What is the likelihood of progression to chronic kidney disease in this patient
ID: 146519 • Letter: W
Question
What is the likelihood of progression to chronic kidney disease in this patient given his underlying metabolic disorder if appropriate treatment isn't followed? What lifestyle, medication and or monitoring procedures may be recommended to decrease the likelihood of progression to chronic kidney disease?
Two years after the initial appointment the man presents at the hospital. He has been vomiting for two days following a fishing trip and has reported large amounts of bloodin vomit (suspected gastroesophageal variceal bleeding). He now weighs 102kg and presented with low blood pressure onadmission. Use the results from blood and urine analysis below for the rest of the calculations. Plasma Urine Result 126 mmol/L 133-143 6.4 mmol/L 3.6-4.6 12 mmol/L 24-32 93 mmol/L 98-108 15 mmol/L 3.0-7.0 30 mmH 200umol/L 60-120 Reference Range Result 3+ Positive Reference Range Dipstick Protein Blood Albumin/Creatinine 0.41g/gExplanation / Answer
Chronic Kidney Disease is often found out by accident, when the doctor tests for something else and test reports show positive results for CKD. It is often un-noticed in most of the pateints, as our kidneys siently funtions for us in the background, we mostly take it for granted. CKD is a long and slow process which results in the loss of kidney function.
Kidneys normally function to remove nitrogenous wastes from our blood, maintain normal pH, maintains osmorality, regulates blood volume,etc. In CKD the kidneys slowly lose its functions, some of the major signs and symptoms include :
A doctor would give the following test to determine the likelihood of CKD.
A person suffering from CKD will show traces of blood in urine, presence of type of protein called albumin.Wastes like urea and creatinine. When kidneys are damaged, they have a hard time removing these from the blood. Once the doctor knows how much creatinine or other unusual substances are in the blood and urineis , he will suggest to go for further tests that confirm CKD, like Glomerular filtration rate (GFR) and estimated GFR (eGFR)
In this case, the blood test reports it is seen that the levels of waste products urea, creatinine are more than the normal range.
Potassium levels in blood is way higher than normal,putting the cardiac muscles at risk.Also there are traces of blood in urine. Elevated K+ levels are generally attributed to failure in renal functions.
The protein is in the range of +3 which indicates proteinureia.
A higher TG level suggest that the patient has high cholesterol, a disease associated with CKD.
Albumin level in blood is lower than normal leads to accumulation of fluid in joints of foot.
The albumin to creatinine ratio in urine is more than the normal ratio, putting the patient in high risk of a chronic kidney disease.
A lower creatinine clearance of 9 also suggest that kidneys are not functioning properly.
Therefore , it can be said that the patient has a diseased kidney, and if proper treatment is not followed it will lead to higher stages of CKD.
Recommended Lifestyle
Medication- There is no specific medication for CKD, but with proper lifestyle management, diet and under professional guidance keeping the kidneys functioning.
Medication can help control many of the problems that cause the condition and complications that can arise as a result of it like high blood pressure, high cholesterol, oedema, anaemia and other related cardiovascular diseases.
Monitoring
In such cases where no specific medications are present, regular contact with professionals is necessary to monitor the condition.
These may include:
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