The Level of BUN and Creatinine that Signify the Need for Dialysis

The BUN test is used to measure the amount of nitrogen in the blood that comes from urea. Therefore, BUN and creatinine test are done to determine if the kidneys are working correctly. The level of blood urea nitrogen (BUN) rises when the kidney is unable to remove urea from the blood normally. The point where BUN and creatinine levels rise above average, it indicates the impairment of kidneys calling for dialysis. The high level of Blood Urea Nitrogen (BUN) and Creatinine indicates a severe renal disorder which affects the normal renal function. The BUN and creatinine will signify the need for dialysis if they reach a level that the status of the kidney becomes inadequate to sustain its functions in the body (Siew & Davenport, 2015). Development of hematuria indicates the presence of the red blood cells in the urine which is an indication that there is a leakage in the urinary tract (the kidney, urethra, or bladder) especially due to glomerulonephritis. The rise in the BUN and creatinine levels and low creatinine level is as a result of water retention and failure to remove all urea from the blood. The retention of water increases the passive reabsorption of urea. The results of this renal damage were shown by the symptoms such as high blood pressure, sore throat, lethargy and lack of appetite. At this point, the patient needed dialysis.

Cause of the Patient’s hypertension

Glomerulonephritis can cause hypertension or high blood pressure due to kidney impairment which makes it fail to remove urea from the blood. The decline in the rate of glomerular filtration causes the waste to build up in the bloodstream. The reduction in the function of the kidney also influences how kidney handle sodium. Patients who have chronic glomerulonephritis are salt sensitive since renal damage stimulates the intrarenal renin-angiotensin-aldosterone system (RAAS) which is usually responsible for transport of tubule sodium and activation of inflammatory pathways which leads to renal damage. RAAS can also lead to cervical cancer because of such inflammatory pathways in the urinary tract (Ihm, 2015). Hypertension in patients with acute glomerulonephritis is usually due to retention of sodium in the blood which leads to fluid overload. Such case is evidenced by suppressing RAAS system.

What I would do if the Patient had developed a Swollen Mouth and Neck after the IVP

Intravenous pyelogram (IVP) is an imaging test done during an X-ray by injecting dye into the veins to enhance clear viewing of the urinary system. This dye causes an allergic reaction to the patient by triggering the body to release histamine. Histamine is responsible for reactions such as swelling of the mouth, neck, face and other areas. It can also cause itchy throat, sneezing, nasal congestion, breathing difficulties, and anaphylactic shock among other side effects. If a patient develops a swollen mouth and neck after intravenous pyelogram (IVP), he/she is given antihistamine doze or steroids to reduce the reaction of the cataract media. A patient can also be instructed to drink plenty of fluid to get rid of the dye. These remedies are generally given before the exam; although, they can reduce the reactions of the cataract media after the test.

References

Ihm, C. G. (2015). Hypertension in chronic glomerulonephritis. Electrolytes & Blood Pressure, 13(2), 41-45.

Siew, E. D., & Davenport, A. (2015). The growth of acute kidney injury: a rising tide or just closer attention to detail?. Kidney international, 87(1), 46-61.