Renal Disease Case
Danny Xiao is 18-year-old young male adult who has chronic kidney disease. His renal disease is thought to be a result of medication he had taken for the treatment of a solid tumor (cancer) when he was 5 years old. He has been cancer free (remission) since he was 6 years old and since then has had a comorbidity of obesity and hypertension. His renal function is deteriorating and is symptomatic. It is felt that initiation of dialysis is recommended in
preparation for a future kidney transplant. He presents to you having increased fatigue and lack of energy and is not able to concentrate at school. He has vomiting episodes and feels unwell mostly in the morning.
Analysis
Danny’s chronic kidney disease condition has been caused by the treatment of a tumor in his childhood. Commonly, such aggressive cancer treatments as chemotherapy or radiation therapy might result in renal failure. The pathophysiology of this process is illustrated by the stimulation of uric acid accumulation in kidneys under the influence of cancer therapy, which ultimately disrupts kidney functioning.
As informed by the patient’s data, the manifestat6ions of renal failure are as follows. Firstly, the patient has dry skin, which is commonly associated with dysfunctional work of kidneys. Secondly, bilateral swelling in the legs and arms is also a manifestation of chronic kidney disease. Thirdly, a high urine protein level demonstrates that kidneys do not filter proteins from urine properly, signifying kidney damage. Fourthly, tiredness and vomiting episodes also indicate kidney dysfunction and manifest chronic kidney disease.
Although glomerular filtration rate (GFR) is not included in Danny’s lab results, it is expected to reach the level of less than 60 mL/min per 1.73 m².
To justify the level of GFR indicated in 3A, one might refer to other indicators from Danny’s lab tests, namely positive urine protein, that demonstrate kidney damage. According to Kalantar-Zadeh et al. (2021), chronic kidney disease is commonly associated with a level of GFR less than 60 mL/min per 1.73 m².
The GFR test is essential for controlling chronic kidney disease progression because it shows the level of GFR in the blood, which indicates the stage of chronic kidney diseases. Ultimately, the information retrieved from the GFR test helps physicians make timely and informed decisions as per the severity of the condition and the urgency of treatment methods.
While Danny is waiting for his kidney transplantation, it is essential to maintain his kidney functioning and manage symptoms. Therefore, one of the effective pharmacological treatments might be Renin–angiotensin–aldosterone system blockade (ACEi, ARB), which prevents kidney failure (Kalantar-Zadeh et al., 2021). Another treatment that can help reduce the risks for hyperkalemia and improve the use of ACEi and ARB is Potassium binders (sodium polystyrene, zirconium, and patiromer). Furthermore, since Danny’s blood pressure is high, it is relevant to prescribe pharmacological treatment aimed at reducing cardiovascular risks and lowering blood pressure. Finally, ‘Tolvaptan for polycystic kidney disease” should be prescribed to slow the “decline in glomerular filtration rate” (Kalantar-Zadeh et al., 2021, p. 3).
In addition to pharmacological treatments, some medical treatments should be administered to ensure the patients’ kidney functioning when waiting for the transplantation. While transplantation is indeed the most effective medical intervention in chronic kidney disease, one of the treatments that prevail is dialysis. Firstly, hemodialysis allows for controlling the functioning of kidneys which is a life-sustaining intervention. Secondly, peritoneal dialysis might be applicable to Danny’s case since it helps stabilize fluids and sustain vital signs. Finally, some lifestyle adjustments might be viewed as treatment opportunities. In particular, physical activity, dietary sodium reduction, and weight lowering might be effective for Danny (Kalantar-Zadeh et al., 2021).
Diabetes Case
Christine, 15 yr type I diabetic. Due to COVID restrictions she had a virtual meeting with her endocrinologist because her parents noticed increased urination, increased thirst (especially at
night), increased hunger and periods of irritability.
Christine’s physician is concerned that she has not been controlling she diabetes very well since she has been overwhelmed with school. The physician has ordered lab testing including a HbA1c (glycosylated hemoglobin).
Before she could get to Lifelabs for her bloodwork she worsened overnight. She omitted a dose before bedtime. The next morning, she had terrible abdominal pain and was vomiting. She was feeling unwell and appeared disorientated. She was taken to the ER by her parents.
Analysis
Christine’s condition is a type I diabetes, which is indicated by her symptoms. In particular, the pathophysiology of the condition is associated with an increased level of blood glucose. It is caused by the dysfunction of insulin-generating cells in the pancreas, leading to a decrease in insulin secretion and high blood glucose production.
The purpose of ordering a HbA1c is to monitor the level of blood glucose and hemoglobin in particular. In type 1 diabetes, the changes in HbA1c indicate progress in the diseases and might be associated with worsening of the patient’s condition. Therefore, it is important to keep the level of HbA1c at “48 mmol/mol (6.5%) as this will reduce the chances of developing diabetes complications” (“Diabetes and hyperglycemia,” 2019, para. 21). These data will allow physicians to prescribe relevant treatment and make informed decisions.
The patient’s symptoms indicate an acute episode of hyperglycemia, which is validated by both symptoms and vital signs. In particular, Christine feels tired, experiences increased urination, increased thirst, has dry lips, is diaphoretic, and has high blood pressure and high blood glucose level.
The condition occurred due to Christine’s failure to take her medication on time the night before the incident. According to “Diabetes and hyperglycemia” (2019), an increase in blood glucose level and acute dehydration are commonly caused by “missing a dose of diabetic medication, tablets or insulin” (para. 8). The pathophysiology of the hyperglycemia condition is based on the “loss of insulin-producing cells in the pancreas” (“Diabetes and hyperglycemia,” 2019, para. 6). Since Christine has a Diabetes 1 condition and is dependent on regular medication intake, the occasion when she missed her medication caused a sudden increase in the level of blood glucose, which induced severe damage to her wellbeing.
The most important element of treatment for Christine’s condition is the administering of additional insulin to stabilize the level of blood glucose level. Regular blood sugar tests should be taken to monitor glucose levels, as well as insulin dosage should be adjusted according to test results. Importantly, the diabetic diet should be followed and physical activity initiated on a regular basis to avoid complications.
Hyperglycemia can occur in both type 1 and type 2 diabetes.
Since increased blood glucose, or hyperglycemia, is the result of a dysfunction in insulin generating cells, this condition might occur in both types of diabetes. Type 1 and type two diabetes require glucose regulation, which is why the failure to do so might result in hyperglycemia for both cases.
References
Diabetes and hyperglycemia. (2019). Web.
Kalantar-Zadeh, K., Jafar, T. H., Nitsch, D., Neuen, B. L., & Perkovic, V. (2021). Chronic kidney disease. The Lancet. Web.