Chronic Kidney Disease (CKD) and Diabetic Ketoacidosis (DKA)

Hi please use the case scenario provided.
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Part 1: Renal Disease Case

Question 1

Danny's chronic kidney disease (CKD) results from nephrotoxicity caused by chemotherapy agents used to treat his solid tumor at age 5. Nephrotoxicity refers to the damage caused to the kidneys by drugs or toxins. Danny's CKD is classified as stage 4 or severe (GFR: 15-29 ml/min/1.73 m2) according to the Kidney Disease Improving Global Outcomes (KDIGO) classification. The primary cause of his CKD is chronic glomerulonephritis due to prolonged exposure to nephrotoxic chemotherapy drugs.

Question 2

The manifestations observed in Danny's case are: i. Peripheral edema manifests fluid retention caused by reduced glomerular filtration rate (GFR) and inadequate sodium and water excretion. ii. Dry skin is caused by anemia due to CKD and a buildup of waste products in the blood, leading to itchiness and dry skin. iii. Sunken eyes and tired appearance resulting from anemia and fatigue due to inadequate erythropoietin production. iv. Vomiting, nausea, and lack of energy are caused by the accumulation of waste products such as urea, metabolic acidosis, and electrolyte imbalance.

Question 3

A. Based on the patient's creatinine level of 543 μmol/L, it can be assumed that Danny's GFR is less than 15 ml/min/1.73 m2.   

B. Creatinine is a waste product of muscle metabolism. Its levels in the blood are inversely proportional to the GFR. The higher the creatinine level, the lower the GFR, which indicates a loss of kidney function. C. The GFR test measures the rate at which blood is filtered through the kidneys, which helps diagnose and stage CKD. It is a crucial test for monitoring kidney function in patients with CKD, as well as for managing medication dosages.

Question 4

A. Pharmacological treatments for Danny's CKD include: • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): These drugs help lower blood pressure and reduce proteinuria, a common complication of CKD. • Erythropoietin-stimulating agents (ESAs): These drugs treat anemia in patients with CKD by stimulating the production of red blood cells. • Phosphate binders: These drugs control serum phosphate levels, which can accumulate in CKD patients and cause complications such as bone disease. B. Medical treatments for Danny's CKD include: • Dialysis: A process that filters waste products, excess fluid, and electrolytes from the blood to maintain chemical balance when the kidneys cannot perform their function. • Nutritional therapy: a diet low in sodium, protein, and potassium can help manage the symptoms and complications of CKD.   

Assignment #2   • Fluid restriction: Reducing fluid intake is essential in preventing complications such as fluid overload and hypertension in CKD patients.

Question 5

Christine's presenting symptoms are consistent with diabetic ketoacidosis (DKA), a serious complication of uncontrolled diabetes. DKA occurs when an absolute or relative insulin deficiency leads to insulin resistance. Without insulin, the body starts breaking down stored fat for energy, producing ketones as a byproduct. As ketone levels rise, they become toxic, leading to metabolic acidosis. This results in symptoms such as increased thirst, frequent urination, abdominal pain, nausea/vomiting, confusion, and fruity breath odor.

Question 6

Ordering an HbA1c is to assess the average blood sugar level over the past 2-3 months. HbA1c is a form of hemoglobin that is glycated when blood sugar levels are elevated, and this glycosylation is irreversible. As a result, the HbA1c level provides an objective measure of the patient's long-term glycemic control, which is important for monitoring and managing diabetes.

Question 7

Based on the patient data, the diagnosis best describes Christine's current condition is diabetic ketoacidosis (DKA).

Question 8

DKA occurs when the body cannot use glucose for energy due to insufficient insulin. As a result, the body starts breaking down stored fat for energy, producing ketones. As ketones accumulate in the blood, they become toxic and lead to metabolic acidosis. In Christine's case,   omitting her bedtime insulin dose led to uncontrolled hyperglycemia, triggering the onset of DKA.

Question 9

The treatment for DKA typically involves insulin administration to lower blood glucose levels and reverse ketosis. Christine will likely need to be admitted to the hospital for close monitoring and management of her fluids, electrolytes, and acid-base balance. In addition to insulin therapy, she may require IV fluids and electrolyte replacement to correct imbalances. Once her symptoms have resolved and her blood glucose levels are stable, she must resume her regular diabetes management plan with a close follow-up with her endocrinologist.

Question 10

A. DKA can occur in patients with type 1 and type 2 diabetes.

B. DKA is more commonly associated with type 1 diabetes. However, it can occur in patients with type 2 diabetes who have some degree of insulin deficiency or experience severe stress (e.g. infection, surgery, trauma), leading to increased insulin requirements. Type 2 diabetes is generally characterized by insulin resistance. However, it can also involve a relative insulin deficiency in some cases. Therefore, although DKA is less common in type 2 diabetes, it is still a potential complication that clinicians must be aware of.