Question

A 58 year old obese woman with hypertension, type 2 diabetes and chronic kidney disease is admitted to hospital after a right femoral neck fracture sustained in a fall. Recently, she has been complaining of fatigue and was started on epoetin alfa subcutaneous injections. Her other medications include an angiotensin converting enzyme inhibitor, a beta blocker, a diuretic, calcium supplementation, and insulin. On review of systems he reports mild tingling in her lower extremities. On examination, her blood pressure is 148/60 mmHG. she is oriented and able to answer questions appropriately. Her lungs are clear and her right lower extremity is in traction in preparation for surgery. She was negative for pericardial friction rub.

1. Describe the pathogenesis of bone disease in her chronic kidney disease.
2. How would this explain her increased likelihood of sustaining a fracture after a fall?
3. Why was erythropoietin therapy initiated?
4. What is the significance of a pericardial friction rub n the setting of chronic kidney disease?

Answer 1

Answer: The pathogenesis of bone disease in chronic kidney disease takes place as when there is a kidney impairment, the normal filtration of nutrients and fluids. This abnormality causes abnormal hormone levels. This causes imbalance in the calcium and phosphorus level of the blood. Hence the loss of excessive calcium causes bone weakening. The bone becomes Fragile, cases of osteoporosis are most common with the people having chronic kidney disease.