NUR 502 Mr. J.R. has a history of fever, vomiting, and diarrhea for 48 hours and has not had any fluid or foods intake. In addition, he presents signs of volume deficit, such as weakness and dizziness upon standing. These manifestations are consistent with dehydration, hypotension, and decreased blood flow to the kidneys

Mr. J.R. has a history of fever, vomiting, and diarrhea for 48 hours and has not had any fluid or foods intake. In addition, he presents signs of volume deficit, such as weakness and dizziness upon standing. These manifestations are consistent with dehydration, hypotension, and decreased blood flow to the kidneys. They are consistent with the prerenal type of AKI.

Mr. J. R.’s symptoms of nausea, vomiting, and diarrhea a few hours after eating the burritos could also suggest a foodborne illness. Toxins from infectious agents could destroy tiny blood vessels, causing Acute Tubular Necrosis, an intrarenal type of Acute Kidney Injury (Dlugash et al., 2021).

Risk factors

Several risk factors are associated to Acute kidney diseases. Age is one of the risk factors for Acute kidney disease. Dlugash et al. (2021) described decreased kidney function and glomerular filtration rate (GFR) associated with age and increased risk for kidney disease. Mr. J. R. is 73 years old and is at increased risk for kidney injury.

Dehydration is associated with volume deficit and decreased renal blood flow. J.R. has had vomiting and diarrhea for 48 hours and has not had fluid or food intake. He is in a volume deficit and has reduced renal blood flow, which increases the risk for AKI.

R.’s wife reported that he ate two burritos from a fast-food restaurant and was diagnosed with gastroenteritis. Therefore, he has a risk of toxins ingestion. According to Dlugash et al. (2021), toxic substances can damage the kidneys and cause Acute Tubular Necrosis.

Lastly, J.R. has an acute infection. Patients with a history of acute infection present a higher risk of developing kidney disease (Gelichi-Ghojogh et al., 2022).

Hematologic system complications

Chronic kidney disease (CKD) is associated with permanent alterations in kidney function and structural abnormalities that translate into various physiological disorders (Chen et al., 2019). For instance, anemia constitutes one of the most common CKD complications. According to Cirillo et al. (2021), multiple factors explain this hematologic complication in patients with CKD.

 First, a decrease in erythropoietin secretion by the damaged kidney causes a lack of production of red blood cells. In addition, CKD patients have a higher risk of iron deficiency due to poor oral intake and blood loss through hemolysis. Furthermore, the organism’s inflammation state causes an increase in hepcidin protein, which negatively affects iron uptake. Ultimately, the accumulation of urea in the patient’s blood suppresses blood marrow function.

Coagulation disorders are another hematologic complication of CKD. J. R. might experience decreased platelet production and dysfunction due to adhesion to endothelial lining and aggregation. All these factors contribute to coagulation disorders, such as increased bleeding time, risk of thrombosis, petechiae, and purpura.

References

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: A review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

Cirillo, L., Somma, C., Allinovi, M. et al. (2021). Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: An observational retrospective study and cost analysis. Sci Rep 11, 7463. https://doi.org/10.1038/s41598-021-86769-z

Dlugash, L., & Story, L. (2021). Applied pathophysiology for the advanced Nurse Practitioner. Jones and Bartlett Learning. 

 Ghelichi-Ghojogh, M., Fararouei, M., Seif, M. et al. (2022). Chronic kidney disease and its health-related factors: A case-control study. BMC Nephrol 23, 24. https://doi.org/10.1186/s12882-021-02655-w