Biweekly exam

1)Anatomical diagnosis -? Glomerulus of kidney                                                                    Etiological diagnosis -  ?? Nephrotic syndrome secondary to the diabetic nephropathy or CKD.   


  2)Reasons for I) Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.


 II) Anemia : decreased erythropoietin. 


III) Hypoalbunemia: capillary basement membrane and podocytes damage.kidney cannot filter protein                                

Acidosis-accumulation of H+ and loss of HCO3

3) Rationale : syp potchlor was given because of the hypokalemia.. Inj. NaHCO3 was given because of metabolic acidosis ..Insulin and antihypertensives are given because known case of DM and HTN. Orofer XT was given because of anemia.. Inj. Lasix was given to decrease her volume overload. Spironolactone was given it was a potassium sparing diuretic.Calcium was given to the patient  because of hypocalcemia secondary to CKD. Indications of NaHCO3:metabolic acidosis in cardiac arrest, Tricyclic antidepressants, aspirin and phenobarbitone overdoses, Hyperkalemia, Crush injuries, C/I  in certain conditions because of adverse reactions like Hypernatremia, metabolic alkalosis, cellulitis, seizures, Tetany, sodium retention, peripheral edema.             


         4) indication of dialysis in this pt: worsening of SOB secondary to metabolic acidosis with Anuria not resolved with high ceiling diuretics...Crucial factor: pt became symptomatic on 3rd day....          


                            5) Causes of same condition : primary : Minimal change disease, Focal segmental glomerulosclerosis, Membranous nephropathy.    Secondary : DM, SLE, HIV , Viral hepatitis, malaria, amyloidosis,  Sarcoidosis, Drugs : Nsaids, gold, pencillamine Cancer: Hodgkin's and non Hodgkin's, solid tumours of GIT, RCC and 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)association of ckd with hrpef


Activation of raas system


Anemia 


Hypercalcemia 


Hyperphosphatemia


Uremic toxins .these critically discuss the potentail contribution to coronary dysfunction, left ventricular stiffening  and delayed left ventricular relaxation


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)Malnutrition is an important complication in CRI patients and ESRD patients on dialysis. SGA is a reliable method of assessing nutritional status. Most important is the fact that it can detect the changing trend of nutritional status, which may be missed by one-time anthropometry and biochemical methods.


11)this 58M had history of fever with cought and elevated tlc with indiacates renal acute kidney injury.As well there is no albuminuria,no edema


In 45M had had pedal edema ,facial piffiness,abdominal distention,anuria with clearly indicates nephrotic nephritic syndrome.and investigations showed that there is microalbuminuria,micro haematuria.Therapy in is patient  


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

Popular posts from this blog

Nephrotic syndrome

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: A 22 year old man  presented with the chief complaint of generalized edema since 2 weeks.  The youngest of 4 and working as a cashier patient reported to work as usual 2 weeks ago, when his friends asked if he overslept and developed a puffy face. Puzzled, the patient immediately saw himself in the mirror and noticed that he had periorbital edema under both eyes. He did not have any rash, lip swelling or difficulty in chewing or pain in ja...
Read more

A 55 yr old with chronic inflammatory symmetrical polyarthritis

Image
This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: A 55 yr old male patient who was a toddy tree climber by occupation  came to opd with complaint of pain in multiple joints associated with restriction of movement   Patient was apparently asymptomatic 10 yrs back .Then he felt pain in bilateral knee joints which is associated with swelling.for which he used medication (proper records not available about medication)which gave him mild symptomatic relief but not completely cured his pai...
Read more

A 44 yr old female came with c/o generalized weakness

Image
  This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.  Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.  This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome. Here is a case i have seen: Pt presented to opd with c/o Generalized weakness. A 44 yr old female who was apparently asymptomatic 1 yr back then developed pain in the legs(dragging type) ,which is a/w generalized weakness and shortness of breath. The pain in the legs were aggravated during the last 2 months ,at the same time patient developed sudden diminision of vision in left eye,where they visited the local ophthalmologist treated with topical drugs.patient was ref...
Read more