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
Comments
Post a Comment