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Answers to Case Questions

1. Filter harmful waste products from the blood and drain them out via the urine, balance the levels of fluids and salt in the body, produce hormones.

2. Infection, damage, tumor, side effects of certain medications.

3. Fatigue, nausea, loss of appetite, skin itching, high blood pressure, difficulty concentrating, difficulty sleeping or excessive sleep, shortness of breath.

4. Dialysis

5. Acute kidney failure occurs when the kidneys stop working suddently.

6. Decreased urination, swelling in legs, ankles, and feet, drowsiness, shortness of breath, itching, joint pain and swelling, loss of appetite, confusion, nausea and/or vomiting, chest pain or pressure, muscle twitching, seizures or coma, stomach and back pain, fever, rash, nosebleed

7. Inadequate blood circulation to the kidneys. Infection, liver failure, medications such as NSAIDS, blood pressure medications, heart failure, serious burns or dehydration, blood or fluid loss

8. Obstruction that blocks the normal flow of urine. Bladder, cervical, colon, or prostate cancer, blood clots in urinary tract, enlarged prostate, kidney stones, bladder nerve damage

9. Damage or injury within the kidney.  Blood clots, cholesterol deposits, medications including NSAIDS, chemotherapy, certain antibiotics, glomerulonephritis, autoimmune diseases like lupus

10. Damage to the tubule cells of the kidneys, which can lead to acute kidney failure.  

11. Blood transfusion reactions, muscle damage (rhabdomyolysis), hypotension that lasts longer than 30 minutes, recent major surgery, septic shock, diabetes, certain medications including aminoglycoside antibiotics and amphotericin (antifungal drug).

12. BUN and Creatinine.

13. Itching, nausea, vomiting, brain damage, and weakness or numbness in the hands and feet.

14. pH, CO2, and electrolytes (Na+, K+, CL-).

15. Can disrupt the heart's rhythm.

16. Elevated Na+ in the extracellular fluid.

17. The patient could be diabetic but the glucose in the urine could also be from the inability of the kidneys to properly filter the blood glucose.

18. Damage to the tubules of the kidney.

19. The presence of protein, cells, and casts in the urine.

20. Medical laboratory scientist.

21. Diuresis reduces the blood volume which is increased due to edema. The increased blood volume causes an increased circulatory load which can lead to heart failure. The diuretic also dilutes the elevated sodium level in the blood.

22. The damaged kidneys are unable to filter protein from the blood. Decreasing protein intake decreases possible further damage to the kidneys.

23. Renal dialysis filters waste products from the blood that are not effectively filtered when the kidneys are malfunctioning.

24. Hemodialysis: Blood is pumped from body to a filter where it is purified and returned to the body.

Advantages: No patient training is required. Disadvantages: Dialysis graft failure, cannot be performed at home-lack of freedom

Peritoneal dialysis: The patient's peritoneal membrane is used as a filter. Fluid is drained in and out of the abdomen.

Advantages: It can be done at home--more freedom.
Disadvantages: Patient training, possible peritonitis and membrane failure.