Kims GM Exam-1


 1) What is your complete anatomic and etiologic diagnosis from the data available in the patient's online record linked above?

Ans)Pt kidney’s have been affected because of the presence of comorbid condition’s like Diabete’s(5yr’s) led to Diabetic nephropathy resulted in hypoalbuminemia leading to Pedal edema.

Classic presentation of kidney failure i.e pedal edema,abdominal distension,Facial puffiness.Where the edema have been progressed from toe to face


2)Reason’s for

Azotemia=Because the kidney’s could not throw out the toxic product’s like NH4,Urea

Anemia=Decreased erythropoetin

Hypoalbuminemia=Nutritional Deficiency & Renal loss

Acidosis=Bicarbonate loss due to renal failure leading to it


3)IV bicarbonate is C/I renal failure

https://www.medsafe.govt.nz/Profs/Datasheet/s/SodiumBicarbonateinjAFT.pd


4)pt condition have been detoriated on 3rd day.Her shortness of breath have been not relieved with diuretic’s.To make pt symptomatically  stable dialysis have been done


 

5.CAUSES OF SOME CONDITIONS


MINIMAL CHANGE DISEASE


FOCAL SEGMENTAL GLOMERULOSCLEROSIS


SECONDARY:


DIABETES MELLITUS


SLE


HIV INFECTION


AMYLOIDOSIS


SARCOIDOSIS


DRUGS:NSAIDS


CANCER;HODGKIN'S DISEASE


NON HODGKIN'S DISEASE


RCC LUNG


6)expected outcomes of ckd patients depend upon age,genes,associated co morbidities                                   This patients condition may deteriorate due to pleural effusion




https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5261605/




7)Macrovascular changes accompanying CKD, such as hypertension and arterial stiffening, have been described to contribute to HFpEF development. Furthermore, several renal factors have a direct impact on the heart and/or coronary microvasculature and may underlie the association between CKD and HFpEF. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC673727



8)mean Hemoglobin levels,before and after study,in rhuepo group we’re 8.85+ or - 1.01g/do and 9.90+ or - 0.29 g/dl,respectively(p less than 0.001) and in control group were,9.00+ or -g/dl and 7.81 + or - g/dl,respectively


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293514/



9)Anaemia contributes to the impairment of health-related quality of life (HRQoL) in patients with CKD [7]. Its impact on patients’ HRQoL burden is exacerbated by reduced physical capacity and energy levels among these patients.



10)S.ALBUMIN:IT IS BELIEVED THAT PRINICIPAL NUTRITION MARKER USED TO IDENTIFY MALNUTRITION PATIENTS WITH CKD BUT ACCORDING TO MDRD STUDY RESTRICTED DIETARY PROTIEN INTAKE TO AS LITTLE AS 0.56g/kg/day S.ALBUMIN REMAINED >4mg/dl EVEN MORE SEVERE RESTRICTION OF DIETARY PROTIEN (0.3-0.49/kg/day) DIDNOT CAUSE REDUCTION IN SERUM ALBUMIN


IF NO. OF OBSERVATIONAL STUDIES,INCLUDING THE ENROLLING HEMODIALYSIS PTS,THE LOW S.ALBUMIN LEVELS IN DIALYSIS PATIENTS ARE A/W SYSTEMIC INFLAMMATION WITH LITTLE EVIDENCE IMPLICATING INADEQUATE NUTRITION AS CAUSATIVE FACTOR


IN SUMMARY A PLETHORA OF CORROBORATIVE CLINICAL EVIDENCE IN GEN.POPULATION AND IN PATIENTS WITH CKD SHOWED S.ALBUMIN IS AN INSENSITIVE INDICATION OF MALNUTRITION



2.Question

This 58M had history of fever with cough and elevated tlc with indiacates renal acute kidney injury.As well there is no albuminuuria,no edema


Etilogy of renal failure in 58M could be fever associated with cough which might have increased leucocyte count and caused renal aki




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