Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary (Chapter 34, Learning Objectives 1 to 4).
What is the difference between azotemia and uremia?
Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?
Instructions:
Full Answer Section
Dietary Restrictions and Anemia
- Dietary Protein Restriction: People with kidney disease are often advised to limit their protein intake. Excess protein can increase the workload on the kidneys, leading to further deterioration of kidney function.
- Anemia: Kidney disease can lead to anemia due to several factors:
- Decreased Erythropoietin Production: The kidneys produce erythropoietin, a hormone that stimulates red blood cell production. Kidney dysfunction can lead to decreased erythropoietin production, resulting in anemia.
- Nutritional Deficiencies: Kidney disease can impair the absorption of essential nutrients, such as iron, vitamin B12, and folate, which are necessary for red blood cell production.
- Inflammation: Chronic kidney disease can cause inflammation, which can contribute to anemia.
Left Ventricular Dysfunction and Kidney Disease
- Cardiovascular Disease: Kidney disease is closely linked to cardiovascular disease. Both conditions share common risk factors, such as hypertension and diabetes.
- Volume Overload: As kidney function declines, the body retains excess fluid, leading to volume overload. This can strain the heart, particularly the left ventricle, which must work harder to pump blood.
- Hypertension: Uncontrolled hypertension can damage the heart muscle and contribute to left ventricular hypertrophy and dysfunction.
By understanding these concepts, we can appreciate the complex interplay between kidney disease, cardiovascular disease, and nutritional factors in patients like Will.