Baz Lazar Overview Introduction Discussion on finals case History Examination Management Last 15 minutes Background Age standardised prevalence Stage 35 85 106 in females 58 in males ID: 547000
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Slide1
Chronic Kidney Disease
Baz
Lazar Slide2
Overview
Introduction
Discussion on finals case
History
Examination
Management
Last 15 minutesSlide3
Background
Age standardised prevalence Stage 3-5 8.5%
10.6% in females, 5.8% in males
Causes:
Diabetes
Hypertension - ? cause or consequence?
Renovascular disease
Infective, obstructive and Reflux nephropathy
Glomerulonephritis
Pyelonephritis
Congenital e.g.
ADPKD, Fabry, Alport
Analgesic
nephropathy – NSAIDs,
Manifestation of systemic disease
:
Myeloma, SLE,
vasculitides
, gout, RCCSlide4
Suffix p to denote proteinuriaSlide5
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 problemSlide6
HistorySlide7
History
BIG BEANS
Breathlessness
Itch
Gout
Bone pain
Energy
Ankle swelling/anorexia
Neuropathy
StonesSlide8
ExaminationSlide9
Scars
http://
www.puvs.org
/sites/default/files/images/
bryscars.jpgSlide10
http://
www.nejm.org
/na101/home/
literatum
/publisher/mms/journals/content/
nejm
/2007/nejm_2007.357.issue-15/nejmicm066807/production/images/large/nejmicm066807_f1.jpegSlide11Slide12Slide13Slide14
15 minutes
Helpful to have a structure
Any tips?Slide15
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 Slide16
Calcium homeostasisSlide17
Drop in blood calciumSlide18
GFR and renal function
Creatinine
Mmol/L
% Renal function remaining
600
5
500
10
400
20
300
30
200
50
150
75
Aim to have transplant by this point if possibleSlide19
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!