Reference no: EM132412741
1. A 55-year-old man with diabetes and coronary heart disease, who had undergone cardiac catheterization with the use of a radiocontrast agent two days ago, is admitted to the emergency department with flu like symptoms including nausea, chills, vomiting, abdominal pain, fatigue and pulmonary congestion. His serum creatinine is elevated and he has protein in his urine. He is admitted to the intensive care unit with a tentative diagnosis of acute kidney injury due to radiocontrast nephropathy.
a. Radiocontrast agents are thought to exert their effects through decreased renal perfusion and through direct toxic effects on renal tubular structures. Explain how each of these phenomena contributes to the development of acute kidney injury.
b. Explain the elevated serum creatinine, proteinuria, and presence of pulmonary congestion.
2. Chronic kidney disease is accompanied by hyperphosphatemia, hypocalcemia, impaired activation of vitamin D, hyperparathyroidism, and skeletal complications.
a. Explain the impaired activation of vitamin D and its consequences on calcium and phosphate homeostasis, parathyroid function, and mineralization of bones in patients with CKD.