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Having chronic kidney disease and smoking. Diagnosed with hypertension. Having nausea, vomiting and short of breath. Suggest treatment?

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General & Family Physician
Practicing since : 2009
Answered : 9398 Questions
XXXXXXX is 70 years old and has chronic kidney disease. He worked as a trade
person as well as manual labourer, often smoking during outdoor work, as he
mainly worked alone. In addition, XXXXXXX drinks heavily and consumes at least 16
cans of beer each night.
XXXXXXX was diagnosed with hypertension 15 years ago and his medication dosage
has increased over that time. More recently, he has been short of breath, has
periods of nausea and vomiting, and has been generally tired.
At a check-up with XXXXs renal specialist, it is found that XXXXXXX has large
concentrations of protein in his urine, his creatinine level is 500 mmol/L and his
estimated GFR is only 11 mL/min. The specialist recommends that XXXXXXX
commences dialysis.
Case questions:
1 Provide a rationale for the strong link between cardiovascular disease and
chronic kidney disease.
2 Discuss the lifestyle choices that XXXXXXX has taken that have contributed to the
development and progression of chronic kidney disease.
3 Describe why XXXX’s symptoms (nausea, vomiting, tiredness) have arisen
4 Explain how dialysis performs some of the functions of the kidneys.
Posted Fri, 20 Sep 2013 in Kidney Conditions
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Answer to all your queries

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing in.

I shall address each of your queries as listed by you, in their respective order.

1. An excess fluid intake, especially alcohol,which can lead to fluid retention puts more strain on the heart. The kidneys help in filtering all the toxic and unwanted substance from the fluid in the body, when there is an excess amount of fluid in the body, the heart has a greater load due to the excess amount of fluid it has to pump. This can result in an increase in the blood pressure (as seen in XXXX). This high blood pressure in turn puts more stress on the kidneys leading to an inadequate amount of fluid and toxic substances being removed from our system, which can result in kidney damage. This results in further fluid retention and in turn more damage to the heart, as a result.

2. Alcohol and smoking both apply quite a lot of pressure on both the heart and kidneys, and of course the lungs as well.

3. The symptoms of nausea, vomiting, exhaustion, etc; have arisen as a result of the kidney damage that is taking place currently. Which is clearly seen with his high urine protein concentration, high creatinine (which are the toxins we have discussed earlier) and low GFR (glomerulofiltration rate), which is the rate at which the kidneys is filtering fluid (as discussed earlier, this will drop, and has significantly dropped in XXXX's case). This is ultimately going to lead to kidney failure, possibly coma and even death if not dealt with at the earliest. Either way, prognosis for life is bad.

4. A dialysis performs only part of the functions a kidney performs. The kidney works by filtering toxic substances out of the blood, and when the kidneys are ailing, then a dialysis helps by filtering part of these toxic substances out. There are different types of dialysis available, but the most commonly used one uses multiple cellulose membranes through which the blood is pumped, which helps retain proteins and cells but helps to remove components which are in excess (toxic substances).

I hope you found my response helpful. Please feel free to write back to me for any further clarifications or a further elaboration.

Best wishes.
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