NURBN2016 - Case Study of Melanie Johnson: Renal Failure Analysis

This case study analyzes the medical history of Melanie Johnson, a 55-year-old woman residing in a rural area, diagnosed with chronic renal failure. The study delves into the anatomy and function of the kidneys, including the role of nephrons and the production of erythropoietin. Melanie's sympt...Read More

Running head: CASE STUDY OF MELANIE
Case Study of Melanie
Name of the Student
Name of the University
Author Note

1CASE STUDY OF MELANIE
Response to Question 1.1
The case study depicts about the medical history of Melanie Johnson who is a 55 year
old woman and lives in rural region of Victoria. According to the human anatomy, the
kidney of the human body is a bean shaped organ that originates from the vertebrates. They
are located in the retroperitoneal space of the left and right side of the human body. Both the
kidneys are protected by the renal capsule that is fibrous connective tissues and apart from
that there are two different layers of the fat bodies that provides extra protection to the organs
and specifically to the outermost layers of the organ that is renal fascia (Natsis et al., 2014).
The internal part of the kidney is divided into three parts and they are renal pelvis, renal
medulla and renal cortex. The functional and structural unit is to referred to as nephron and
this unit is comprised small tubules and the tiny vessels receives fluids from the blood vessels
of the cortex region of the kidney (Dalton & Haguenau, 2013). The hormone erythropoietin is
produced from the renal cortex region. The structure named Bowman’s Capsule present in the
cortex is associated with the blood filtration function of the nephron. The renal arteries are
located in the renal pelvic region and it is branched into abdominal aorta that supplies blood
to the different regions of kidney. Apart from that, both the kidneys are attached to ureter
that carries urine to the urinary bladder (Natsis et al., 2014).
Response to Question 1.2
From the case study of Melanie Johnson, it can be stated that the patient is suffering
from renal failure and along with this she also experienced nausea, general pruritus and
enhanced tiredness.
The study of Liyanage et al. (2015), stated that chronic renal failure is the progressive
and permanent loss of the functions of the kidney and this condition leads to gradual
functional loss of the filtration capacity of the glomerulus. In this case scenario, the patient

2CASE STUDY OF MELANIE
had high blood pressure (190/100) that is quite abnormal while considering the range of
normal blood pressure range (120/80) (AlGhatrif, & Lakatta, 2015). Kidney is engaged in the
function of filtering the waste products of the bloods and also the extra body fluids. The
condition of high blood pressure can cause narrowing of the blood vessels present in the
kidney region of the human body. The palpation condition of the patient poses the risk of
heart failure and thereby enhances the blood pressure of the main vein connected to the
kidney by showing abnormal cardiac rhythm (Liyanage et al., 2015). As a consequences of
this altered blood supply to the kidney, the glomerular filtration rate was also reduced in case
of Melanie. The study of Gebäck et al. (2015), reported that normal range of GFR for woman
should be within 90- 120Ml/min/1.73m2 but in case of Melanie the GFR was almost
10ml/min/1.73m2. The altered serum creatinine level of the patient is also associated with the
altered function of the kidney. According to the study of Anders, Davis and Thurau (2016), it
is stated that the altered kidney function is unable to eliminate the urea from the blood in a
proper manner and thus blood urine level is enhanced in this case study. The blood serum
urea level is 17mMol/l and due to this same mechanism serum potassium level is also higher
than the normal level in case of Melanie (Melanie-5.7mmol/l ; Normal range- 3.6 to 5.2
mmol/L).
In this context, there will be clinical manifestations such as heart failure, uremia and
hyperkalemia. The condition of uremia may be reported due to the high level of urea and
hyperkalemia is the result of enhanced blood potassium level. The condition of hypertension
may cause heart failure as well (Morrissey, 2014). In this condition, transplantation, renal
replacement therapy and consumption of vitamin D supplementation can be prescribed for the
treatment (Webster, 2017).
Response to Question 1.3

3CASE STUDY OF MELANIE
Factors Acute kidney failure Chronic kidney failure
Cause Any type of infection,
wound, ingestion of drugs
can prompt acute kidney
failure (Webster et al.,
2015).
Usually resulted by elevated
blood glucose level , blood
pressure which harm blood
vessels of the kidney.
Reversibility It is generally reversible. It is permanent.
Usefulness of the kidney In acute kidney failure, the
functionality of the kidney
is around 50% of the actual
function that can be
inverted.
In chronic kidney failure ,
the functionality of the
kidney reduced to 10 - 15%
which cannot be regained
(Webster, 2017).
Peripheral neuropathy Peripheral neuropathy is
not observed.
Peripheral neuropathy is
reported.
Renal osteodystrophy It is not seen in acute
kidney failure
It is observable in acute
kidney failure
Treatment It can be treated with
dialysis exercise,
appropriate diet, and fluid
restrictions (Lankadeva et
al., 2018).
It can be treated by using
hemodialysis and kidney
transplantation.
Response to Question 1.4

4CASE STUDY OF MELANIE
The process of removing the waste products of the body from the blood in an artificial
way is generally referred to as hemodialysis and this therapy is mainly applied in case of the
patients with kidney failure. After diagnosing, it was reported that, the patient had chronic
kidney failure and she was advised hemodialysis to remove the products such as urea,
creatinine. During the dialysis process, the blood goes through the dialyzer and during the
waste products are removed from the blood of the human being. Then the instrument pumps
blood through the filter and then the blood is returned to the body. In one end of the solution,
the blood enters through the tiny fibers and the dialysis solution passes in the opposite
direction on the outside of the body (Shahgholian & Yousefi, 2015). The urea and creatinine
move into the solution and during this time the filtered blood is transferred to the body of the
individuals. In such case scenario, there may be various side effects such as low blood
pressure and muscle fatigue and high level of minerals in the body (Biniyaz et al., 2013).

5CASE STUDY OF MELANIE
References
AlGhatrif, M., & Lakatta, E. G. (2015). The conundrum of arterial stiffness, elevated blood
pressure, and aging. Current hypertension reports, 17(2), 12.
Anders, H. J., Davis, J. M., & Thurau, K. (2016). Nephron protection in diabetic kidney
disease. New England Journal of Medicine, 375(21), 2096-2098.
Biniyaz, V., Tayebi, A., Sadeghi Shermeh, M., Ebadi, A., & Neamati, E. (2013). The effect
of supplementation with intravenous vitamin C on fatigue of hemodialysis
patients. Iran J Crit Care Nurs, 6(3), 145-54.
Dalton, A. J., & Haguenau, F. (Eds.). (2013). Ultrastructure of the Kidney. Academic Press.
Gebäck, C., Hansson, S., Martinell, J., Sandberg, T., Sixt, R., & Jodal, U. (2015). Renal
function in adult women with urinary tract infection in childhood. Pediatric
Nephrology, 30(9), 1493-1499.
Lankadeva, Y. R., Kosaka, J., Evans, R. G., & May, C. N. (2018). An ovine model for
studying the pathophysiology of septic acute kidney injury. In Traumatic and
Ischemic Injury (pp. 207-218). Humana Press, New York, NY.
Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H. M., Okpechi, I., ... & Rodgers, A.
(2015). Worldwide access to treatment for end-stage kidney disease: a systematic
review. The Lancet, 385(9981), 1975-1982.
Morrissey, H. (2014). Health promotion: Blood pressure testing. Australian
Pharmacist, 33(10), 48.
Natsis, K., Piagkou, M., Skotsimara, A., Protogerou, V., Tsitouridis, I., & Skandalakis, P.
(2014). Horseshoe kidney: a review of anatomy and pathology. Surgical and
Radiologic Anatomy, 36(6), 517-526.

6CASE STUDY OF MELANIE
Shahgholian, N., & Yousefi, H. (2015). Supporting hemodialysis patients: A
phenomenological study. Iranian journal of nursing and midwifery research, 20(5),
626.
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney
disease. The lancet, 389(10075), 1238-1252.