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SBI241 Pathophysiology for Healthcare

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SBI241 Pathophysiology for Healthcare

Question

Answered

Question:

Case Study

  1. 47-year-old male truck driver presents to the emergency department with intractable nausea and vomiting, dyspnoea on exertion, and dizziness. The nausea began about two weeks prior to admission; vomiting has occurred within the last few days. There is no history of medication or toxin exposure. He has lost some weight recently and his current body weight is 52 kg. His past medical history is positive for hypertension diagnosed 14 years ago with no follow-up. He has smoked 1 packet per day for 27 years.

  2. physical examination, his blood pressure is 160/120 mmHg, temperature 36.7°C, pulse 100/min. His skin is pale with numerous areas of bruising and excoriations. Chest x-ray shows moderate cardiomegaly with increased pulmonary vascular markings and hazy obliteration of the lower lung bases. Abdominal ultrasound examination shows a right kidney size of 7 cm and a left kidney size of 6.8 cm (normal kidney size approx. 10 cm).

Laboratory evaluation reveals:

Urinalysis

 

Protein

1+

Blood

1+

Glucose

Neg

Casts

Neg

Bacteria

Neg

 

Blood report

Reference range

  

WBC

6.7 x 109/L

4.5-11 x 109/L

Platelets

250 x 109/L

150-400 x 109/L

Haematocrit

0.29

0.40-0.54 (adult male)

Creatinine

641 umol/L

60–110 umol/L (adult male)

Urea

35.2 mmol/L

3.0-8.0 mmol/L (adult)

Calcium

1.75 mmol/L

2.10–2.60 mmol/L

Uric Acid

0.68 mmol/L

0.20-0.45 mmol/L (male)

Please answer the following two questions:

  1. What is the pathophysiological basis of renal changes in long-standing hypertension?

  2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage?

SBI241 Pathophysiology for Healthcare

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