Blood Pressure Woes

George is a 55 y.o. male who has had hypertension (HTN) for the last 5 years.  His HTN is only partially controlled. He is trying to watch his diet, but does not exercise like he should due to his high-stress job.  He is also on HTN medication.  He monitors his blood pressure at home on a regular basis.  For the past month he has noticed his blood pressure seems to be higher than usual and even harder to control, but figured it was due to the stress of a big project at work.  In the past 2 weeks, however, he has noticed he does not feel like eating much; he is fatigued; he seems to be urinating more often; and he has been losing weight.   He decides to go in to see the doctor.

George’s doctor decides to run several tests with the following results.

Blood Test Results:

RBC:  3.8 million cells/mcL

WBC:  10,000 cells/mcL

Hgb:  11.0 gm/dL

Urine Test Results:

GFR:  45 mL/min/1.73m

Creatinine:  3g/24 hr.

Protein:  3g/24 hr.

The diagnosis George received was Chronic Renal Failure.

1. a) What supports the diagnosis if chronic renal failure instead of acute renal failure?  Give reasons from George’s history; his signs/symptoms.
2. b) Which of the blood test results are abnormal?  Why would chronic kidney failure cause these abnormal results?
3. c) Which of the urine test results are abnormal?  Why does chronic kidney failure cause these abnormal results?
4. d) If George was in the second stage of chronic renal failure, what percent of his nephrons have been lost? What changes will be seen in the GFR; urination; and percent of nephrons lost when George reaches end-stage renal failure?
5. e) How will George’s condition be treated?  Is it curable?

2. Which Electrolyte?

Betty is a 69 y.o. woman who has been taking furosemide for the last two years to treat her Congestive Heart Failure.  Lately she has noticed that her legs seem very weak and she has been feeling “pins and needles” in them.  She has also felt nauseated lately, so has been eating very little the last two weeks.  She goes in to see her doctor and he decides to do an EKG and run some lab tests to check for electrolyte imbalances.  The findings are as follows.

EKG:  shows prolonged repolarization

Serum Levels:

Sodium (Na+):  140 mEq/L

Potassium (K+):  3.0 mEq/L

Calcium (Ca++):  5.0 mEq/L

Magnesium (Mg++):  3 mEq/L

The doctor is able to diagnose Betty’s electrolyte imbalance and gives her a list of foods to eat and prescribes a new medication/supplement to use for a short period of time.

1. a) Which electrolyte balance was diagnosed?  Which lab results support this diagnosis?  Is there anything else in Betty’s history that would support this diagnosis?
2. b) What foods would the doctor recommend Betty eat?  Why?
3. c) What medication/supplement might the doctor prescribe?  Why would it probably only be needed for a short period of time?
4. d) Why is it important for Betty to be on furosemide for her Congestive Heart Failure?  What does this drug do?
5. e) If Betty asks you why this electrolyte is important, what would you tell her?