Urinary Case Study

Chien-Shiung Wu is a 76 retired engineer who has been in poor health for years.  Ten years ago he had a stroke and recovered.  He takes an ACE inhibitor medication for chronic high blood pressureThe force exerted by gases in the respiratory system, affecting airflow and gas exchange..  In recent months his neighbors noticed that he was having trouble getting around and was forgetful.  On a visit to his doctor’s office, his chronic arteriosclerosis has occluded his arteriesBlood vessels that carry oxygenated blood away from the heart (except pulmonary arteries, which carr.

Mr. Wu recently underwent successful bypass surgery.  During the surgery, his blood pressure dropped very low (45/30) for a few minutes.  Forty-eight hours have passed since the surgery.  He is currently in intensive care general.  The general anesthesia used takes about 48 hours to wear off and prevents the ability to urinate.  Forty-eight hours after surgery, his blood pressure has increased to normal but his urineThe liquid waste excreted by the kidneys. output has decreased to 18 mL/hr.  This condition is known as oliguria.

A 500 mL waterThe universal solvent essential for life. challenge test was performed.  In this test, Mr. Wu was administered IV fluids.  He increased urine production only slightly and his blood pressure rose.  The low blood pressure that occurred during the surgery damaged the kidney nephrons, making them unable to produce urine.

The necrosis of the kidney associated with surgery combined with kidney damage from Mr. Wagner’s chronic atherosclerosis, lead to the loss of function of the majority of his nephrons.  This condition is known as acute renal failure.  The kidney is the main organ that excretes nitrogenous wastesMetabolic waste products like urea, creatinine, and uric acid, excreted by the kidneys. and excess hydrogen ionsCharged atoms or molecules..  A loss of kidney function increases the amount of these particles in the blood, with severe consequences.

His vital signsObjective clinical findings observable by a provider (e.g., edema, fever). and symptomsSubjective experiences reported by the patient (e.g., nausea, fatigue). are as follows:

• • BP 172/106 mmHg
  • Temperature 98.5°F
  • Pulse 116
  • Respirations 22 times per minute and shallow
  • Swelling and pain in lower extremities
  • Pitted skinThe body’s largest organ, providing protection and regulation. in extremities
  • Pallor
  • Confusion
  • Vomiting

A urinalysis, CBC, and ABG showed the following:

Urinalysis results

Category	Lab result
Specific gravity	1.050
Proteins	Present
Color	Dark Orange/brown
Osmolarity	2100 mOsm/L
Glucose	200 mg/dL

Blood analysis results

Category	Lab Result
BUN	30 mg/d after surgery, but over 48 hours increased to 120 mg/dL.
Creatinine, serum	3.2 mg/dL
Na+, serum	159 mEq/L
K+, serum	6.1 mEq/L
Hematocrit	34%
Osmolarity	250 mOsm/L
Albumin	1.2 g/dL

What can you conclude about the cellsThe basic structural and functional units of life. of the DCT according to the serum potassium(K⁺): Major ICF cation; essential for muscle and nerve function. results?

Is the tubuloglomerular mechanismA feedback mechanism in which the macula densa regulates glomerular filtration rate based on sodium successful in its communication with the glomerulusA network of capillaries in the nephron where blood filtration occurs. to adjust filtrationThe process by which fluid moves out of capillaries into surrounding tissues due to hydrostatic pre rate?

According to the albuminA plasma protein that helps maintain osmotic pressure and transport substances. in the blood and proteinsLarge molecules made of amino acids with various functions in the body. in the urine, does Mr. Wu have hyperproteinemia or hypoproteinemia?

According to Mr. Wu’s initial signs, does he have edemaExcess fluid in interstitial spaces.? How is his blood’s colloid osmotic pressureThe pressure exerted by proteins (mainly albumin) in the blood that pulls water into the capillaries related to the edema?

Blood gas results

Category	Lab Result
pHA measure of hydrogen ion concentration in a solution.	7.20
pCO2	30 mmHg
PO2	75 mmHg
HCO3–	20 mEq/L
O2 saturation	92%

Is Mr. Wu in acidosisA condition where blood pH falls below 7.35. or alkalosisA condition where blood pH rises above 7.45.? Referring back to his initial signs, what are Mr. Wu’s lungs trying to do to mediate the effects of kidney failure?

Mr. Wu received a bicarbonate(HCO₃⁻) – A crucial buffer in blood that helps maintain pH balance; formed when carbon dioxide IV treatment but must have kidney dialysis immediately to cleanse the blood of these toxic elements.  However, dialysis is only a stopgap measure and has serious complications associated with it.  The problems with dialysis combined with Mr. Wu”s overall poor health give him a poor prognosis.