Dirty Blood (Case Study‪)‬

My blood is dirty," Brian explains to the triage nurse when he arrives at the emergency room requesting urgent dialysis. He has a dialysis catheter in place and says his last dialysis was approximately one month ago. Further questioning reveals that he has autosomal dominant polycystic kidney disease (PCKD), which also afflicted his father, an uncle, and two cousins. His father died of kidney failure when Brian was a teenager. Brian is now in his forties and has worked a series of construction jobs--some with health insurance, some without. Six years ago a doctor discovered his elevated blood creatinine level. He saw a half dozen nephrologists before beginning dialysis, but never the same doctor twice, and when asked he cannot recall any of their names. A year ago, his creatinine level reached fifteen (normal is about one) and doctors discovered fluid around his heart. This was when he started dialysis.