Case Report On Chronic Renal Failure In Adults

Abstract:
Introduction: The fifth or ultimate stage of CKD, also known as ESKD or chronic renal failure,
occurs when a patient's kidney loss has progressed to the point that permanent renal
replacement treatment is required.
Main Symptoms in CRF: The main signs and symptoms-Fever/cough/cold/abdominal
pain/vomiting/loose stool/edema/giddiness/back pain.
Diagnostic evaluation: blood test: Hb-6.5gm%, total RBC count-3.5million/cu mm, HCT-28.4%,
total WBC count-9.6/cu mm. monocytes-03%, granulocytes-85%,
lymphocytes-10%,calcium-9.1mg/day, creatinine-urine test-71.8mg/dl, KFT- urea-111mg/dl,
cretinine14.0, sodium 134mmol/l, potassium-6.5(pl. repeat), magnesium-2.4mmol/l,
phosphorus-7.3mmol/l, RBS glucose-plasma random -222mmhg, uric acid -8.1mg/dl, urinary
protein- 905mg/dl, bloodpressure-140/90mmhg.
Therapeutic interventions: inj. Levoflox 500mg IV OD, inj. ctri 1gm IV BD X 5days, inj. Pan 40mg
IV OD, inj. Emset 4mg IV OD, inj. Insulin m(30/70) 18u(BFF)-0-12u(BD) inj. EPO 10000 IU SC post
dialysis once per week, tab. Nicardia 20mg TDS, tab. Febuxostat 40mg OD, tab. Shelcal 500mg
OD, tab. autrin OD, tab. Sevelamer 400mg BD, tab. Envas 5mg HS, tab.met XL 25mg OD.
Outcome: after treatment, the adult show improvement. His abdominal pain was
relieved and his diabetes and hypertension were in control.
Causes: Most waste materials produced by our bodies can be eliminated through our kidneys.
However, if the blood flow to the kidneys is disrupted, or if the kidneys are not functioning
effectively due to damage or disease, or if the urine outflow is restricted, a problem can arise.
My patient is suffering from the illness.
The majority of the time, progressive kidney impairment is caused by a chronic disease (a long-
term illness), such as diabetes.
• Diabetes Types 1 and 2 are associated to chronic renal disease. Excess sugar (glucose) can build
up in the blood if the patient's diabetes is not effectively controlled. Kidney disease is uncommon
in the first ten years of diabetes; it develops more frequently 15 to 25 years following diagnosis.
Conclusion: My patient was admitted to male medicine ward no.-24, AVBRH with a known case
of chronic renal failure and he had complaint of abdominal pain, back pain, giddiness. After
getting appropriate treatment his condition was improved.
Keywords: chronic renal failure, hypertension, giddiness, diabetes.
Introduction: Renal failure is caused by a long-term kidney condition. Chronic renal failure is a
condition in which the kidneys' ability to function normally is impaired. Hemodialysis is the
most prevalent kind of therapy in traditional medicine, and it substitutes some functions of the
kidney but not its endocrine or metabolic processes. Another possibility is a kidney transplant,
which can extend the life of people with end-stage renal failure by many years. Both of these
treatments are successful, but they are not inexpensive or accessible, and so are not well
accepted by the Indian populace. Patients with chronic kidney disease pose a wide variety of
diagnostic and management issues, which may be further complicated by a history of dialysis
or renal transplantation. Symptoms develop slowly and aren’t specific to the disease. Some
people have on symptoms at all and are diagnosed by a lab test. Whole body symptoms are
fatigue, high blood pressure, or water-electrolyte imbalance, there are also some common
symptoms like kidney damage, abnormal heart rhythm, failure to thrive, fluidin the lungs,
insufficient urine production, itching, kidney failure, severe unintentional weight loss, or
swelling.
Patient identification: A male adult of 24 years old from Wardha was admitted to male
medicine ward no.-24, AVBRH on 13th of February 2020 with chief complaint of abdominal
pain, fever, cough, with a known case of chronic renal failure. He is 62kg and his height is
182cm.
Present medical history: A male adult of 24 years old who was brought to AVBRH on 13th of
February 2020 by his parents with chief complaint of abdominal pain, (Right hypochondriac
region) and fever and he was admitted to male medicine ward no.-24. He is a known case of
chronic renal failure with diabetes mellitus, hypertension, the male was inactive on admission.
Past medical history:My patient was diagnosed to have apparently alright 6 months back he
started complaining of back pain and has complain of gastritis since 2-3 months and has
giddiness since 2 weeks, diabetes mellitus type-1 since 15years, hypertension since 3 weeks,
no history of cold/cough/fever, no history of loose of stool, abdominal pain, vomiting, no
history of pedal edema, no history of back pain no history of TB and HIV aids.
Family history: There are four members in the family. My patient was diagnosed to have chronic
renal failure with diabetes mellitus and hypertension. His parents were not diagnosed to be
carrier of diabetes mellitus and hypertension. Type of marriage of the parents is non –
consanguineous marriage. All there members of the family were not having complaints in their
health except for my patient who was being admitted in the hospital.
Past interventions and outcome: My patient was diagnosed with diabetes mellitus type-1 when
he was of 10 years of old, from that time onwards he was he was taking his medications and
due to this disease he got diagnosed chronic renal failure and the he was admittedto hospital
time to time for treatment of the disease mostly hemodialysis. It was found effective as the
patient does not develop complications till then.
Clinical finding: fatigue, ammonia-smelling breath, foamy urine, difficulty urinating or frequent
urination.
Etiology: Chronic renal failure develops when a disease or condition inhibits kidney function,
causing kidney damage to deteriorate over time. Chronic kidney disease is caused by a variety of
diseases and disorders, including: • Type 1 or type 2 diabetes.
• Hypertension (high blood pressure).

• Glomerulonephritis is an inflammation of the filtration units of the kidney (glomeruli).

• Interstitial nephritis, which is an inflammation of the tubules and surrounding tissues of the
kidney.
Physical examination: there is not much abnormality found in head to toe examination. My
patient is lead and thin and having dull look. He is weak and well cooperative. Though it is
found that he chest inspection(ribcage for symmetry-symmetrical, movement-normal,
sternorib joint skin integrity-maintained), palpation (to aid fremitus-normal), auscultation
(respiratory tube-normal, heart rate-normal, breath sound-normal), percussion (pleural
effusion-normal, pneumothorax-normal), abdomen (inspection-scar and patches are absent),
palpation (abnormal masses are absent), auscultation (normal sound heart), percussion (gas
and fluid collection are absent).
Diagnostic assessment: blood test-Hb% 11.1gm%, total RBC count4.06millions/cu.mm, total
WBC count 7500cu.mm, RDW13.2%, monocytes03%, granulocytes65%, lymphocytes30%, total
platelet count2.56lacs/cu.mm, KFT (urine105mg/dl, creatinine11.6mg/dl, sodium134mmol/l,
potassium4.5mmol/l), LFT(ALT(SGPT)29U/L, AST(SGOT)30U/L, albumin3.0g/dL, total
bilirubin0.8mg/dl), phosphorus7.3mg/dl.
Therapeutic intervention: inj. Levoflox 500 mg IV OD(a/d) x days, imj. Ctri gm IV BD x 6 days, inj.
Pan 40 mg IV OD, inj. Emset 4mg IV TDS, inj. Insulin m (30/70)18u (BFF)-0-12u(BD), inj. Epo
10000 iu sc post dialysis once a week, tab nicardio 20 mg TDS, tab febuxostat 40 mg OD, tab
shelcal 500 mg OD, tab, tab. Autrin OD, tab. Sevelamer 400 mg BD, tab. Envas 5 mg HS, tab.met
xl 25 mg OD 1-0-0
Discussion
Most waste materials produced by our bodies can be eliminated through our kidneys. However,
if the blood flow to the kidneys is disrupted, or if the kidneys are not functioning effectively due
to damage or disease, or if the urine outflow is restricted, a problem can arise. My patient is
suffering from the illness.
The majority of the time, progressive kidney impairment is caused by a chronic disease (a long-
term illness), such as diabetes.
• Diabetes Types 1 and 2 are associated to chronic renal disease. Excess sugar (glucose) can
build up in the blood if the patient's diabetes is not effectively controlled. Kidney disease is
uncommon in the first ten years of diabetes; it develops more frequently 15 to 25 years
following diagnosis.
NURSING MANEGMENT:
• Identifying probable sources of fluid imbalance and assessing fluid status.
• Putting in place a dietary plan to guarantee appropriate nourishment.
• Provide the patient and family with explanations and information on ESRD and its problems.

• Assist the patient and his or her family with emotional issues.Conclusion: chronic renal
failure is the most common case found in adults and in old age people, it is very important to
diagnose in early stage so that the child will not develop complications from the disease. It is
relatable disease if a person having diabetes mellitus type-1, with hypertension, at the early
stage of age then the person is having the high risk of having this disease. It is also very
important to take preventive measures like KFT and LFT test complete blood count test urine
test, it helps to diagnosed it earlier is very important. My patient shows great improvement
after getting the treatment and the treatment was still going on till my last date of care.
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