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49-year-old male farmer presents to the emergency department with intractable nausea and vomiting, dyspnoea on exertion, and dizziness. The nausea began about two weeks prior to admission. There is no history of medication or toxin exposure. He has lost some weight recently and his current body weight is 52 kg. His past medical history is positive for hypertension diagnosed 4 years ago with no follow-up. He has smoked 1 packet per day for 20 years.
The attending nurse in the emergency department reports his blood pressure to be 160/120 mmHg, temperature 36.7C, pulse 93/min. His skin is pale with numerous areas of spontaneous bruising. Chest x-ray shows increased pulmonary vascular markings and hazy obliteration of the lower lung bases. Abdominal ultrasound examination shows a right kidney size of 7 cm and a left kidney size of 6.8 cm (normal kidney size approx. 10 cm).
Laboratory evaluation reveals:
10.7 x 10
4.5-11 x 10
245 x 10
150-400 x 10
0.40-0.54 (adult male)
60110 umol/L (adult male)
3.0-8.0 mmol/L (adult)
0.20-0.45 mmol/L (male)
Hes admitted to the nephrology ward for further evaluation and management of his condition.
Please answer the following TWO questions:
Q1. What is the pathophysiological basis of hypertension in a patient with chronic kidney disease?
Q2. Based on the clinical picture and laboratory investigations provided, what stage of chronic kidney disease this patient is in and what will be the main management approach at this stage?
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