Renal Failure – A Case Study

Discuss how Robert’s lifestyle choices have contributed to the development and progression of chronic kidney disease.

Chronic renal disease is the failure of the renal system, especially the kidneys, progressively, over a period of time. Though many causes can be attributed to chronic kidney disease, lifestyle disorders account for a significant percentage of the disease (Stengel et al., 2003). In the case of Mr. Robert, he was a 68 year old man, who smoked heavily, drank heavily, and has chronic diabetes, chronic hypertension, and high level of salts in urine. Though his clinical presentation does not reveal his weight, chances of accumulating high cholesterol are high, given the increased body salt levels. He also seems to have a history of consuming unhealthy diet in large quantities, as it is reflected in his poor physical shape.Renal Failure – A Case Study

Chronic renal disease in Mr. Robert might have been a culmination of his poor lifestyle choices, which he has been following continuously for the past 30 to 40 years. Given his increased age, the most ideal step that he could have taken is to reduce the consumption of alcohol, sugary, salty and fried food, and cut down on his smoking. Despite being a manual laborer, the activity levels were not sufficient, and thus led to the poor excretion of toxins from the body. Mr. Robert was under treatment for hypertension and diabetes since 15 years, and still his lifestyle has not been modified. The combination of his poor lifestyle, his pre-existing conditions, and acquired illnesses has led to the development and exacerbation of chronic kidney failure.

2. Provide the rationale for cardiovascular disease and type 2 diabetes as major risk factors for chronic kidney disease.

Chronic Renal disease is most commonly attributed to two major factors – Type 2 Diabetes, and cardiovascular disease. The rationale behind linking the disease with the factors is discussed below (Australian Institute of Health and Welfare, 2014).Renal Failure – A Case Study

Type 2 Diabetes causes the arterioles, venues and capillaries of the renal circulation to be injured, and prevents their rapid healing. This leads to incomplete and impaired renal circulation, and retention of salts and toxic wastes in the kidney. Hypertension is also a side effect of chronic diabetes. This leads to complications like protienurea, edema of the lower limbs, nervous damage, improper voiding from the bladder, etc, which subsequently results in chronic kidney disease. Other complications are bacterial infections of the kidney due to increased blood sugar content, urinary incontinence, and urinary tract infections.

Cardiovascular diseases are those that affect the heart and the blood vessels, and the entire systemic circulation. In the case of impaired arterial circulation to the body, the renal system receives less oxygenated blood, and thus less venous return. This, similar to diabetes mellitus, causes a residue of salts and toxins that have to be excreted by the kidney via urine, to build up within the walls of the kidneys. This leads to impaired purification of the blood by the kidneys due to insufficient elimination of toxic wastes, thus leading to multiple organ failure (Liu et al., 2014).

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Both Type 2 Diabetes Mellitus and cardiovascular diseases are interlinked, and are connected to lifestyle factors, causing renal failure. However, if the signs and symptoms of the conditions are ignored, and the issue is not managed properly, it would lead to chronic kidney disease and subsequent failure (Hajhosseiny et al., 2013).

3. What stage of chronic kidney disease Robert has developed? Explain why Robert’s symptoms (nausea, vomiting and tiredness) have arisen now?

Mr. Robert is in his end stage or established renal failure. This is due to the sever reduction in his glomerular filtration rate (GFR), which is only 11 ml/min, which ideally must be more than 90ml/min. This calls for permanent renal replacement therapy under hemodialysis. This is backed up by his grim reports of high blood sugar levels, blood pressure, and urea-creatinine levels. The nd stage renal disease would bring up a lot of newer signs and symptoms, which are the manifestations of the systemic damage encountered by the body all the time (Murtagh et al., 2007).Renal Failure – A Case Study

The level of the hormone erythropoietin, which is most essential for red blood cell production and the blood oxygenation, is reduced with kidney disease. This results in the oxygen carrying capacity of the blood to be reduced, resulting in anaemia. With anaemia, the oxygen supply to the body cells is reduced, thus causing fatigue (Eschbach et al., 1987).

With chronic kidney disease, there would be uremia, the deposition of toxic renal wastes in the blood. This would impair with digestion, leaving a metallic taste in one’s mouth, and leading to bad breath, nausea, and vomiting.

Mr. Robert experiences shortness of breath, especially on exertion. This can be attributed to two major factors – the anaemia, which has led to poor oxygenation to the body and subsequently to the pulmonary circulation as well; and the accumulation of the toxic wastes around the lungs due to uremia, which reduces the respiratory parameters to a large extent, by exerting pressures on the diaphragm and the chest cavity (Palmer, 2003).

4. Explain in detail the role of dialysis in managing Robert’s condition.

First of all, it must be noted that Mr. Robert is a geriatric patient in the end stage of his renal disease, having almost all the risk factors, symptoms, complications, and lifestyle habits which would exacerbate the condition for almost over 20 years. Thus, it must be understood that the prognosis would be poor, and high hopes cannot be placed on the patient’s recovery, even though the best steps to manage him shall be taken (Mange et al., 2001).Renal Failure – A Case Study

Upon admission of the patient, hemodialysis must be commenced, after stabilizing the vitals and the fluid balance of the patient. The main purpose of dialysis is to remove the accumulated toxic wastes and fluids from the body, serving akin to the human kidney. This would reduce the toxic overload on the kidneys of the patient, thus enabling them to function better. The GFR would show steady improvements, and the urine levels of urea-creatinine also would come down. Along with dialysis, strict lifestyle and diet control is also mandated, so as not to exacerbate the existing condition. Intake of drugs for his other pre-existing conditions such as diabetes and hypertension would have to be monitored, as it would still lead to increased loads on the kidney (Drukker et al., 2012).

Mr. Robert would ideally have to undergo prolonged periods of dialysis, in order to stabilize his GFR. If his initial stabilization is successful, the interval between two dialysis schedules will be extended. However, constant monitoring and hospitalization is necessary, in order to achieve a better prognosis.Renal Failure – A Case Study