1. A young woman presented with classical symptoms of early renal insufficiency. She also had a been a diagnosed diabetic since her late teens. In this case study, the patient had received two antibiotics for a recurring urinary tract infection. As we have seen, many of the cases of renal failure are due to toxic substances which accumulate in the renal cortex causing tubular necrosis and/or ischemia (temporary deficiency in the blood supply). The effects of tubular necrosis vary widely from one patient to the next and depend on the substance or condition causing this pathologic condition.
In effect, the renal tubules are damaged and cannot fulfill their normal activities of tubular excretion, secretion, and reabsorption. Hypervolemia, the body's retention of water which in turn increases the blood volume, is one of the more serious effects, leading to increased blood pressure and cardiac overload. The exchange of potassium from intracellular fluid to the plasma poses the potential for disruption of the heart's conduction mechanism. Waste products such as urea and creatinine cannot be excreted. Hydrogen ion balances are disrupted leading to metabolic acidosis.
2. Symptoms of renal failure depend widely on the underlying cause(s). In this case, the disease was in its early stages. Edema (retention of fluid in tissues), oliguria (decreased urinary output), and increased blood pressure (due to increased fluid retention) were seen.
3. Diagnosis is based on the patient's history and key blood and chemistry values. BUN and Creatinine measure the waste products in the blood. Electrolyte values, bicarbonate, and pH measure the severity of the acidosis. Proteins, cells, and casts in the urine are indicative of renal damage.
4. Treatment options also vary with renal failure. In renal failure cases where toxin levels are extremely high in the blood, renal dialysis, either peritoneal or hemodialysis, must be performed to clear the bloodstream of the offending toxins as well as the build-up of waste products the kidneys have been unable to remove. Careful monitoring of the patient's blood electrolyte and water balance are the key to restoring the health of the renal failure patient. Diuretics may be used as indicated to reduce the blood volume and dilute the electrolyte values.
5. Prevention. Patients with underlying conditions such as diabetes mellitus may be more susceptible to the tubular necrosis described above. Care must be exercised when administering potential kidney toxins such as antibiotics, injectable x-ray contrast media, and other substances.
6. Prognosis of patients with renal failure vary. 50% will recover with some combination of treatments. Others will develop chronic renal insufficiency and will require long-term treatment. Others will ultimately develop what is called end-stage renal disease and die from such complications as heart failure.
7. The clinic physician, family physician, and nephrologist all worked together to diagnose and treat this patient. Nurses trained in treating kidney patients monitored vitals, administered I.V's and gave supportive therapy as needed. If the patient had required dialysis, technicians trained in dialysis would have performed the procedure. Medical Laboratory Technologists performed the blood and urine testing. This patient's medical records were vital to her diagnosis. Individuals trained in health information technology are responsible for accurately maintaining these records.