Porth's Essentials of Pathophysiology, 4e

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R E V I EW E X E R C I S E S

1. A 55-year-old man with diabetes and coronary heart disease, who had undergone cardiac catheterization with the use of a radiocontrast agent 2 days ago, is admitted to the emergency department with a flulike syndrome including chills, nausea, vomiting, abdominal pain, fatigue, and pulmonary congestion. His serum creatinine is elevated, and he has protein in his urine. He is admitted to the intensive care unit with a tentative diagnosis of acute kidney injury due to radiocontrast nephropathy. A. Radiocontrast agents are thought to exert their effects through decreased renal perfusion and through direct toxic effects on renal tubular structures. Explain how each of these phenomena contributes to the development of acute kidney injury. B. Explain the elevated serum creatinine, proteinuria, and presence of pulmonary congestion. 2. A 35-year-old, 70-kg white man with diabetes mellitus is seen in the diabetic clinic for his 6-month check-up. His serum creatinine, which was slightly elevated at his last visit, is now 1.6 mg/dL. A. Use the following website to estimate his GFR: http://www.kidney.org/professionals/kdoqi/ gfr_calculator.cfm B. Would he be classified as having chronic kidney disease? If so, what stage? What might be done to delay or prevent further deterioration of his kidney function? 3. Chronic kidney disease is accompanied by hyperphosphatemia, hypocalcemia, impaired activation of vitamin D, hyperparathyroidism, and skeletal complications. A. Explain the impaired activation of vitamin D and its consequences on calcium and phosphate homeostasis, parathyroid function, and mineralization of bone in persons with CKD. B. Explain the possible complications of the administration of activated forms of vitamin D on parathyroid function and calcium and phosphate homeostasis. R E F E R E N C E S 1. Rahman M, Shad F, Smith MC. Acute renal injury: a guide to diagnosis and management. Am Fam Physician. 2012;86(7):631–639. 2. Kellum JA, Lameire N; for the KDIGO Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013;17:204, 1–15.