Assessing Renal Patients - PowerPoint Presentation

Assessing Renal Patients
Assessing Renal Patients

Assessing Renal Patients - Description


Sharondeep Gill Overview Chronic Kidney Disease History Examination Fistula Cases Clinical Topics Summary CKD CKD GFR lt60 for gt3 months Renal failure GFRlt15 or need for dialysistransplant ID: 510744 Download Presentation

Tags

disease kidney chronic renal kidney disease renal chronic polycystic stage egfr minute dialysis ckd examination syndrome thrill oedema impairment

Embed / Share - Assessing Renal Patients


Presentation on theme: "Assessing Renal Patients"— Presentation transcript


Slide1

Assessing Renal Patients

Sharondeep

GillSlide2

Overview

Chronic Kidney Disease

History

Examination

Fistula

Cases

Clinical Topics

SummarySlide3

CKDSlide4

CKD

GFR <60 for >3 months

Renal failure: GFR<15 or need for dialysis/transplant

Causes

Hypertension

Diabetes

Glomerulonephritis

Polycystic Kidney Disease

Chronic

Obstruction

Infection - Chronic Pyelonephritis

Medications - AnalgesicsSlide5

CKD Stages

Stage 1: normal

eGFR

>90 ml/minute/1.73 m

2

with other evidence of chronic kidney

damage.

Stage 2: mild impairment

eGFR

60-89 ml/minute/1.73 m

2

with other evidence of chronic kidney damage.

Stage 3a: moderate impairment

eGFR

45-59 ml/minute/1.73 m

2

.

Stage 3b: moderate impairment

eGFR

30-44 ml/minute/1.73 m

2

.

Stage 4: severe impairment

eGFR

15-29 ml/minute/1.73 m

2

.

Stage 5: established renal failure (ERF)

eGFR

less than 15 ml/minute/1.73 m

2

or on dialysis

.

-Persistent

microalbuminuria

, proteinuria or haematuria

(after exclusion of other causes -

eg

, urological disease).

-Structural

abnormalities of the kidneys, demonstrated on ultrasound scanning or other radiological tests -

eg

, polycystic kidney disease, reflux nephropathy.

-Biopsy-proven

chronic glomerulonephritis.Slide6

HISTORYSlide7

History

Normal

Hx

+

A

norexia

, nausea, vomiting, fatigue, weakness, pruritus, lethargy, peripheral oedema, dyspnoea, insomnia, muscle cramps, pulmonary oedema,

nocturia

, polyuria and

headache.

Hiccups

, pericarditis, coma and seizures

only

in

very severe

CKD

.

PMHx

:

diabetes, hypertension, polycystic kidney disease

Dialysis

Transplant – functioning?

DHx

:

Diabetic or antihypertensive medications

Immunosuppression

Steroids

FHx

:

Polycystic kidney disease

Diabetes

HypertensionSlide8

EXAMINATIONSlide9

Examination

WIPER – wash hands, intro, patients name/dob, explain + consent, reposition

Inspection

Around the bed

Nutritional status – wasting?

Excoriations

Cushing Syndrome

Hands

Flapping tremor (uraemia)

Nails –

leukonychia

(

hypoalbuminaemia

in

nephrotic

syndrome),

koilonychia

(Fe deficiency anaemia in nephritic syndrome

Pulse

BP

Arms: AV fistula – expose both arms fully, palpate and

auscultateSlide10

Examination - Fistula

Used in haemodialysis

Surgical procedure to connect artery side to end with ligation of distal vein

Higher pressure and increased flow

Use 6-8 weeks post formation

Active: palpable thrill, audible bruit, access marks

Types: Radio-cephalic

,

Ulnar-

basilic

,

brachio

-cephalic

Implications: body image, clothing, avoid trauma, no

bp

/blood taking

Complications: infection, stenosis, thrombosis, bleeding, failure

Steal syndrome: distal tissue ischaemiaSlide11

Examination

Head & Neck

Eyes – conjunctival pallor

Mouth/tongue – gingival hypertrophy (immunosuppression)

Neck – JVP, scar (

parathroidectomy

)

Abdo

Inspection

Distension

Scars

Hockey stick/Rutherford Morrison

Previous peritoneal dialysis

Back

Palpation – LIF mass

Percussion

Auscultation (renal bruits)

Peripheral oedemaSlide12

Case 1Slide13

Mr AB Age 54Slide14

No thrill, no audible bruit

2 x small soft masses either side of umbilicus

10cm firm, non tender mass below scarSlide15

Case 2Slide16

Mr CD Age 58

No thrill, no audible bruit

Well healed scarSlide17
Slide18

Case 3Slide19

Mrs EF Age 54

Thrill & bruit, puncture markSlide20

10cm firm, non tender mass below scarSlide21

Clinical Topics

Causes of CKD

Haemodialysis vs Peritoneal Dialysis

Indications for haemodialysis

Renal Transplant

Immunosuppression and its complications

Cushing Syndrome

Polycystic Kidney Disease

Hyperparathyroidism

Renal

OsteodystrophySlide22

Haemodialysis Indications

Persistent hyperkalaemia >7

mmol

Acidosis pH <7.2

Refractory pulmonary oedema

Uraemia causing pericarditis / encephalopathy

Posioning

/ overdose e.g. aspirinSlide23

Polycystic Kidney Disease

50% will get ESRF

Can

also get cysts in

liver

, pancreas, brain, and arterial blood vessels

Autosomal dominant

PKD1 mutation on

Chrom

16 (85%)

PKD2 mutation (15%)

Autosomal recessive

Tend to present younger

May need nephrectomy if severe

Associated with: mitral valve prolapse, SAHSlide24

Hyperparathyroidism

Renal

osteodystrophy

:

1.

O

steoporosis

2. Hyperparathyroidism

3.

Osteomalacia

4.

Osteosclerosis

pepperpot

lesions & rugger jersey spine” – sclerotic end plates and lucent central areasSlide25

Resources

Levey

AS, Coresh J (2012). Chronic Kidney Disease. Lancet 379: 165-180.

http

://

www.37med.com/uploadfile/2012/0118/20120118055854639.pdf

BTS Guidelines on Renal Transplant

http

://www.bts.org.uk/Documents/Guidelines/Active/transplantationguidelinesFINALApril08%20(2).pdf

Patient.co.uk

OHCM

Shom More....
By: phoebe-click
Views: 59
Type: Public

Download Section

Please download the presentation from below link :


Download Presentation - The PPT/PDF document "Assessing Renal Patients" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.

Try DocSlides online tool for compressing your PDF Files Try Now