If your patient’s kidneys lose the ability to concentrate urine, he may develop polyuria and nocturia.
His urine may have a low specific gravity and a high sodium concentration.
Your patient may have a low serum sodium level because of his kidneys’ inability to reabsorb sodium.
And his serum potassium and phosphate levels may be elevated because of reduced renal excretion of potassium and phosphate.
If his kidneys lose their ability to produce erythropoietin, he may become anemic.
He may have jugular vein distention, a full and bounding pulse, peripheral edema, pulmonary edema, and heart failure.
And he may develop anorexia, nausea, vomiting, diarrhea, lethargy, and difficulty concentrating.
Usually, this pain, called claudication, disappears with rest.
If his femoral pulse is diminished, he may have aorto iliac disease.
As the disease progresses, the pain will increasingly limit a patient’s activity, and he’ll feel pain at rest.
However, this position further compromises venous return, decreasing blood flow to his legs.
The skin of the affected leg may be hairless, cold to the touch, dry, and shiny.
When the affected leg is elevated, it may be pale.
If peripheral vascular disease results in severe ischemia, painful ulcers may form at pressure sites and over bony prominences, such as the heel, ankle, toes, and dorsum of the foot.
They also may be covered with black eschar.
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