A Case Study on Sharon Diabetes and Chronic Kidney Disease Interrelation

CASE STUDY 1
A CASE STUDY ON SHARON DIABETES AND CHRONIC KIDNEY DISEASE
INTERELATION .
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CASE STUDY 2
Diabetes affects the blood vessels by destroying endothelial epithelium of the blood
vessels. Diabetes contributes to microvascular and macro vascular complications. Chronic
kidney disease results due to renal artery being unable to perform ultrafiltration. High blood
sugar levels in the blood affects the glomerular endothelial cells which results in hyper filtration
(Thomas, Cooper and Zimmet,2016). This results in the loss of glucose, albumin and proteins in
the blood. Consequently, the renal angiotensin system reacts by increasing the blood pressure as
low blood volume is circulating in the body. Her blood pressure is 140/95 mm/Hg.This
contributes to the vicious cycle of high amount of body fluids due to the renal angiotensin system
yet the kidney’s glomerular filtration rate is decreased (Bansal et.al, 2015).
The kidneys are involved in glucose reabsorption which take places in the proximal
tubules through the sodium glucose transporters (Bakris, Fonseca, Sharma and Wright, 2009). In
chronic kidney disease due to the high amounts of glucose being hyper filtered the sodium
glucose transporters increase in number contributing to higher levels of glucose being absorbed.
This worsens the hyperglycemia as the blood glucose levels are already high and presence of
tissue insulin resistance.
Chronic kidney disease is classified into different stages according to the loss in
glomerular filtration rate. In stage one the glomerular filtration rate is below 90ml/mi. This can
remain undetected as the nephrons compensate for the destroyed ones maintaining an otherwise
normal state. Stage two the glomerular filtration rate is between 60 to 89 ml/min.Sharon is in
stage two. Stage three the glomerular filtration rate is now 30 to 59 ml/minute and the kidney

CASE STUDY 3
condition are deteriorating as the remaining nephrons are now overcompensating and some are
already destroyed. Stage four otherwise known as end stage renal disease the patient has a
glomerular filtration rate of below 29ml/minute. This is known as end stage renal disease and
calls for hemodialysis where the urea, excess electrolytes are exchanged in extracorporeal circuit
and returned to the body. Chronic kidney disease is a life time disease and while it cannot be
stopped it can be managed by controlling the causative factors such as diabetes. Sharon needs
urgent review by a nephrologist. While stage one and stage two exhibit in proteinuria and
albuminuria stage three and four exhibit uremia which is highly fatal if left untreated.
Sharon’s glomerular filtration is 85ml/minute. This process progresses in stages as the
nephrons are decreased then hyper compensate for the decreased glomerular filtration rate. The
decreased nephrons are then unable to perform their function resulting in a lower glomerular
filtration rate and finally end stage renal stage disease due to the effect of diabetes on the
efferent, afferent arterioles and glomerular capillaries.
Metformin is an oral antidiabetic drug in the biguanide class. It works by decreasing the
glucose hepatic output and decreasing insulin resistance of the tissue. The bioavailability of the
drug is 45 to 65 % after intestine absorption. Metformin does not bind to plasma proteins Its half-
life is 4 to 9 hours. Sharon is on metformin Sandoz 1000 mg daily. The drug is metabolized by
kidney elimination. Renal clearance of the drug is most effective in patients with normal
creatinine clearance. Type two diabetes is controlled by weight control but if it beyond control
then use of oral antidiabetic drugs is utilized.