Expert Witness Journal Issue 63 October 2025 - Flipbook - Page 15
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2. Chronic Kidney Disease (CKD) and Its
Progression
• Description: Gradual, long-term decline in
kidney function that can lead to end-stage
renal disease.
• Causes in negligence cases:
ɿ Delayed diagnosis of hypertension or
diabetes, the leading causes of CKD.
ɿ Failure to monitor kidney function in
patients with known risk factors.
ɿ Inadequate follow-up or specialist
referral when early signs of CKD appear.
•
5. End-Stage Renal Disease (ESRD) and Dialysis
Complications
• Description: Complete or near-complete
kidney failure requiring dialysis or transplant.
• Causes in negligence cases:
ɿ Failure to manage earlier stages of CKD
or AKI.
ɿ Poor management of dialysis access
(e.g., infections, clotted 昀椀stulas due to
negligence).
ɿ Inadequate monitoring during
dialysis sessions, leading to electrolyte
imbalances or hypotension.
Why it matters legally:
ɿ Missed opportunities to slow CKD
progression through medication,
blood pressure control, or lifestyle
interventions can be grounds for
negligence.
ɿ Failure to diagnose CKD early can result
in avoidable dialysis, transplantation, or
premature death.
•
3. Drug-Induced Nephrotoxicity
• Description: Kidney damage caused by
medications or substances.
• Common culprits: NSAIDs, aminoglycosides,
chemotherapy agents, lithium, and
IV contrast dye.
• Causes in negligence cases:
ɿ Prescribing nephrotoxic drugs without
monitoring kidney function.
ɿ Continuing such drugs despite clear
warning signs of renal impairment.
ɿ Failure to adjust dosages in patients with
impaired renal function.
•
•
Why it matters legally:
ɿ There are well-established monitoring
standards (e.g., baseline renal testing
before contrast scans, dose adjustment in
renal impairment).
ɿ Negligence claims often hinge on
whether clinicians failed to adhere to
these standards.
Why it matters legally:
ɿ A failed transplant is devastating and
usually avoidable with proper care.
ɿ Negligence cases often focus on
whether standard protocols for
immunosuppression and monitoring
were followed.
7. Hypertensive and Diabetic Nephropathy
Mismanagement
• Description: Progressive kidney damage
caused by uncontrolled high blood pressure or
diabetes.
• Causes in negligence cases:
ɿ Failure to diagnose or adequately control
blood pressure or blood glucose.
ɿ Inadequate monitoring of kidney
function in long-term diabetic or
hypertensive patients.
•
Why it matters legally:
ɿ Kidney damage from obstruction
is usually preventable with timely
intervention.
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Why it matters legally:
ɿ ESRD represents a catastrophic, lifealtering outcome for patients.
ɿ Negligence claims often involve high
compensation for ongoing care,
disability, and loss of quality of life.
6. Renal Transplant Complications
• Description: Kidney transplant failure due to
rejection, infection, or surgical complications.
• Causes in negligence cases:
ɿ Failure to recognize early signs of
rejection.
ɿ Medication errors involving
immunosuppressive drugs.
ɿ Surgical or post-operative
mismanagement.
4. Obstructive Uropathy (Blocked Kidneys)
• Description: Blockage of urine 昀氀ow, which can
cause kidney damage if untreated.
• Causes in negligence cases:
ɿ Failure to promptly investigate
symptoms such as 昀氀ank pain, hematuria,
or anuria.
ɿ Delayed imaging (e.g., ultrasound,
CT scan) to detect stones, tumors, or
enlarged prostate.
ɿ Delayed urological intervention to
relieve obstruction.
•
Courts assess whether delays in diagnosis
or intervention were unreasonable.
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Why it matters legally:
ɿ These are among the most preventable
causes of kidney failure.
ɿ Negligence claims may argue that earlier
interventions could have slowed or
prevented progression to CKD or ESRD.
OCTOBER/NOVEMBER 2025
