Saturday, October 28, 2023

Conclusion Caturday: Florence Feels Feeble (Case 2)


Picture of stuffed alpaca Professor Pocky and stuffed camel Douglas
Photo of TA Douglas (Left) and Professor Pocky (Right) taken by Dr. Haus
 

Click For Explanation of Case Flow

 

Click for Test Case Tuesday:  Florence Feels Feeble

 

Click for Thoughtful Thursday:  Florence Feels Feeble 

 

Quick Review


Diagnosis:

🌌CHRONIC KIDNEY DISEASE (FAILURE)🌌

 

Pathophysiological Point:

Florence is suffering from a disease where her body's nephrons (kidney cells) are slowly dying.  This means her kidneys are slowly shutting down.

 

 Questions, Answers, and Further Information:

 

Level 1 Questions, Answers, and Further Information:

  1. Explain what the kidneys do and why they are important.

    The major kidney function are:  filtering the blood of waste products, regulating blood pressure, regulate production of red blood cells, breakdown of drugs, metabolism of hormones, synthesize vitamin D, manage electrolyte levels, and maintaining blood pH. 

    All the above functions of the kidney affect EVERY other organ system in the body.  The body cannot function very long if the kidneys are not able to complete all of their functions accurately.

  2. If Florence has dilute urine, what does she need to have access to AT ALL TIMES?  (HINT:  Dilute urine means Florence is peeing out more water than normal)

    Florence needs 24/7 access to WATER.  Her dilute urine means Florence is losing a lot of water in her urine and she will need to drink more water to replace all the water she is losing.  Florence is losing water because one of the kidneys jobs is to keep water in the body but if her kidneys are not working the water is lost in the urine instead of kept in the body.

  3. Challenge question, why does Florence have a low number of red blood cells in her body?  (HINT:  For this one you will need to do some information gathering on the kidneys' different jobs)

    Florence has a low number of red blood cells in her body because one of the kidneys' jobs is to tell the body to make more red blood cells.  If the kidneys are slowly failing, they cannot release a hormone called erythropoietin (EPO).  Without erythropoietin, the body does not know it needs to produce and release more red blood cells.

    Helpful Links:

 

Level 2 Questions, Answers, and Further Information:

  1. Explain pathophysiologically why Florence has pale gums on physical exam and is anemic on blood work.  Be sure to explain all the steps of the process that is NOT occurring in Florence due to her chronic kidney disease.

    Florence has pale gums due to her anemia. This anemia is caused by Florence's Chronic Kidney disease and the dying of her nephrons. The nephrons are responsible for releasing erythropoietin (EPO) into the bloodstream. After the kidneys release EPO, it travels to the bone marrow to stimulate erythropoiesis. This causes the bone marrow to produce and release red blood cells. With Chronic Kidney Disease, the kidneys can no longer produce enough EPO and the bone marrow is not receiving the stimulation to produce enough red blood cells for the body.

  2. Urea is a waste product that is normally urinated out of a patient's body via their kidneys and is an acid.  What acid-base status would you expect in Florence's bloodstream?

    Florence's acid-base status would be a metabolic acidosis (must have both terms to be correct).

  3. Challenge question, what TWO compensatory mechanisms are activated in Florence's body (there are two – assume the juxtaglomerular cells are still functional)?  (HINT:  Think about Florence's dilute urine)

    The two compensatory mechanisms which are activated in Florence are the Renin-Angiotensin-Aldosterone System (RAAS) and Anti-Diuretic Hormone (ADH).

    Helpful Links:

Level 3 Questions, Answers, and Further Information:

  1. Describe the treatment plan you would recommend for Florence and why you are recommending each part of your treatment plan.  Please answer this question as if you are speaking to a professional colleague.

    Florence has been diagnosed with Chronic Kidney Disease and there are countless treatments for Chronic Kidney Disease that depends on the patient's stage of disease, ability to administer treatments, and the goals for the patient's quality of life.  Some treatments for Chronic Kidney Disease are starting a patient on a renal diet to protect the kidneys, pH, electrolyte balance, etc. in the body, medications to decrease blood pressure (ACE inhibitors, angiotensin blockers, etc.), erythropoietin (EPO), subcutaneous fluids, phosphate binders, etc.

    As a reminder, I am not an internal medicine expert and there are multiple correct answers to this question depending on the patient and the availability of care.  The important point to keep in mind is that with Chronic Kidney Disease we are prolonging the inevitable, there cannot cure the kidney failure (unless we do a kidney transplant).  We are keeping the patient's quality of life high through counteracting the negative side effects of Chronic Kidney Disease.  See resources below for treatment recommendations based on IRIS staging.

  2.  Describe your recommended treatment plan and why you are recommending each part of your treatment plan.  Please answer this question as if you are explaining it to a client/patient without a scientific background.

    Today we have diagnosed Florence with Chronic Kidney Disease.  This means Florence's kidneys are slowly starting to shut down.  The kidneys are important for keeping Florence healthy and removing waste material from her body.  Florence is now losing a lot of water in her urine because she cannot keep it in her body due to her kidney disease.  We can help support Florence's kidneys to keep them as healthy as possible and to make her comfortable until her kidneys become too damaged.  This will include feeding her a diet that will protect her kidneys as well as providing her supplemental water.  Florence will also be placed on medications that will make her more comfortable and keep her feeling better.

  3.  Explain the pathophysiology of at least TWO (2) different etiologies of Chronic Kidney Disease.

    I am trusting you all to pick two etiologies of Chronic Kidney Disease and to explain the pathophysiology of them.  Be sure to view the helpful links below that will contain research articles diving into the pathophysiology of the potential causes of Chronic Kidney Disease.

    Helpful Links:

      

Day 3 Conclusion

I hope you enjoyed Florence's case!  Don't forget to...

📚 Review material related to Florence's case 

🤩 Get excited for upcoming cases

Dr. Haus's Unsolicited Life Advice: Stay Hydrated
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