Scenario A
Acute renal failure: Ms. Jones, a 68-year-old female, underwent open-heart surgery to replace several blocked vessels in her heart. On her first day postoperatively, it was noted that she had very little urine output.
1. What is happening to Ms. Jones’s kidneys, and why is it causing the observed symptom?
Ms. Jones just had open-heart surgery and her kidneys did not have enough blood flowing to them (possibly because of low blood pressure during the surgery) and are struggling to work effectively now (The Mayo Clinic Staff, 2011).
2. What other symptoms and signs might occur?
Confusion, Fluid retention, fatigue, drowsiness, and an ammonia smell to the breath are a few other signs and symptoms that may occur with acute renal failure although some signs may be confused with post-operative complaints (The Mayo Clinic Staff, 2011).
3. What is causing Ms. Jones’s kidney disease?
Ms. Jones’s recent open-heart surgery is most likely the cause of her kidney disease. Low blood pressure during the operation caused her kidneys to stop working because of lack of blood to the organ to filter toxins from the body (Leurs, 1989).
4. What are possible treatment options, and what is the prognosis?
A variety of medication can be used to treat kidney failure in this case, including temporary dialysis (The Mayo Clinic Staff, 2011). The prognosis for Ms. Jones is good she will most likely recover, and suffer no long term effects.
Scenario B
Chronic renal failure: Mr. Hodges, a 73-year-old man, has had congestive heart failure for the past 5 years. His doctor has told him that his heart is not functioning well, needing more and more medicine to maintain circulatory function. He has noticed that he is not urinating more than once a day.
5. Why is the condition of Mr. Hodges’s kidneys affecting the rest of his body?
Congestive heart failure (CHF) and chronic renal failure (CRF) are two of three medical conditions that create a cycle of worsening problems to the patient. I would not doubt that Mr. Hodges is also anemic because of his worsening symptoms; a third of patients who suffer from both are. Frequently, non-steroid anti-inflammatory drugs are given to ease symptoms of CHF, increasing symptoms of CRF (Iaina, 2005).
6. As his chronic renal failure worsens what other symptoms and signs might occur in his respiratory, digestive, nervous, and urinary systems?
As he progresses into end stage renal failure, urea will build up in the body creating ammonia which in high concentration causes diarrhea, vomiting, and nausea (Zellman. 2010). Mental confusion will develop as ammonia concentrations in the blood increase, tissues will swell as the body can no longer get rid of excess waste, tingling of limbs and labored breathing can be expected as well.
7. What is causing Mr. Hodges’s kidney disease?
Mr. Hodges’s kidney disease is most likely being caused by medications he is taking for congestive heart failure. Medications for congestive heart failure can lower blood pressure (Zellman, 2010) restricting blood flow to the kidneys. Congestive heart failure is also more aggressively treated in most cases than chronic renal failure (Iaina, 2006).
8. What are possible treatment options, and what is the prognosis?
Possible treatment options are bed rest (Zellman, 2010) a variety of medications such as diuretics for CHF and CRF, dialysis, and lastly transplant, although he is probably not the best candidate for it because of his underlying condition. The prognosis for Mr. Hodges is poor, with proper medication management for both conditions he may survive for a few more years but his quality of life will be reduced (Iaina, 2006).

References:

Iaina, A. (2005). Therapy insight: congestive heart failure, chronic kidney disease and anemia, the cardio-renal-anemia syndrome. . Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16265380
Iaina, A. (2006). Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. . Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16868702
Leurs, P. (1989). Acute renal failure after cardiovascular surgery. Current concepts in pathophysiology, prevention and treatment . Retrieved from http://eurheartj.oxfordjournals.org/content/10/suppl_H/38.abstract
The Mayo Clinic Staff. (2011). Acute kidney failure. Retrieved from http://www.mayoclinic.com/health/kidney-failure/DS00280 Zelman, M., Tompary, E., Raymond, J., Holdaway, P., & Mulvihill, M. (2010). Human diseases: A systemic approach (7th ed.). Upper Saddle River, NJ: Pearson.