Urinary Function:
Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder.
Case Study Questions
The attending physician is thinking that Mr. J.R. has developed an Acute Kidney Injury (AKI). Analyzing the case presented name the possible types of Acute Kidney Injury. Link the clinical manifestations described to the different types of Acute Kidney injury.
Create a list of risk factors the patient might have and explain why.
Unfortunately, the damage on J.R. kidney became irreversible and he is now diagnosed with Chronic kidney disease. Please describe the complications that the patient might have on his Hematologic system (Coagulopathy and Anemia) and the pathophysiologic mechanisms involved.
Full Answer Section
. Intrarenal AKI:
- Caused by direct damage to the kidneys themselves.
- Possible linkage to Mr. J.R.'s case:
- Food poisoning from burritos (toxins affecting kidney function)
- Potential use of Pepto-Bismol (high salicylate content can harm kidneys)
3. Postrenal AKI:
- Caused by obstruction in the urinary tract that prevents urine flow.
- Possible linkage to Mr. J.R.'s case:
- No specific indication present, but urinary output should be monitored.
Risk Factors for AKI in Mr. J.R.:
- Age (over 65)
- Dehydration
- Gastroenteritis
- Fever
- Potential nephrotoxic substances (food poisoning, Pepto-Bismol)
- Underlying chronic health conditions (if any)
Complications of Chronic Kidney Disease (CKD) on Hematologic System:
1. Coagulopathy:
- Impaired platelet function and reduced production of clotting factors due to decreased kidney function.
- Consequences:
- Increased risk of bleeding, including nosebleeds, easy bruising, and prolonged bleeding after injury.
- Pathophysiology:
- Decreased production of erythropoietin (hormone stimulating red blood cell production) by the kidneys leads to anemia.
- Anemia further impairs oxygen delivery and clotting mechanisms.
2. Anemia:
- Decreased red blood cell production due to erythropoietin deficiency from CKD.
- Consequences:
- Fatigue, weakness, shortness of breath, pale skin, and dizziness.
- Worsened by gastrointestinal bleeding due to AKI.
- Pathophysiology:
- Damaged kidneys produce less erythropoietin, leading to decreased red blood cell production.
- Anemia worsens oxygen delivery, impacting various organ functions.
Additional Considerations:
- Further investigations like urinalysis, blood tests, and imaging studies are crucial to confirm the type and severity of AKI and CKD.
- Prompt management of underlying causes and supportive care are essential to prevent further kidney damage and address complications.
- CKD requires ongoing monitoring and management to control symptoms and prevent further complications.
Remember, this analysis is based on the limited information provided. A comprehensive assessment by healthcare professionals is essential for accurate diagnosis and appropriate treatment for Mr. J.R.