Patients with Chronic Kidney Disease

Question 1

1. Describe how CKD has affected their medical status.

Answer 1

kidney failure leading to weight loss which has actually improved DM and chances of transplant

dx. and uncertainty of the dx. has caused a lot of stress, including high BP; trying to regain normality in schedule can be really important

Question 2

1. Understand the pathophysiology of associated medical conditions.

Answer 2

diabetes is a big complicator, previous disease requiring chemo-theurapeutics can have a life-time limit

treatment with ACEI can lead to cough
hyperthyroidism complicated with DM leading to kidney damage

complicating primary hyperaldosteronism that causes low K+

expansion of extracellular space in nephrotic syndrome but ECV can be low

Question 3

1. Describe appropriate therapies related to their CKD.

Answer 3

biopsy can be extremely unpleasant (done under local anesthesia

vasculitits, membranous nephrotic syn: cyclophosphamide, secondary rituximab

angiography to detect fibromuscular dysplasia causing persistent HTN

getting on the transplant list most effective without going to dialysis

balancing diuretic use can be really tricky, esp if its mostly patient directed on the daily

Question 4

2. Describe how CKD has affected their financial situation.

Answer 4

drugs like rituximab are really expensive, like $73,000 with the cost of medication and infusion costs
dietary changes and cost for transport to clinic
loss of time at work or ability to hold a steady job

Question 5

3. Describe how CKD has affected social relationships..

Answer 5

strain on relationships- fiancé left
requiring a lot of support from relationships- daughter offered to donate
certain level of uncertainty in planning for the future

Question 6

4. Describe how CKD has affected their occupation.

Answer 6

taking time off work, in some cases changed what they were able to do at work, in other cases no change at all