HSC 4555 Which of the following is true of the pathogenesis

| June 13, 2018

Case-2: Patient History
A 58-year-old obese woman with
hypertension, type 2 diabetes, and chronic kidney disease is admitted to
hospital after a right femoral neck fracture sustained in a fall. Recently, she
has been complaining of fatigue and was started on epoetin alfa (erythropoietin)
subcutaneous injections. Her other medications include an
angiotensin-converting enzyme inhibitor, a ?-blocker, a diuretic, calcium
supplementation, and insulin. On review of systems, she reports mild tingling
in her lower extremities. On examination, her blood pressure is 148/60 mm Hg.
She is oriented and able to answer questions appropriately. There is no
evidence of jugular venous distention or pericardial friction rub.
Analyze this case study and answer the next
two questions that follow.
1.
Which
of the following is true of the pathogenesis of bone disease in chronic kidney
disease? (select all that apply)
a.
In this patient, low serum calcium and hyperphosphatemia trigger
PTH secretion, which depletes bone calcium and contributes to osteomalacia and
osteoporosis.
b.
In this patient, hypocalcemia results and is further exacerbated
by high serum phosphate levels from impaired phosphate excretion by the kidney.
c.
In this patient, calcium is poorly absorbed from the gut because
of decreased renally generated vitamin 1,25-(OH)2 D3 levels.
d.
This patient probably suffers from osteoporosis, accelerated by
her underlying renal failure. The pathogenesis of bone disease is
multifactorial.
2.
Why
was erythropoietin therapy initiated? (select all that apply)
a.
This treatment is indicated for this patient because of impaired
synthesis of erythropoietin by the kidney and thus decreased erythropoiesis.
b.
This
treatment is used to treat bone fracture
c.
This treatment is used to treat diabetes.
d.
This treatment is used to treat anemia seen in chronic kidney
disease.
Case-3: Patient History
P.W. is 23 years old. He was the victim of
a hit-and-run auto-pedestrian accident and suffered multiple abrasions, a
concussion, and a deep laceration of his left thigh. He was discovered
approximately 2 hours after the incident and is now in the emergency
department. P.W.’s vital signs and hematocrit suggest that he has had a blood
loss of about 2500 ml. A urinary catheter is inserted to monitor urine output,
and fluid resuscitation is initiated while his wounds are cleaned and sutured.
The urine output is averaging 15 ml/hr, with a high urine osmolality and low
urine sodium.
Analyze this case study and answer the next
four questions that follow.
1.
What
type of renal failure is P.W. likely developing? (select all that apply)
a.
Postrenal
Acute Renal Failure
b.
Prerenal
Acute Renal Failure
c.
Chronic
Renal Failure
d.
Intrarenal
acute renal failure
2.
Based
on your answer for the previous question, what is the best therapy for
preventing this from occurring? (select all that apply)
a.
Adequate extracellular volume replacement with blood or isotonic
fluids to ensure adequate circulating blood volume and perfusion pressure to
the kidney is essential.
b.
Antibiotic therapy should be administered immediately.
c.
Restriction of fluid intake to prevent increase in circulating
blood volume and perfusion pressure to the kidney is essential.
d.
Dialysis should be initiated immediately.
3.
In
addition to urine output, what laboratory data should be monitored to assess
changes in P.W.’s renal function? (select all that apply)
a.
Creatinine clearance can be measured to more accurately assess
glomerular filtration rate.
b.
Serum BUN, creatinine, and potassium should be monitored. An
increase indicates decreased renal function.
c.
Serum sodium may be useful in determining the correct IV fluid
composition to administer.
d.
Serum BUN, creatinine, and potassium should be monitored. A
decrease indicates decreased renal function.
4.
If
P.W.’s renal function does not return to normal, but continues to be
diminished, what renal disorder might develop? (select all that apply)
a.
He may develop nephrotic syndrome
b.
He may develop renal calculi.
c.
He may develop pyelonephritis
d. He
may progress to acute tubular necrosis

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