高血压英文ppt精品课件a case study about chronic renal

A Case Study about Chronic Renal Disease by Michelle LeBlanc Patient History 27 year old female who presented to the Emergency Room with the following symptoms: Vomiting for 2 days Dehydration Sever migraine headache Blood pressure 158 / 100 Patient has a history of Chronic Renal Disease with nephrectomy and transplant one year prior Questions to Consider What complications are associated with Chronic Kidney Disease (CKD)? How does CKD affect kidney function? What are the symptoms of CKD? What laboratory results correlate with kidney disease? What is dialysis? Laboratory Results TEST PATIENT RESULTS REFERENCE RANGES Na (mmol/L) 136 135 145 K (mmol/L) 6.8 3.5 5.2 Cl (mmol/L) 93 95 107 CO2 (mmol/L) 17 21 31 Anion Gap 26 5 17 Glucose (mg/dL) 94 65 110 BUN (mg/dL) 83 8 22 Creatinine (mg/dL) 14.5 0.7 1.5 Calcium (mg/dL) 9.3 8.5 10.5 Phosphorous (mg/dL) 10.4 2.3 4.3 Albumin 3.9 3.5 5.1 Laboratory Results continued TEST PATIENT RESULTS REFERENCE RANGES WBC (bill/L) 9.3 4.3 10.9 RBC (tril/L) 2.51 3.87 5. 08 Hemoglobin (g/dL) 7.0 12.1 15.0 Hematocrit (%) 21.0 35.4 44.2 Iron (mcg/dL) 269 30 160 TIBC (mcg/dL) 388 228 417 % Saturation (%) 69 15 55 Ferritin (ng/mL) 26,946 (by dilution) 12 207 TSH (ulU/mL) 6.69 0.5 5.2 Prolactin (ng/mL) 47.5 Less than 24 Diagnosis Primary: Hypertensive (unspecified) renal disease with renal failure Secondary: Post-surgical dialysis Anemia (based on Hgb and Hct result) Migraine and fever Iron metabolism disorder (based on Iron difficult or painful urination. Puffiness around eyes, swelling of hands and feet, especially in children. What are the symptoms of chronic renal disease? Changes in urination Swelling of hands and feet Fatique or weakness Shortness of breath Metallic taste in mouth Back or flank pain Loss of appetite Nausea / vomiting Evaluation of Renal Function Examine circulating levels of: Non-protein nitrogenous compounds (e.g, BUN and creatinine) Glomerular filtration rate Secretory capacity Kidneys reabsorptive capacity for water and electrolytes Abnormal laboratory results: Increased serum creatinine / BUN Increased potassium and phosphorous Abnormal thyroid and hormone levels secondary to renal insufficiency Anemia Treatment Hemodialysis Blood is pumped from the body to a special filter (or dialyzer) with two parts, one for blood and one for a washing fluid called dialysate. A thin membrane separates these two parts. Blood cells, protein and other important things remain in the blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away. The purified blood is returned to the body. Dialysis Process Dialysis Process - continued Dietary Recommendations Low protein Low potassium / phosphorous Kidney Transplant Renal transplantation is considered an effective form of replacement therapy with a success rate of 80% survival after one year and 60% survival after 4 years. Evaluation for transplant includes: Measurement of general operative health Full human leukocyte antigen tissue typing Full screen for infectious diseases Patient Outcome Tests for Hereditary Hemochromatosis gene were negative and no pituitary tumor was detected Patient was released after one week in the hospital Discharged with a battery of 16 different medications! Summary Patient with a history of renal disease was admitted with vomiting, headache and high blood pressure Many secondary complications due to renal disease and nephrectomy Treatment upon discharge was to continue dialysis, follow a restricted diet, and continue on prescribed medications Follow up visit scheduled for renal check and evaluation of hyperprolactinemia and hypothyroidism References Kidney Disease, Living with One Kidney, Dialysis - National Kidney Foundation, , Last accessed 11/08/04. Kidney and Urologic Diseases, National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), /kudiseas