Case Summary
Mr. C. is a 32-year-old single male seeking information about bariatric surgery for obesity. He reports a history of being overweight, gaining 100 pounds in the last 2-3 years, and experiencing symptoms such as shortness of breath with activity, swollen ankles, and pruritus over the last six months. He also reports a diagnosis of sleep apnea and high blood pressure, which he tries to control with dietary sodium restriction.
Objective
Mr. C. has a height of 68 inches and a weight of 134.5 kg, which indicates obesity. His blood pressure is 172/98, and his heart rate is 88. He also has 3+ pitting edema in his bilateral feet and ankles. Laboratory results show fasting blood glucose of 146 mg/dL, total cholesterol of 250 mg/dL, triglycerides of 312 mg/dL, HDL of 30 mg/dL, creatinine of 1.8 mg/dL, and BUN of 32 mg/dL. These values indicate potential metabolic and cardiovascular complications.
Potential Health Risks for Obesity and Bariatric Surgery
Obesity is associated with several illnesses and health issues, including cardiovascular disease, diabetes, sleep apnea, and various kinds of cancer. Mr. C. is at a higher risk for hypertension, high cholesterol, and elevated blood glucose levels due to his weight and existing conditions. Bariatric surgery has the potential to produce significant weight loss, which would reduce or eliminate Mr. C’s health problems (Schauer et al., 2012). A thorough evaluation by a bariatric professional and a thorough discussion of the treatment’s benefits and risks should be conducted before surgery.
Functional Health Patterns
- Health Perception. Mr. C. is searching for information about bariatric surgery, indicating an awareness of his obesity and potential health risks.
- Health Management. Mr. C. reports trying to control his high blood pressure with dietary sodium restriction, indicating a desire to manage his health.
- Nutritional. Mr. C.’s obesity and laboratory results indicating elevated cholesterol and triglycerides suggest potential problems with his dietary habits.
- Metabolic. Mr. C.’s obesity, high indicators for blood pressure, cholesterol, and blood glucose levels presuppose potential metabolic complications.
- Elimination. The pitting edema in Mr. C.’s feet and ankles suggests potential problems with his renal function.
Stages and Contributing Factors of End-Stage Renal Disease
End-stage renal disease (ESRD) is the final stage of chronic kidney disease and is characterized by a severe decline in kidney function. The progression of chronic kidney disease is typically divided into five stages, with ESRD being the final stage. They include:
- Stage 1. Normal or high kidney function with normal or slightly elevated protein levels in the urine.
- Stage 2. Mildly reduced kidney function with higher levels of protein in the urine.
- Stage 3. Moderately reduced kidney function with moderate to high protein levels in the urine.
- Stage 4. Severely worsened kidney function with extreme protein levels in the urine and a significant decline in overall kidney function.
- Stage 5. ESRD, in which kidney function is less than 15%. At this stage, the kidneys can no longer adequately remove waste products and excess fluids from the body and require replacement therapy, such as dialysis or transplantation.
Diabetes is the leading cause of ESRD. High blood sugar levels, as well as high blood pressure, can damage the blood vessels in the kidneys, leading to reduced kidney function (Vaidya et al., 2021). Glomerulonephritis is a contributing factor to ESRD and a group of conditions that cause inflammation and damage to the glomeruli, which are the kidneys’ filtering units.
Additionally, polycystic kidney disease is a risk factor for end-stage renal disease. Multiple cysts develop in the kidneys as a result of this genetic condition, causing structural damage and impaired kidney function (Durkie et al., 2021). ESRD is brought on by the illness known as nephrotic syndrome, which is marked by high protein levels in the urine, low protein levels in the blood, and edema owing to fluid buildup.
Scarring from kidney injury caused by kidney stones might eventually limit kidney function. In addition, predisposing factors for end-stage renal disease include obesity, smoking, and a family history of kidney disease. Slowing the course of renal disease and lowering the chance of acquiring ESRD may be achieved by early identification and care of underlying diseases and risk factors.
Health Promotion and Prevention Opportunities
Health promotion and prevention opportunities for individuals with end-stage renal disease include regularly monitoring and managing blood pressure, blood sugar, and cholesterol levels to reduce the risk of cardiovascular disease, adopting a healthy diet that is low in sodium, potassium, and phosphorus to reduce the strain on the kidneys, and engaging in regular physical activity to improve overall health and well-being. In addition, Mr. C. should be counseled to maintain careful control of his hypertension and diabetes to forestall the occurrence of any more kidney damage.
Resources for ESRD Patients
Monitoring kidney function is essential for avoiding deterioration and modifying medication. Imaging scans may be needed to effectively detect renal disease. ESRD sufferers must also get all their medications (Stevens et al., 2010). High blood pressure, anemia, and bone degeneration may necessitate medication. Symptoms like high blood pressure may need medication. Kids may also require antibiotics to treat or prevent illnesses.
End-stage renal disease therapy is worthless without a healthy lifestyle. This may be achieved by eating well, exercising, and avoiding cigarettes and alcohol. Staying hydrated and reducing sodium consumption should also be advised. A multidisciplinary team may help ESRD patients. Nephrologists, nurses, nutritionists, psychologists, and social workers may provide such comprehensive help and also help ESRD patients cope emotionally and psychologically.
References
Durkie, M., Chong, J., Valluru, M. K., Harris, P. C., & Ong, A. C. (2021). Biallelic inheritance of hypomorphic PKD1 variants is highly prevalent in very early onset polycystic kidney disease. Genetics in Medicine, 23(4), 689-697. Web.
Schauer, P. R., Kashyap, S. R., Wolski, K., Brethauer, S. A., Kirwan, J. P., Pothier, C. E.,… & Bhatt, D. L. (2012). Bariatric surgery versus intensive medical therapy in obese patients with diabetes. New England Journal of Medicine, 366(17), 1567-1576. Web.
Stevens, L. A., Viswanathan, G., & Weiner, D. E. (2010). Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Advances in chronic kidney disease, 17(4), 293-301. Web.
Vaidya, S. R., & Aeddula, N. R. (2021). Chronic renal failure. StatPearls Publishing.