Chronic Kidney Injury

Puan WNWY, 46 years old Malay lady with known history of renal impairment was brought to ED by her family after an episode of loss of Consciousness. On arrival, she already regains her consciousness but drowsy and confused.

On further questioning, her family said that she starts develop dizziness since three days ago associated with lethargy and loss of appetite. She was recently discharge from hospital after defaulting peritoneal dialysis.

There is no history of shortness of breath and chest pain.

On examination, the patient is ill- looking woman with sallow-face appearance. There is systolic murmur on auscultation of the heart but the lung fields are clear. There is no ankle edema noted.

BP: 214/ 82

PR: 123 bpm

T: 37⁰ C

Glucose level: 9.2 mmol/L

A full blood count, BUSE and ABG was ordered. While waiting for the result, IV line is set on patient left dorsum of the hand but IV drip is not giving due to kidney problem.

Result of FBC

WBC: 6.1 X 10⁹ L

RBC: 1.85 X 10¹² L

Hb: 5.5 g/dL (11.7-15.7)

HCT: 16.6% (37-47)

MCV: 89.7 fL

MCH: 29.7 pg

MCHC: 33.1 g/dL

Platelet: 127 X 10⁹/L

ABG result

pH: 7.05 (7.35-7.45)

pCO₂ : 16 (35-45)

pO₂ : 131 (75-100)

SO₂: 98%

HCO₃^- : 4mol/L (22-26)

BUSE

Urea: 46.3 mmol/L(2.5-7.5)

Na+: 139.1 mmol/L(135-145)

K+: 4.3 mmol/L (3.5-5.0)

Cl- : 111.8 mmol/L (98-107)

Creatinine: 1568.9 mmol/L (70-130)

Uric acid: 786.5 mg/dL (2.3-6mg/dL)

Clinical impression

1) Chronic Kidney Injury

2) Severe Metabolic Acidosis secondary to Chronic Kidney Injury

3) Hypertension

4) Cardiac problem? Need to rule out.

Management

1) Peritoneal dialysis is indicated

2) Admit patient to the ward

3) Restricted fluid intake.

4) Correct the acid base disturbance.

5) ECG and chest X-ray.

6) Manage the hypertension