Question

Mr. B., a 35-year-old white male, was diagnosed with insulin-dependent diabetes mellitus (IDDM) at the age of 21. He has had significant renal impairment for about 5 years and has been on a hemodialysis program for about 1 year.
Past History:
Mr. B. has been on insulin since 21 years of age. He has never been treated for ketosis or diabetic coma. His current insulin regimen is Ultra Lente, 6 units every morning and 6 units every evening, with a sliding scale of regular insulin with each meal. He has been admitted to the hospital for evaluation of his renal function and work-up for kidney transplant.
Current Status:
Mr. B. states that he has gained 15 pounds over the last 3 weeks and has noted edema in both legs, which has not been significantly improved by dialysis. Blood pressure has also been elevated, measuring about 170/110. He has noted symptoms of occasional blurred vision and increasing nosebleeds. Current medications include insulin, as above, and minoxidil, 10 mg every morning and 2.5 mg every night. He has no known allergies.
His vital signs are as follows: blood pressure 190/104, heart rate 104, respirations 16, temperature 97.6° F. He has jugular venous distention without carotid bruits. Heart rhythm is regular with Il/VI systolic ejection murmur at the left sternal border, no rubs noted. He has 3+ pitting edema to his knees bilaterally. Lungs are clear to auscultation and percussion bilaterally. Respiratory excursion is symmetrical and adequate bilaterally. White blood cell count is 9600; hematocrit 31.3 ml, hemoglobin 11 g, mean corpuscular volume 88.3 um3, platelets 59,000/mm3. prothrombin time (PT) 9.9 sec., partial prothrombin time (PTT) 31 sec., potassium 5.2 rnEq/L, sodium 134 mEq/L, glucose 228 mg/dl, blood urea nitrogen 88 mg/dl, creatinine 8.1 mg/dl, albumin 3.1 g/dl, total protein 5.5 g/dl, phosphorus 7.4 mg/dl, cholesterol 441 mg/dl, LDH 1159 units, calcium 8.9 mEq/L, pH 7.32, Po2 68 mm Hg, PCO2 32 mm Hg, oxygen saturation 94%, bicarbonate 17 mEq/L. The urinalysis showed specific gravity of 1.009, protein 3+, blood 1+, white blood cells 5 to 6, and a few bacteria. Electrocardiogram showed a normal sinus rhythm, and chest roentgenogram indicated no acute cardiac or pulmonary pathology.

1. Why is the patient anemic?

2. What is uremia? What are the symptoms of uremia?

3.What is azotemia? Has azotemia occurred in this patient? Support your answer.

Answer 1

1). If the blood pressure falls below the normal levels, a hormone called erythropoietin (EPO) is released from the endocrine cells of the kidney. Erythroblast is formed from the proerythroblast, which is produced from the Erythrocyte Colony-Forming Unit due to the stimulation of the hormone erythropoietin (EPO). This results in the increased RBC production that contributes the increased blood volume.

In diabetes patients, the kidney cells loss their functional activity and the production of EPO decreases. This results in decreased production of erythrocytes and anemia.