A Case Study on Chronic Kidney Failure

This case study on chronic renal failure discusses the symptoms, diagnostic results, and stages of renal failure. Glenda, a fifty-six-year-old Indigenous aboriginal woman from Tiwi Islands, has been admitted with symptoms like loss of appetite, vomiting tendency, confusion, itchy face, and fatigue. The diagnostic reports reveal severely compromised functioning of the kidneys, indicating end stage 4 of chronic renal disease. The article provides recommendations for medical intervention and interdisciplinary team approach to treat chronic renal failure comprehensively.

Running head: A CASE STUDY ON CHRONIC KIDNEY FAILURE
A CASE STUDY ON CHRONIC KIDNEY FAILURE
Name of the Student
Name of the University
Author’s Note

1A CASE STUDY ON CHRONIC KIDNEY FAILURE
Table of Contents
Introduction................................................................................................................................2
Symptoms and diagnostic results...............................................................................................3
Evalution of Glenda’s symptoms...............................................................................................3
The analysis of the subjective symptoms...............................................................................4
Analysis of objective test results............................................................................................5
The laboratory diagnostic tests...................................................................................................6
Pathophysiological analysis of the tests.....................................................................................7
The stages of renal failure..........................................................................................................9
Patient consent.........................................................................................................................10
Recommendations....................................................................................................................11
Medical intervention............................................................................................................11
Interdisciplinary team approch.............................................................................................12
Conclusion................................................................................................................................12
References................................................................................................................................14

2A CASE STUDY ON CHRONIC KIDNEY FAILURE
Introduction
Chronic renal failure refers to the slow damage leading to loss of regular functionality
of the kidneys (WHO, 2010). Hypertension, diabetes mellitus, adverse reaction to drugs and
other medical conditions attribute to the chronic renal failure. The term acute renal failure is
used when the suddenly significant damage occurs to the kidney and the damage progresses
very fast; whereas the chronic failure of kidneys takes time for manifestation of the disease
(MacGinley, Walker & Irving, 2013). The end stage renal failure is a very advanced form of
the disease which has progressed over months or even years with the symptoms developing
slowly but consistently worsening over time (Iacoviello 2015).
The analysis of survey data and research studies has highlighted that 10% of
Australians over the age of eighteen have some symptoms associated with the chronic renal
disease and the end stage chronic kidney failure is also accountable for over 11% deaths in
Australia every year (CKD survey, 2019). The diagnostics of renal disease can be in form of
high level of creatinine in the blood presence of protein namely albumin in the urine, frothy
urine, anomalous creatinine clearance test and so on. Due to lack of awareness, more than ten
percent of patient in Australia suffering from chronic renal failure are unaware of their
deteriorating health condition. Indigenous Australians are comparatively more likely to suffer
from end stage renal failure and get hospitalised with renal failure to non-Indigenous
Australians (Green & O'mahony, 2011).
This assignment is a case study on Glenda who is a fifty six year old Indigenous
aboriginal female from Tiwi Islands. The diagnostic reports will be thoroughly analysed prior
to structuring a proper healthcare plan along with the required medical interventions to treat
her condition comprehensively.

3A CASE STUDY ON CHRONIC KIDNEY FAILURE
Symptoms and diagnostic results
Glenda, a fifty six year old Indigenous aboriginal woman from Tiwi Islands, has been
admitted with the following symptoms. She has quite a few subjective symptoms and
anomalous findings in her preliminary test report which have been highlighted in the table
below.
Subjective Symptoms
Loss of appetite
Tendency to vomit
Feeling of confusion
Itching on face
Fatigue
Objective test results
Symptom Condition Normal range
Temperature 36.5 degree Celsius is around 37 degree Celsius
Rate of pulse 89 beats per minute 60-100 beats per minute
Rate of respiration 20 respirations per minute. 12-20 breaths per minute
Blood pressure 156/97 mm 120/80 mm Hg
Saturation level of oxygen 96% 95-100%
Level of blood glucose 6mmol/L 4.4-6.1mmol/L
Urine analysis Protein in urine Protein in urine refers to kidney
damage
Evalution of Glenda’s symptoms
The subjective symptoms along with abnormal objective test results have been
thoroughly examined and probable causes have been discussed.

4A CASE STUDY ON CHRONIC KIDNEY FAILURE
The analysis of the subjective symptoms
i. The loss of appetite
Glenda had frequent complains of loss of her appetite which is medically termed as
anorexia. Damaged kidneys cause imbalance of the amino acids which elevates the flow of
the tryptophan across the blood-brain barrier causing generation of hyper-serotoninergic
effect thereby increasing the reluctance to eat (Pieniazek et al. 2015).
ii. Nausea or vomiting tendency
Glenda is also suffering from nausea or vomiting tendency. The reduced rate of
glomerular filtration has led to the upsurge of waste products in blood due to inefficient
excretion of waste thereby causing uremia which results in nausea (Hassan 2014).
iii. Confusion
Dizziness and confusion along with concentration problem is also another discomfort
of Glenda. Anemia might be the main cause behind it. Renal failure results in lack of
hemoglobin in blood which leads to reduced flow of oxygen to the brain thereby causing
confusion and dizziness and hampers normal functions of brain like memory and regular
concentration (Rashid et al. 2015).
iv. Itchy face
Glenda’s irritation on her face can be attributed to her failing kidneys as itchy face or
pruritus is a known symptom of chronic renal failure. Loss of regular functions of the kidneys
leads to accretion of toxins in the body leading to toxin deposition causing severe itching of
various parts of body (Park et al. 2015).

5A CASE STUDY ON CHRONIC KIDNEY FAILURE
v. Fatigue
Glenda’s fatigue is another symptom of anemia caused by the renal failure. Kidneys
release erythropoietin which initiates red blood cells formation that transports oxygen and
required products throughout the body (Giovanetti 2014). Damaged and diseased kidneys fail
to produce adequate erythropoietin thereby causing anemia thus causing production of
reduced number of RBCs. This leads to reduced flow of the oxygen to brain along with
various muscles of body therefore causing fatigue (Chillon et al. 2014).
Analysis of objective test results
i. Temperature
The normal temperature of the human body is 37 °Celsius approximately and
Glenda’s temperature was about 36.5 °Celsius thus it is normal and not of concern.
ii. Rate of pulse
The typical rate of the pulse varies between 60-100 beats/minute of an adult and
Glenda’s pulse was recorded as 89 beats/ minute which is considered regular.
iii. Rate of respiration
The standard respiration rate is 12-20 breaths/ minute for an adult at rest and Glenda’s
was recorded as 20 respirations/ minute therefore not of concern
iv. Blood pressure
The sphygmomanometer revealed Glenda’s blood pressure to be 156/97 mm Hg that
is quite high considering regular range of 120/80 mm of Hg for an adult individual. Given the
other symptoms of Glenda’s physiology, it can be identified as renal hypertension which is
caused by chronic kidney disease. Renal hypertension occurs with reduced flow of fluids to

6A CASE STUDY ON CHRONIC KIDNEY FAILURE
and from the kidneys due to kidney arteries getting narrower or damaged caused by chronic
renal failure leading to renal artery stenosis. Due to the reduced blood flow to the kidneys,
dehydration like signal is generated thereby signaling the brain to retain sodium and water.
This anomalous water retention leads to the additional fluid buildup in the vessels thereby
elevating the pressure of the blood (Okenzere et al. 2015).
v. Saturation level of oxygen
Glenda’s saturation level of oxygen was recorded as 96% which is within the normal
range of 95% to 100%, therefore it is not of concern.
vi. Level of blood glucose
The typical glucose level of the blood ranges between 4.4 mmol/L to 6.1mmol/L for
an adult and Glenda’s blood glucose level was recorded as 4mmol/L which is normal.
vii. Urinalysis
The presence of protein in urine as reflected in the urinalysis indicates kidney
problems as protein is not supposed to be present in normal functioning kidneys. Other
diagnostic tests are required to understand the precise condition of the kidneys (Albuquerque
et al. 2015).
The laboratory diagnostic tests
A summarized table has been constructed below with the various diagnostic tests and
the level detected in Glenda along with the normal range for reference.
Symptom Level detected in Glenda Normal range
Creatinine clearance rate 8.2ml/minute 100ml/minute
Level of creatinine in serum 1132/umol/L 150/umol/L

7A CASE STUDY ON CHRONIC KIDNEY FAILURE
Level of Urea 45mmol/L 3.5 to 6.5mmol/L
Level of Sodium 128mmol/L 135 to 145mmol/L
Level of Potassium 6mmol/L 3.5 to 5mmol/L
Level of Haematocrit 20% 40%
Level of Bicarbonates 11.5 mmol/L 22 to 28 mmol/L
Anion Gap 20mEq/L 8 to 16mEq/L
Level of Calcium 1.98mmol/L 2.2 to 2.6mmol/L
Level of Phosphate 5.4 mg/dl 3 to 4.5mg/dl
Blood pH 6.1 7.35 to 7.45
Pathophysiological analysis of the tests
i. Creatinine clearance rate
The regular rate of creatinine clearance is approximately 100ml/minute whereas it it
severely low for Glenda (8.2ml/minute) indicating kidney problem. Creatinine clearance test
reflects the renal glomerular filtration rate which in this case is severely compromised
(Bullock and Hales 2013).
ii. Level of serum creatinine
Normal creatinine level in the serum is 150/μmol/L for an adult whereas it is
1132/μmol/L for Glenda thus indicating progressive kidney failure. This high level of
creatinine is noted with severely compromised filtration function of the kidneys (Hall 2015).
iii. Level of Urea

8A CASE STUDY ON CHRONIC KIDNEY FAILURE
The normal urea level of blood is 3.5 mmol/L to 6.5mmol/L approximately but urea
level detected in Glenda is about 45mmol/L which is considerably high thus indicating severe
renal failure in excreting waste from the body (Hall 2015).
iv. Level of Sodium
The blood sodium level ranging between 135 to 145mmol/L is normal and
128mmol/L of sodium has been recorded in Glenda’s blood work. This does not require
much attention.
v. Level of Potassium
The blood potassium must be within 3.5 to 5mmol/L for a normal adult. However
6mmol/L was recorded as the potassium level in Glenda indicative of renal issue (Bullock
and Hales 2013).
vi. Level of Hematocrit
Glenda’s level of hematocrit has been recorded to be only 20% when it must be 40%
and above for normal women. This reflects anemic conditions of Glenda and highlights the
lesser quantity of RBC in blood caused due to renal failure (Hall 2015).
vii. Level of Bicarbonates
The bicarbonates present in the blood must be ranged in between 22 mmol/L to 28
mmol/L but it was recorded as 11.5 mmol/L which is much lower compared to desired range
indicating metabolic acidosis. Metabolic acidosis is prevalent in patients with advanced
chronic kidney failure leading to inadequate manufacture of bicarbonates in blood (Hall
2015).
viii. Anion Gap

9A CASE STUDY ON CHRONIC KIDNEY FAILURE
Normal anion gap in the blood ranges between 8mEq/L to 16mEq/L, however
20mEq/L of anion gap was recorded in Glenda signifying kidney malfunction (Hall 2015).
ix. Calcium level
The calcium normal range in blood lies between 2.2mmol/L to 2.6mmol/L however it
is 1.98mmol/L in Glenda indicative of renal problems of the patient (Hall 2015).
x. Level of Phosphate
Normal level of blood phosphate in an adult ranges between 3mg/dl to 4.5mg/dl but
5.4mg/dl was recorded in Glenda. Higher levels of phosphate in blood might be a sign of
kidney disorder (Hall 2015).
xi. Level of pH
The pH of blood generally lies between 7.35 to 7.45 however blood pH of Glenda was
recorded as 6.1 signifying irregular renal functioning as kidneys has crucial role in
maintenance of the pH balance of the blood (Hall 2015).
From critical evaluation of the above anomalous diagnostic results of Glenda points
towards severely compromised functioning of the kidney attributed to chronic renal failure.
The creatinine clearance test reflects the glomerular filtration rate of the kidneys. The
creatinine clearance rate or glomerular filtration rate in normal adults is 100ml/minute
approximately whereas it is 8.2ml/minute for Glenda which is extremely low indicating
major kidney problem where the function is severely compromised.
The stages of renal failure
The chronic kidney disease can be divided in 5 phases on the basis of declining
glomerular filtrate rate signifying reducing functionality of the kidneys and advancement of

10A CASE STUDY ON CHRONIC KIDNEY FAILURE
renal failure (CKD survey, 2019). The table below summarizes the five progressive stages of
chronic renal disease along with the glomerular filtrate rate (GFR) for each stage.
Stages of renal
failure
Progress of the Chronic kidney disease
(CKD)
Glomerular filtrate rate
(GFR)
No renal disease GFR > 90 mL/min
Stage 1 Mild CKD GFR = 60-89 mL/min
Stage 2 Moderate CKD GFR = 45-59 mL/min
Stage 3A Moderate CKD GFR = 30-44 mL/min
Stage 3B Severe CKD GFR = 15-29 mL/min
Stage 4 End Stage CKD GFR <15 mL/min
Stage 5 Complete renal failure GFR <5 mL/min
From the above table on stages of renal failure, it can be concluded that Glenda is
suffering from end stage 4 of chronic renal disease with critically low glomerular filtration
rate of 8.2ml/minute indicating severely compromised functioning of the kidneys along with
extremely high creatinine level and low percentage of haemocrit reflecting anemia (Cayir and
Kosan 2015).
Patient consent
As the patient Glenda is a fifty six year old indigenous aboriginal woman from Tiwi
Islands, proper communication will be lacking therefore treatment might have to be started
with implied consent instead of acquiring proper written consent from the patient or her
family members (Ellis, 2019). However, care must be taken by the nurse in addressing the
consent. In normal cases, verbal or written consent from the patient or the family member is
of utmost importance but exception has to be made in Glenda’s case and treatment has to be

11A CASE STUDY ON CHRONIC KIDNEY FAILURE
started with implied consent based on the fact that she being brought to the hospital in need
of treatment and therefore it is implied that she needs medical help. Pictorial references along
with signs and hand gestures can be used to communicate with patient and members of her
family.
Recommendations
Medical intervention
There are no drugs or medicines for the treatment of chronic kidney failure. However,
there are medical procedures to reduce the excretory wastes from the blood as damaged
kidneys are unable to function adequately along with transplantation of kidneys (Chen and
Wang 2014).
Haemodialysis must be immediately started for Glenda as critically low glomerular
filtration rate and high level of creatinine indicates loss of renal functioning and excretory
function of kidneys, therefore blood must be purified with the help of haemodialysis to
remove the waste and toxins from the blood as kidney is unable to being in end stage 4 of
chronic renal disease (George, Mohamed and Maamoun 2014).
Another method that could be added along with haemodialysis is peritoneal dialysis
where a connection is made with the lining of the abdominal peritoneum wall and dialysate is
infused into the blood to purify it (Pieniazek and Gwozdzinski 2015). This dialysate absorbs
the excretory waste along with the fluid from the blood while using the peritoneum as the
filter (Coskun et al. 2014).

12A CASE STUDY ON CHRONIC KIDNEY FAILURE
Glenda could have applied for renal transplantation however, Glenda and her family
members must be properly educated about the condition and explained in simple lucid
language with the help of an interpreter if required; considering the fact that Glenda is a fifty
six years old indigenous aboriginal woman from Tiwi Islands and proper consent must be
taken even before putting Glenda’s name in the renal transplantation waiting list. If no one is
available knowing the Tiwi language, then it is probably best to simply continue with the
dialysis procedures and not opt for renal transplantation (Green and O'mahony 2011).
Interdisciplinary team approch
The nursing along with the healthcare management team must carefully monitor
Glenda during dialysis and pay extra attention to attend to her discomfort if any as proper
communication based on English language is absent here (Burgeois & Van der Riet, 2012).
The nurses must rely on sign language and pictorial references to communicate with the
patient (Roberts 2012). However, the health care team must monitor the blood pressure along
with making sure that Glenda is being medical supplements as prescribed by the doctor in
addition to checking the objective data of the patient regularly.
Conclusion
Therefore, it can be concluded that Glenda who is fifty six year old indigenous
aboriginal female residing at Tiwi Islands, is suffering from end stage 4 of chronic renal
disease with critically low rate of glomerular filtration at 8.2ml/minute indicating severely
compromised functioning of the kidneys along with extremely high creatinine level and low
percentage of haemocrit reflecting anemia. Haemodialysis is highly recommended for Glenda
along with careful monitoring of her symptoms and sign language indicative of discomfort as
proper communication is absent in this case. Here use of hand gestures and signs along with
pictorial references will help Glenda and her family members to communicate.

13A CASE STUDY ON CHRONIC KIDNEY FAILURE

14A CASE STUDY ON CHRONIC KIDNEY FAILURE
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