N4 Pathophysiology AY 23-24

Hello, as the group collectively researched for the questions, the following are our answers:

1) How specifically does the nicotine substance from smoking lower the level of HDL?
- The chemicals in tobacco smoke can lower HDL levels in different ways. They reduce proteins called cholesteryl ester transfer protein (CETP) and fats called lecithin, which are needed to build HDL. Smoking also impairs the liver's ability to clear excess triglycerides from the blood. Nicotine, specifically nicotine deposits, triggers a buildup of lipids in the liver. According to a 2022 study, smoking is linked to NAFLD because nicotine accumulates in the intestine and activates a specific protein called AMPK. This sets off a chain of events producing ceramides, and lipids accumulating in the liver and can cause NAFLD progression.

2) The patient occasionally drinks alcohol. Can you further elaborate on the mechanism where alcohol drinking causes higher levels of LDL?
- The liver helps reduce LDL through the bile it produces. It breaks down and eliminates excess cholesterol from the body. Drinking alcohol promotes liver disease, and impaired liver function disrupts normal lipid metabolism, leading to increasing levels of LDL. Upon further research, studies have shown that occasional alcohol drinking (more specifically of healthy alcohols such as red and white wines) increases HDL levels or good cholesterol, and helps collect the excess LDL. Also, due to the lack of information provided if the patient has drank alcohol recently and still drinks even with CKD, the risk of increasing LDL levels would not be significant. In contrast, if ever, occasional drinking helps raise HDL and may not pose risks to the patient according to Fan et al., (2019), however, it can be noted that even the consumption of small amounts of alcohol can be associated with increased death risk considering that the patient is at stage 5 CKD already.

I hope this answers your questions! Thank you!

Hello, as the group collectively researched for the questions, the following are our answers:
1. Can poor appetite can be related to having a fever or being febrile?
- Poor appetite can be related to the patient’s fever as the immune system tries to fight off the infection that caused the fever by releasing cytokines. The release of cytokines affects the hypothalamus which may result in feeding suppression. IL-1 beta and IFN act directly and specifically on the glucose-sensitive neurons in the ventromedial hypothalamic nucleus (a "satiety" site) and the lateral hypothalamic area (a "hunger" site).

2. Why does hyperlipidemia cause hypertension?
- The accumulation of fats or lipids in the bloodstream can block the blood vessels, causing the path through which blood may flow to narrow down. More pressure is applied to a narrowed blood vessel for blood to be able to pass through.

3. Maybe your group would like to add the factors why age is a risk factor.
- Age is a risk factor in CKD due to the kidney’s natural aging. As one ages, there is a natural tendency of the body organs to age or degenerate as well since cell reproduction in older people becomes slower. Additionally, some noncommunicable diseases that are prevalent in aging people, such as diabetes, hypertension, and CV diseases, contribute to kidney damage. (Chronic Kidney Disease (CKD) in the United States - Age).

I hope this answers your questions! Thank you!

Hello Group 2,

Thank you for your feedback on our pathophysiology diagram. We appreciate your insights and suggestions. Upon deliberation with the group, here are our responses to your questions and comments:

1. We included more detailed information on the mechanisms of medications, specifically how they address or potentially exacerbate conditions within the pathophysiology of the patient's case. This addition clarifies the role of each medication in managing CKD and its complications from the side effects.

2. We ensured that all colors, including the light gray boxes, were clearly defined in the legend to avoid any confusion. We also distinguished between different elements such as "complications" and other categories. Additionally, we refined the lines and mechanisms in the diagram for better clarity and coherence.

We made the necessary revisions to improve our diagram and enhance its clarity. Thank you!