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A Case Study about
Chronic Renal Disease
by Michelle LeBlanc
Patient History
27 year old female who presented to the
Emergency Room with the following
symptoms:
–
–
–
–
Vomiting for 2 days
Dehydration
Sever migraine headache
Blood pressure 158 / 100
Patient has a history of Chronic Renal
Disease with nephrectomy and transplant
one year prior
Questions to Consider
What complications are associated
with Chronic Kidney Disease (CKD)?
How does CKD affect kidney
function?
What are the symptoms of CKD?
What laboratory results correlate
with kidney disease?
What is dialysis?
Laboratory Results
TEST
PATIENT RESULTS
REFERENCE
RANGES
Na (mmol/L)
136
135 – 145
K (mmol/L)
6.8
3.5 – 5.2
Cl (mmol/L)
93
95 – 107
CO2 (mmol/L)
17
21 – 31
Anion Gap
26
5 – 17
Glucose (mg/dL)
94
65 – 110
BUN (mg/dL)
83
8 – 22
14.5
0.7 – 1.5
9.3
8.5 – 10.5
10.4
2.3 – 4.3
3.9
3.5 – 5.1
Creatinine (mg/dL)
Calcium (mg/dL)
Phosphorous (mg/dL)
Albumin
Laboratory Results – continued
TEST
PATIENT RESULTS
REFERENCE
RANGES
WBC (bill/L)
9.3
RBC (tril/L)
2.51
3.87 – 5. 08
7.0
12.1 – 15.0
Hematocrit (%)
21.0
35.4 – 44.2
Iron (mcg/dL)
269
30 – 160
TIBC (mcg/dL)
388
228 – 417
Hemoglobin (g/dL)
% Saturation (%)
Ferritin (ng/mL)
69
4.3 – 10.9
15 – 55
26,946 (by dilution)
12 – 207
TSH (ulU/mL)
6.69
0.5 – 5.2
Prolactin (ng/mL)
47.5
Less than 24
Diagnosis
Primary: Hypertensive (unspecified) renal
disease with renal failure
Secondary:
–
–
–
–
Post-surgical dialysis
Anemia (based on Hgb and Hct result)
Migraine and fever
Iron metabolism disorder (based on Iron & Saturation
results)
– Anterior pituitary hyperfunction
result)
(based on Prolactin
– Unspecified hypothyroid (based on TSH result)
– Acquired absence of kidney (based on History)
Renal Function
The main function of a healthy kidney is
to:
• Help remove waste and excess fluid
• Filter the blood, keeping some compounds
while removing others
• Control the production of red blood cells
• Make vitamins that control growth
• Release hormones that help regulate blood
pressure
• Help regulate blood pressure, red blood cells,
and the amount of certain nutrients in the
body, such as calcium and potassium.
Chronic Kidney Disease
Chronic kidney (or
renal) disease
occurs when the
kidneys are no
longer able to
clean toxins and
waste products
from the blood and
perform their
functions to full
capacity
Chronic Kidney Disease
Presently there are about 240,000 end
stage renal disease patients in the United
States with 200 cases per 1 million
persons
The number one cause of renal disease is
Diabetes Mellitus which is responsible for
40% of all kidney failure
High blood pressure (or hypertension)
accounts for about 24%
CKD may be hereditary or likely acquired
What are the warning signs of
kidney disease?
Although many forms of kidney disease do not
produce symptoms until late into the course of
the disease, there are six warning signs of kidney
diseases:
– High Blood Pressure
– Blood and/or protein in the urine.
– A creatinine blood test greater than 1.2 for women and
1.4 for men.
– A filtration rate (GFR) less than 60
– More frequent urination, particularly at night; difficult or
painful urination. Puffiness around eyes, swelling of
hands and feet, especially in children.
What are the symptoms of chronic
renal disease?
Changes in urination
Swelling of hands and feet
Fatique or weakness
Shortness of breath
Metallic taste in mouth
Back or flank pain
Loss of appetite
Nausea / vomiting
Evaluation of Renal Function
Examine circulating levels of:
– Non-protein nitrogenous compounds (e.g, BUN
and creatinine)
– Glomerular filtration rate
– Secretory capacity
– Kidney’s reabsorptive capacity for water and
electrolytes
Abnormal laboratory results:
– Increased serum creatinine / BUN
– Increased potassium and phosphorous
– Abnormal thyroid and hormone levels
secondary to renal insufficiency
– Anemia
Treatment
Hemodialysis
– Blood is pumped from the body to a special
filter (or dialyzer) with two parts, one for blood
and one for a washing fluid called dialysate. A
thin membrane separates these two parts.
– Blood cells, protein and other important things
remain in the blood because they are too big
to pass through the membrane. Smaller waste
products in the blood, such as urea, creatinine,
potassium and extra fluid pass through the
membrane and are washed away.
– The purified blood is returned to the body.
Dialysis Process
Dialysis Process - continued
Dietary Recommendations
Low protein
Low potassium / phosphorous
Kidney Transplant
Renal transplantation is considered an
effective form of replacement therapy with
a success rate of 80% survival after one
year and 60% survival after 4 years.
Evaluation for transplant includes:
– Measurement of general operative health
– Full human leukocyte antigen tissue typing
– Full screen for infectious diseases
Patient Outcome
Tests for Hereditary Hemochromatosis
gene were negative and no pituitary
tumor was detected
Patient was released after one week in
the hospital
Discharged with a battery of 16
different medications!
Summary
Patient with a history of renal disease was
admitted with vomiting, headache and
high blood pressure
Many secondary complications due to
renal disease and nephrectomy
Treatment upon discharge was to continue
dialysis, follow a restricted diet, and
continue on prescribed medications
Follow up visit scheduled for renal check
and evaluation of hyperprolactinemia and
hypothyroidism
References
Kidney Disease, Living with One Kidney,
Dialysis - National Kidney Foundation,
www.kidney.org, Last accessed 11/08/04.
Kidney and Urologic Diseases, National
Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC),
http://kidney.niddk.nih.gov/kudiseases/az.asp Last accessed 11/08/04.
Credits
This case study was
prepared by
Michelle Leblanc, MT(ASCP)
while she was a
Medical Technology student
in the
2004 MT Class at
William Beaumont
Hospital,
Royal Oak, MI.