
3.
Diagnosis is based on the patients history and key blood and
chemistry values. BUN and Creatinine measure the waste
products in the blood. Electrolyte values, bicarbonate, and
pH measure the severity of the acidosis. Proteins, cells,
and casts in the urine are indicative of renal damage.
4.
Treatment options also vary with renal failure. In renal failure
cases where toxin levels are extremely high in the blood, renal
dialysis, either peritoneal or hemodialysis, must be performed to
clear the bloodstream of the offending toxins as well as the
build-up of waste products the kidneys have been unable to
remove. Careful monitoring of the patient's blood
electrolyte and water balance are the key to restoring the health
of the renal failure patient. Diuretics
may be used as indicated to reduce the blood volume and dilute
the electrolyte values.
5.
Prevention. Patients with underlying conditions such as diabetes
mellitus, may be more susceptible to the tubular necrosis
described above. Care must be exercised when administering
potential kidney toxins such as antibiotics, injectable x-ray
contrast media, and other substances.
6.
Prognosis of patients with renal failure vary. 50% will recover
with some combination of treatments. Others will develop chronic
renal insufficiency and will require long term treatment. Others
will ultimately develop what is called end stage renal disease
and die from such complications as heart failure.
7.
The clinic physician, family physician, and nephrologist all
worked together to diagnose and treat this patient. Nurses
trained in treating kidney patients monitored vitals,
administered I.V's and gave supportive therapy as needed.
If the patient had required dialysis, technicians trained in
dialysis would have performed the procedure. Clinical
laboratory scientists performed the blood and urine testing.
This patient's medical records were vital to her diagnosis.
Individuals trained in health information technology are
responsible for accurately maintaining these records.
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