A Case of Chronic Kidney Disease-PART2
April 18th 2012 08:05
Elevated blood pressure can also be explained by renal problems. Sodium in the body is not excreted. Where sodium is, water follows. This leads to increased blood volume which is contributory to increase in blood pressure. Another explanation for this has something to do with the activation of the renin-angiotensin-aldosterone system. We know very well that in chronic kidney diseases, the excretion function is impaired. The macula densa of the remaining tubules sense such decrease in electrolyte concentration (especially sodium)in the urine. This stimulates the JG cells to secrete renin, which converts angiotensinogen to angiotensin 1. Angiotensin 1 is in turn converted to angiotensin 2 in the lungs. And the process leads to aldosterone secretion, which in normal individuals improve renal perfusion, and excretory functions. However, in chronic kidney disease patients, since only few nephrons have survived, the process goes on and on. Further angiotensin is produced. We all know that angiotensin is a potent vasoconstrictor. This aggravates elevation of blood pressure.
Interestingly, this patient had chronic hepatitis B infection. His major manifestation of such is hypoalbuminemia. This further contributes to edema and pulmonary congestion. Other comorbidity includes HCVD, CAD and Type 2 Diabetes Mellitus.
Hemodialysis is an important element of this patient’s management. Control of blood pressure is warranted. Fluid and electrolyte correction is also needed. Erythropoietin administration is important to manage anemia. Control of sugar and bad cholesterol is also very important in this case. The present management for this case is further discussed in other sections of the chart.
Hemodialysis is an important element of this patient’s management. Control of blood pressure is warranted. Fluid and electrolyte correction is also needed. Erythropoietin administration is important to manage anemia. Control of sugar and bad cholesterol is also very important in this case. The present management for this case is further discussed in other sections of the chart.
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