Question

Case Study

Salma is a 48-year-old female patient who has a history of anemia, Type 2 diabetes mellitus and hypertension for the last few years. This morning, she has been brought to the Emergency Department (ED) complaining of dyspnea, lethargy, upper and lower extremities edema and pruritus. Salma has also been complaining of nausea and she vomited on arrival to the ED. On the assessment, it was found that Salma had gained 11 Kgs in weight since last month. Salma’s vital signs were: BP 160/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 36 °C. Based on her assessment and investigation results, Salma was required to be admitted to the hospital for being diagnosed with renal disorders. Salma’s lab results were as follows:

Chemistry	Patient Value	Normal Values	Urinalysis
Sodium	131	136-146 mmol/L	pH 6.0 Specific gravity 1.010 Protein 1+ Glucose negative Acetone negative 24-hour urine collection: Volume 680 ml Protein 660 mg/dl Creatinine 195 mg/dl
Potassium	6.4	3.5-5.3 mmol/L
Chloride	111	98-108 mmol/L
BUN	168	7-22 mg/dl
Creatinine	17.1	0.7-1.5 mg/dl
Glucose	112	70-110 mg/dl
Calcium	7.8	8.9-10.3 mg/dl
Phosphorus	10.4	2.6-6.4 mg/dl
Alkaline Phosphatase	321	30-110 IU/L
Hemoglobin	7.9	14-17 gm/dl
Parathyroid Hormone	915	10-65 pg/ml

Q1:

2. Based on the previous clinical manifestations:

Name three renal conditions that Salma could have. ?

Q2:

Explain why Salma could have “superficial skin lesions?    

Answer 1

Ans 1). possible renal conditions are

i)5th stage chronic kidney disease due to prolonged type 2 diabetes mellitus and and anemia.

ii) Diabetic nephropathy which is charaterised by edema and diabetes mellitus which inhibits the action of nephron that purify blood.

iii)Glomerulonephritis owing to low Hb level as a result of anemia which lowers the glomerular filtration rate(GFR).

Ans 2) Puritus is a common and distressing symptom in CKD patients.These causes itching all over the body or specific areas.Moreover these patients have dry skin thus itching can lead to rashes causing lesions.In addition to that when itching on edemamatous soft tissuses leads to vasculitic ulcers.skin involvement is almost upto 77% in these patients with higher frequency of renal involvement