PATIENT ONE
A need to urinate many times and passing large amounts of diluted urine is a major symptom of diabetes insipidus. Due to the large out-put of urine a person becomes very thirsty and as a result drinks a lot of water. In the case of the patient and going by her parents’ explanation, I could say that she is suffering from diabetes insipidus. That is why she was urinating too much to the extent of wetting the bed and drinking large quantities of water.
When a one’s pituitary glands or kidney are not functioning normally, diabetes insipidus could occur. Diabetes insipidus is in two forms namely the nephrogenic and central diabetes insipidus and. The pituitary gland fails to produce sufficient anti-diuretic hormone (ADH). The hormone is also known as vasopressin. It is a hormone that aids the regulation of the amounts of water the body reserves on a consistent basis. On the other hand, the kidneys cease acting in response to the volumes of water in the body in nephrogenic diabetes (Fujiwara & Bichet., 2012, 10). Both types of insipidus diabetes makes the body to remove great volumes of very thin urine. Due to loosing large amounts of water, a person gets very thirsty and in return drinks water in large quantities. Due to dehydration, patients especially children become weak and tired.
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To determine if the patient indeed has diabetes insipidus, I would conduct a water deprivation test. The test is aimed at allowing the patient to get extremely dehydrated while blood and urine samples are being taken. During dehydration, vasopressin is also given to check the ability of kidneys to retain water (Blevins & Wand, 2015, 73). The blood and urine samples are used to assess the concentration of blood and urine and determine the amount of electrolytes in the blood. If I note an increased urine concentration it would mean the kidneys are responding to the vasopressin message to improve water conservation. Thus, the patient would be having central diabetes insipidus. If I note that the kidneys fail to sense the hormone, the condition would be diabetes insipidus.
If the tests would be positive, I would recommend the patient to drink large volumes of water frequently. For people who can easily access water, the disease is manageable. If the diabetes insipidus is central I would recommend intake of desmopressin drugs. The drugs work by modifying the fluid imbalance by replacing vasopressin with desmopressin (Baylis & Chetham, 2014, 86). For nephrogenic diabetes insipidus I would recommend anti-inflammatory medicines and diuretics. I would also recommend that the patient cuts down on salt intake, caffeine and protein intake. Proper diet will help to assist water retention in the body.
PATIENT TWO
Patients suffering from high blood pressure are highly likely to contact getting kidney diseases. Due to his long standing history of hypertension and hyperlipidemia, and the symptoms he has been experiencing, I diagnose the patient might be having chronic kidney disease. The condition is also identified as the Chronic Renal Disease. Its patients experience persistent puffiness in the eyes, swollen feet and frequent urination although little urine comes out among others.
According to Matovinovic (2007), Chronic Renal Disease makes kidneys unable to filter waste from the body causing creatinine levels in the blood to increase. In comparison with other capillary beds, glomerular capillaries are more likely to get hemodynamic injury since glomerular filtration relies on rather high intra and trans-glomerular pressure. Glomerular injury causes the above symptoms of renal disease that the patient exhibited. A spot urinalysis was conducted on the patient to measure the amount of creatinine in his urine and albumin. It revealed micro-albuminuria. According to Levey et al., (2009, 608) the Glomerular Filtration Rate (GFR) shows how well kidneys are cleaning the blood. The clients GFR was low than 90, the normal rate, which simply meant his kidneys were not functioning well.
A reduction in life expectancy is expected in patients with lower level of kidney function (Coresh et al, 2007, 2041). All the symptoms the patients exhibited indicate that he is at advanced level of kidney failure. As such, his life expectancy is expected to be shorter. Also research shows that kidney patients in mid-age have a shorter life expectancy compared to younger patients (Coresh et al, 2007, 2041).
References
Baylis, P. & Cheetham, T. (2014) Diabetes Insipidus: Archives of diseases in childhood Vol. 79, 86
Blevins, J. & Wand, G. (2015) “Diabetes Insipidus: critical Care Medicine” Vol. 20, 73
Coresh, J., Selvin E. & Stevan L (2007) “Prevalence of Chronic Kidney Disease in the United States.” Vol 298, 2041
Fujiwara, M. & Bichet, D. (2012) “Molecular Biology of Hereditary Diabetes Insipidus”, Journal of the American Society of Nephrology. Vol. 16, 10
Levey A., Stevan A. & Schmid C. (2009) “A New Equation to Estimate Glomerular Filtration Rate.” Vol. 150, 608.
Matovinovic S. (2009) “Pathophysiology and Classification of Kidney Disease.” Vol 20 (1), 9
