Chronic Renal Disease: J.H. and ESRD J. H. is a 55-year-old African American male who presented himself to the Emergency Department with a progressively worsening headache. He had a blood pressure (BP) of 233/134, with complaints of regular abdominal pain with nausea and vomiting and shortness of breath with exertion. Alert and oriented, he stated non-compliance with his BP medications and refusal to do dialysis since his initial diagnosis.
Pathophysiology
ESRD is the fifth and final stage of CKD according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (Abbasi, Chertow, & Hall, 2010). It is an irreversible deterioration of a patient 's kidney function leading to death in the absence of dialysis or transplantation (Abbasi, Chertow, & Hall, 2010). CKD is associated with systemic diseases such as hypertension, diabetes mellitus, systemic lupus erythematosus, or direct kidney problems, including kidney stones, acute kidney injury, chronic glomerulonephritis, chronic pyelonephritis, obstructive uropathies, or vascular disorders (McCance & Huether, 2014).
The measure of kidney function is directly related to the renal blood flow (McCane & Huether, 2014), a certain drop leads to uremia followed by an onslaught of clinical manifestations …show more content…
Elevated PTH can lead to osteomalacia and osteititis fibrosa, and metastatic calcifications which may cause gangrenous fingers and toes (Lewis et al., 2010). Pulmonary wise, fluid overload leads to pleural effusion, rales, pulmonary edema, whereas metabolic acidosis leads to Kussmaul respirations (McCance & Huether, 2014). Uremic pleuritis and uremic pneumonitis are also typical with CKD (Lewis et al., 2010). Patient J.H. complained of shortness of breath on
Pathophysiology
ESRD is the fifth and final stage of CKD according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (Abbasi, Chertow, & Hall, 2010). It is an irreversible deterioration of a patient 's kidney function leading to death in the absence of dialysis or transplantation (Abbasi, Chertow, & Hall, 2010). CKD is associated with systemic diseases such as hypertension, diabetes mellitus, systemic lupus erythematosus, or direct kidney problems, including kidney stones, acute kidney injury, chronic glomerulonephritis, chronic pyelonephritis, obstructive uropathies, or vascular disorders (McCance & Huether, 2014).
The measure of kidney function is directly related to the renal blood flow (McCane & Huether, 2014), a certain drop leads to uremia followed by an onslaught of clinical manifestations …show more content…
Elevated PTH can lead to osteomalacia and osteititis fibrosa, and metastatic calcifications which may cause gangrenous fingers and toes (Lewis et al., 2010). Pulmonary wise, fluid overload leads to pleural effusion, rales, pulmonary edema, whereas metabolic acidosis leads to Kussmaul respirations (McCance & Huether, 2014). Uremic pleuritis and uremic pneumonitis are also typical with CKD (Lewis et al., 2010). Patient J.H. complained of shortness of breath on