. What stage of chronic kidney disease Robert has developed? Explain why Robert’s symptoms (nausea, vomiting and tiredness) have arisen now.

. What stage of chronic kidney disease Robert has developed? Explain why Robert’s symptoms (nausea, vomiting and tiredness) have arisen now.

As the renal specialists recommends Robert to commence dialysis, it indicates, Robert has developed end stage renal disease (ESRD). In this condition kidneys stop functioning adequately for an affected individual to live without a transplant or dialysis. This type of kidney failure is permanent and cannot be reversed. This is also referred to as stage 5 chronic kidney disease with a GFR of 15ml/min or less than that. Robert’s estimated GFR is only 11 mL/min, which further confirms the extent of his renal damage.

Robert’s symptoms (nausea, vomiting and tiredness) have arisen in this stage due to electrolyte imbalance, acidosis and uremia. Renal failure causes elevated level of blood urea nitrogen (BUN). Metabolic acidosis happens as number of active nephrons declines in chronic kidney disease. Urea enzymes decompose urea into ammonia that can further stimulate gastrointestinal mucosa, which further lead to nausea and vomiting (Murtagh, Addington-Hall, & Higginson, 2007). Kidney failure may also decline the renal ‘concentration’ capacity. Frequent night urination causes high BUN and hemoconcentration, which further lead to vomiting and nausea. Anaemia can give rise to extreme fatigue and may worsen Robert’s condition. Impaired kidneys lessen the production of hormone erythropoietin (EPO) that enables red blood cell production from the bone marrow. This condition further leads to shortness of breath on exertion. It is evident from the case study that Robert worked as manual labour, so putting strain on health in the form of physical effort is a part of his daily activities that further worsen his condition.4.