Assignment Task
Case Study
A 47-year-old male truck driver presents to the emergency department with intractable nausea and vomiting, dyspnoea on exertion, and dizziness. The nausea began about two weeks prior to admission; vomiting has occurred within the last few days. There is no history of medication or toxin exposure. He has lost some weight recently and his current body weight is 52 kg. His past medical history is positive for hypertension diagnosed 14 years ago with no follow-up. He has smoked 1 packet per day for
27 years. On physical examination, his blood pressure is 160/120 mmHg, temperature 36.7°C, pulse 100/min. His skin is pale with numerous areas of bruising and excoriations. Chest x-ray shows moderate cardiomegaly with increased pulmonary vascular markings and hazy obliteration of the lower lung bases. Abdominal ultrasound examination shows a right kidney size of 7 cm and a left kidney size of 6.8 cm (normal kidney size approx. 10 cm).
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Urinalysis
Protein 1+
Blood 1+
Glucose Neg
Casts Neg
Bacteria Neg
Please answer the following TWO questions:
1. What is the pathophysiological basis of renal changes in long-standing hypertension?
2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage?
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