+ Chronic Kidney Disease Baz Lazar
+ Overview Introduction Discussion on finals case History Examination Management Last 15 minutes
+ Background Age standardised prevalence Stage % 10.6% in females, 5.8% in males Causes: 1. Diabetes 2. Hypertension - ? cause or consequence? 3. Renovascular disease 4. Infective, obstructive and Reflux nephropathy 5. Glomerulonephritis 6. Pyelonephritis 7. Congenital e.g. ADPKD, Fabry, Alport 8. Analgesic nephropathy – NSAIDs, 9. Manifestation of systemic disease: Myeloma, SLE, vasculitides, gout, RCC
+ Suffix p to denote proteinuria
+ Case 60 year old gentleman suffering from renal failure for many years. Has creatinine of 640 umol/L Please take a history from this gentleman, focussing on his chronic renal problem
+ History
+ BIG BEANS Breathlessness Itch Gout Bone pain Energy Ankle swelling/anorexia Neuropathy Stones
+ Examination
+ Scars
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+ 15 minutes Helpful to have a structure Any tips?
+ Divide page into 3 Summary and differentials + Problem list Investigations Management Then, if time, try to think on some possible questions and how to answer them
+ Calcium homeostasis
+ Drop in blood calcium
+ GFR and renal function Creatinine Mmol/L % Renal function remaining Aim to have transplant by this point if possible
+ Summary BIG BEANS Focussed examination – think about the cause Manage those 15 minutes – plan some answers if possible If stuck on management, think on symptoms and how you could treat them Don’t forget Psychosocial and MDT Good luck!