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Chronic Kidney Disease

Chronic Kidney Disease . Baz Lazar. Overview . Introduction Discussion on finals case History Examination Management Last 15 minutes. Background. Age standardised prevalence Stage 3-5 8.5% 10.6% in females, 5.8% in males Causes: Diabetes Hypertension - ? cause or consequence?

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Chronic Kidney Disease

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  1. Chronic Kidney Disease Baz Lazar

  2. Overview • Introduction • Discussion on finals case • History • Examination • Management • Last 15 minutes

  3. 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, RCC

  4. Suffix p to denote proteinuria

  5. 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

  6. History

  7. History • BIG BEANS • Breathlessness • Itch • Gout • Bone pain • Energy • Ankle swelling/anorexia • Neuropathy • Stones

  8. Examination

  9. Scars http://www.puvs.org/sites/default/files/images/bryscars.jpg

  10. http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2007/nejm_2007.357.issue-15/nejmicm066807/production/images/large/nejmicm066807_f1.jpeghttp://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2007/nejm_2007.357.issue-15/nejmicm066807/production/images/large/nejmicm066807_f1.jpeg

  11. 15 minutes • Helpful to have a structure • Any tips?

  12. 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

  13. Drop in blood calcium

  14. 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!

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