What physiologic complications of CKD does Dean exhibit? Dean is a 33-year-old African American male who presents to the hospital with reports of experiencing progressively worsening shortness of breath and weakness over the past 3 months. He attributes his fatigue to having a newborn child at home and studying for the bar exam. Three days prior to admission, Dean developed a cough, shortness of breath (orthopnea) that worsens at night (paroxysmal nocturnal dyspnea), and dyspnea with minimal exertion. He reports foamy, dark colored urine and increased frequency of nocturnal urination. Dean lives with his wife and infant daughter and recently graduated from law school. Dean states that his grandmother died of kidney disease at age 65 years.