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Question 1:  

Identify the type of kidney injury which Sarah has and justify this based on the information in the case study. Explain the pathophysiology of this type of kidney injury 

Acute Kidney Injury, also known as acute renal failure, is the sudden loss of kidney function. When this occurs, the kidney’s are unable to remove waste products and excess fluid, which then build up in the body and disrupt the body’s usual chemical balance(Bullock & Hales, 2018). Based on the information in the case study, it is suspected that the type of kidney injury that Sarah may have is postrenal acute kidney injury.  

Postrenal acute kidney injury occurs when an obstruction in the urinary tract below the kidneys (includes the ureters, bladder and urethra)causes waste to build up in the kidneys. A blockage in the urinary tract may cause urine to build up in one or both kidneys. Over time, this fluid buildup can prevent the normal flow of urine out of the kidney (Bullock & Hales, 2018). A postrenal acute kidney injury obstruction can include kidney stones, prostate hypertrophy or cancerous tumours.  

For example, if a kidney stone is found in the ureter or both ureters, this can obstruct the flow of urine causing a backup of fluid back to the kidney. As a result, there is an increase in renal tubule pressure which decreases the pressure gradient and lowers the amount of fluid being filtered across. This then affects the Glomerular filtration rate and fewer waste products such as urea and creatinine are being filtered out of the blood, subsequently causing oliguria to occur (McCance & Huether, 2014).  

Question 2:  

Describe the clinical manifestations of the type of kidney injury which Sarah has and relate these to the changes which occur in the renal system. Ensure that you discuss the specific clinical manifestations that Sarah has when answering the question.  

The clinical manifestations of postrenal acute kidney injury that Sarah has presented with include oliguria. Oliguria is the sudden decrease of urine output, which can last for hours, with an estimated glomerular filtration rate of less than 0.5ml/kg/hr. Oliguria is the result of urinary outflow obstruction. Oliguria can also cause other symptoms such as nausea, vomiting, body pain and fevers (McCance & Huether, 2014). 

Another clinical manifestation of post renal acute kidney injury that Sarah has presented with is also dysuria. Dysuria is defined as discomfort that is associated with urination. Patients often describe dysuria as a painful burning sensation that occurs at the beginning of or during urination (McCance & Huether, 2014). Another symptom of postrenal acute kidney injury that Saraha has presented with is nausea and flank pain. Flank pain is one of the most common symptoms of postrenal acute kidney injury. When obstruction occurs and distends the bladder or in Sarah’s case the ureters, flank pain can develop and other symptoms such as nausea and vomiting can occur.   

Question 3: 

Discuss the diagnostic procedures for this type of kidney injury based on Sarah’s risk factors and clinical manifestations. Ensure that you discuss the specific diagnostic procedures conducted on Sarah in the case study and how these contribute to her diagnosis. 

The diagnostic procedures for postrenal acute kidney injury based on Sarah’s risk factors and clinical manifestations would include a physical examination. This assessment gives insight into what is happening internally and can be achieved by checking whether or not a patient’s vital signs are within normal ranges. These vital signs include blood pressure, temperature, heart and repsiratory rate, and oxygen saturation levels (Sp02). Based on these findings, Sarah’s temperature, heart and respiratory rate were all within expected ranges however, results indicated that Sarah’s blood pressure was slightly elevated. 

A medical history is also a significant part of the diagnosis as it clues in on a patient’s current health status. Due to her sedentary work, Sarah has gained weight, she is often thirsty when she gets home, and has been under a lot of pressure at work with an important deadline. Currently, Sarah’s medical history indicates that her risk factors, which include dehydration, lack of exercise and diet, are likely to be the contributing factors for her condition.  

Further assessments that can assist with diagnostic process would include a urinalysis and blood test which is required to check for Sarah’s full blood count, electrolyte levels, creatinine and glomerular filtration rate (Bullock & Hales, 2018). Sarah’s tests results reveal that she has increased serum creatinne levels, her urine output is 0.5ml/kg/hr (a sign of oligura), with a GFR of 45ml/min. The purpose of these tests is to determine kidney function and the extent of change in relation to the expected normal ranges. Sarah also had a CT scan which showed a 3mm kidney stone in the ureter. Based on the CT scan, assessments, blood and urinalysis test conducted, Sarah was diagnosed with postrenal acute kidney injury.  

Question 4: 

Explain why the pharmacological treatment prescribed to Sarah is suitable for treating this type of kidney injury. Outline the mechanism of action and how these treatments are usually administered. Ensure that you discuss the dosage and administration route prescribed to Sarah when answering the question. 

Whilst in hospital the doctor prescribed Sarah with intravenous fluids and 2.5mg of morphine intravenously every 3 hours, and based on the blood test, urinalysis and CT results Sarah was also given 12.5mg of hydrochlorothiazide orally. The pharmacological treatment prescribed for Sarah is suitable for treating postrenal acute kidney injury as it aims to remove the obstruction before any irreversable damage to the kidneys occurs.  

Sarah was prescribed 2.5mg of Morphine every 3 hours intravenously. This pharmacological treatment option is most suitable for Sarah as morphine is an analgesic and narcotic drug that is used to relieve server pain (Bullock & Manias, 2016). Morphine can be administered orally, intramuscularly, subcutaneously or intravenously. The route of administration for morphine in Sarah’s case is intravenously for 3 hours, which is suitable as intravenous administration allows the drug to directly enter into the systemic circulation by avoiding the first-pass drug effect resulting in immediate drug effect.  

Sarah was also prescribed intravenous fluids and 12.5mg of hydrochlorothiazide orally. Hydrochlorothiazide is a thiazide diuretic, a type of diuretic that increases urine formation and inhibits sodium and chloride reabsorption at the distal convoluted tubule, which combined with increased fluid intake will lead to increased urine excretion (Bullock & Manias, 2016). Hydrochlorothiazide comes as a tablet and is admnistered orally. This pharmacological treatment is most suitable for Sarah as hydrochlorothiazide will help with flushing Sarah’s urolithiasis through the renal system and the intravenous fluids will help increase Sarah’s fluid intake as one of her risk factors is also dehydration. 

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