Question

Case Study

Salma is a 48-year-old female patient who has a history of anemia, Type 2 diabetes mellitus and hypertension for the last few years. This morning, she has been brought to the Emergency Department (ED) complaining of dyspnea, lethargy, upper and lower extremities edema and pruritus. Salma has also been complaining of nausea and she vomited on arrival to the ED. On the assessment, it was found that Salma had gained 11 Kgs in weight since last month. Salma’s vital signs were: BP 160/90 mmHg, Pulse 110 beats/min, RR 28 breaths/min, and Temperature 36 °C. Based on her assessment and investigation results, Salma was required to be admitted to the hospital for being diagnosed with renal disorders. Salma’s lab results were as follows:

Explain two mechanisms whereby renal disorders can lead to anemia?

Answer 1

Following are the mechanism where by renal dis orders can lead to anemia

1)Anemia may develop during the early stages of CKD ( chronic kidney disease)when the normal kidney function drop to 20 to 50 percent. It becomes more worse as the renal disease progress.

*When kidneys are diseased or damaged,the production of EPO ( erythropoietin) is very low . As a result, the bone marrow makes fewer red blood cells in count that normal , hence causing anemia. When blood contain less amount of red blood cells, it deprives the body to meet its oxygen requirements .

2)Other common causes of anemia in people with renal disease is due to low levels of the following nutrients in food:

#iron _ body uses iron to make rbc

#vitamin B12

#folic acid

These are necessary for red blood cells to make hemoglobin, it is the main oxygen-carrying protein in the red blood cells.

# The disordered iron homeostasis is also a major contributor to the anemia in renal disease.

Iron is capable of accepting and donating ens .It is also essential for biologic reactions, such as oxygen transport, cellular respiration, and DNA synthesis. However, this same property makes excess iron toxic by producing free radicals which can damage the rbc cells. Thus leading to anemia .

Since the patient has diabetes mellitus type 2 the chance of developing anemia is earlier with renal impairment and from other causes . It is mainly due to predominance of damage to renal interstitium, systemic inflammation, and autonomic neuropathy .

The patient shows vomiting as soon she enter to the ED because of lack of nutrients. It include iron, vitamin B12, and folic acid.The body needs nutrients to make red blood cells which in turn necessary to meet the oxygen requirements.