Pathophysiology Case Study 2:
Clinical History:
A 52 year old diabetic is admitted with a history of increasing tiredness and loss of appetite and weight over the last 6 months. He complains of reduced urine output over the past month. The symptoms have progressively increased in the last week with headaches, nausea, vomiting and insomnia. He has also observed swelling of his feet and face. While in the ward the patient developed itchiness of the skin (pruritus) and hiccups. On examination he is very pale and his blood pressure is found to be elevated (170/100). He has mild to moderate ankle oedema (swelling).

Family History:
He has a family history of diabetes and hypertension and admits to poor control of his Diabetes.

Lab Investigations:
Laboratory investigations show him to be severely anaemic. His serum creatinine and Urea levels are elevated. A 24 urine samples was found to have significant elevations in Albumin. Electrolyte imbalances with elevated serum K+ and Na+. Elevated BUN test.

Guidelines for group discussion:
What is the likely diagnosis?
What are the common causes that could lead to this condition?
What are the major physiological functions of the kidney?
What is the likely cause for the progressive nephron loss observed in patients with chronic hypertension and diabetes?
How would you define chronic renal failure based on the glomerular filtration rate?
What is the characteristic ECG finding of Hyperkalemia and why is it clinically relevant?
What does the BUN test measure?
Explain the occurrence of anaemia and hypertension in relation to the pathophysiological changes in the kidney.
Why does the patient complain of headache, nausea, vomiting and pruritus?
What are the treatment options for a patient in end stage renal failure?
What criteria need to be satisfied to enable a successful donor match for renal transplant?
What are the potential complications of renal transplant?
All students are required to bring in evidence of preparation..this would take the form of a two double sided word processed A4 sheets (references included) with short answers to the guideline questions given above. Do not include the questions but number the answers appropriately. No hand written scripts will be accepted. Failure to annex the individual prep answers with your group answer sheet will result in the student loosing 20% of the mark automatically.