Question

Mr. H., age 68 years, has a long history of hypertension. He has had more headaches recently, his legs and feet are swollen, and he has noticed that more frequent voiding, both during the day and at night, is necessary. He constantly feels tired and does not feel hungry. Mr. H’.s blood pressure is 170/110, his pulse is 94, and he has gained 12 pounds in the last 2 months. Diagnostic test findings related to the blood and urine include elevated serum creatinine and rea levels, low serum bicarbonate, low hemoglobin and hematocrit, and low serum sodium. The urine contains protein and has a very low specific gravity. The diagnosis is renal insufficiency or chronic renal failure due to nephrosclerosis. 2) Explain the cause of the edema and weight gain. 3) State three factors contributing to fatigue. 4) Explain why Mr. H.: a. Is voiding frequently b. Has very dilute urine 5) Explain why Mr. H. has: a. High blood pressure b. Anemia c. Metabolic acidosis 6) List the signs indicating that Mr. H. has progressed into uremia or end-stage renal failure. 7) List three reasons why development of pneumonia is a high risk for Mr. H.

Answer 1

Nephrosclerosis is much more similar to arteriosclerosis . It is hardening and thickening of the walls of the small arteries and arterioles of the kidney which happen due to occlusion or narrowing of lumen of those blood vessels(arteriolosclerosis) by hyaline due to high blood pressure. So Inadequate blood flow occurs in renal system leading to tissue scarring around glomeruli which leads to decreased filtration of waste products presenting as renal failure. This is known as hypertensive nephropathy. Chronic nephropathy accompany glomerular damage and causes presence of protein and blood in urine.

2. Due to ischemia of the tissues in glomeruli blood flow to kidneys are decreased and hyalinisation of afferent arteriole leads to decrease in the glomerular filtration rate along with changes in renin angiotensin activity in CRF leads to fluid retention . Excess fluid gets trapped in extracellular spaces presenting as edema. Fluid retention leads to weight gain. As Mr.H is elderly with high blood pressure and CRF he has high possibility to heart failure . Important symptoms of heart failure is edema and weight gain.

3.The three factors contributing to fatigue are

• Loss of appetite
• Uremia
• Anemia
• Headache
• Frequent urination

4. a. As the function of nephrons are lost in an individual with CRF , the kidneys ability to absorb water in the urine declines leading to presence of excess volume of urine in body. It leads to frequent urination.

b .As excess water is not absorbed , urine is very diluted

5. a. Narrowed renal small arteries decreases the blood flow which decreases the ability of filtration of kidneys . This causes fluid retention in body . Fluid retention causes overload in the systemic circulation . That overload to heart may cause high pressure in arteries and veins . Congestive heart failure may occur. So hypertension occurs.

b.Anemia occurs because of decreased secretion of erythropoietin by kidneys as they are damaged . Erythropoietin stimulates the bone marrow to produce red blood cells. When that hormone is produced in low ranges , RBC production is not active , so anemia occurs.

c. Kidney plays an evident role in maintaining acid base balance. Due to nephrons damage ,kidneys cannot filter the acid and ammonia increases in body which leads to sodium bicarbonate decreased level .