The diagnosis is Chronic Renal failure because of the duration of the illness. It would have been acute renal failure if the duration was less than 48 hours, but George has been having Polyuria for 2 weeks prior to presentation.
The Polyuria is as a result of the inability of George's Kidneys to concentrate urine. Also, he has been losing weight because of the loss of appetite. And the fatigue he is experiencing is as a result of the anemia he has.
The blood results show anemia with a RBC count of 3.8 million cells/mcL. Also the Hemoglobin concentration is 11 g/dl, putting the packed cell volume at 33%. This also points to anemia.
The kidney is the site of erythropoietin production. Erythropoietin is needed for red blood cell production. Chronic kidney disease causes a reduction in erythropoietin production which results in anemia.
The Urinalysis result shows that the GFR at 45 mL/min is greatly reduced at 37%. There is also heavy proteinuria. Creatinine level is also increased. With CKD, the metabolic function of the kidney is reduced, leading to accumulation of metabolic waste in the body. This is in the form of Urea and Creatinine. There is increased accumulation of Creatinine also partly due to increased destruction of body cells from tissue hypoxia. The reduced GFR is as a result of destruction of the renal tubules and glomerulus which is the functional unit of the kidney.
At the second stage of CRF, more than 50% of nephrons are destroyed. Only between 30 and 50% of nephrons are functional. The GFR would be between 30 and 50 mls/min.
At end stage renal failure, <15% of the nephrons are functional. George needs medical treatment and renal replacement therapy. Medical treatment includes use of ACE Inhibitors, treatment of hyperlipidemia and avoidance of nephrotoxins. Erythropoietin is used to treat anemia. Renal replacement therapy includes dialysis and renal transplantation.
Hypercalcemia
The laboratory result shows elevated calcium level. The normal serum calcium level is between 2.25-2.65 mEq/l but her blood tests show 5.0mEq/l. the weakness and nausea corroborates this.
The Doctor would have recommended a low calcium diet so as not to increase the body level of calcium
The Doctor would prescribe Disodium Pamidronate which lowers calcium ion over 2 to 3 days. The drug has a quick onset of action and it acts rapidly and we don’t want to tip Betty into hypocalcaemia.
Furosemide is used to treat Congestive Cardiac failure because it reduces the preload which in turn reduces the work load on heart contractility thereby reducing the effect of the heart failure.
Is essential for muscle contraction. It is also a clotting factor that is needed for normal blood clotting. It is essential in the absorption of vitamin B12. It is also a constituent of bone and teeth. It is therefore needed for normal growth and development.
References
Robin R Hemphill, Erik D Schraga (2010). Hypercalcemia in Emergency Medicine. Medscape Reference. Accessed on 13th February 2012 from http://emedicine.medscape.com/article/766373-overview
M Agraharkar (2010). Hypercalcemia. Medscape Reference. Accessed on 13th February 2012 from http://emedicine.medscape.com/article/240681-overview
Pradeep Arora, Vecihi Batuman (2010). Chronic Kidney Disease. Medscape Reference. Accessed on 13th February 2012 from http://emedicine.medscape.com/article/238798-overview
