Assignment

Applied
medicine
 Assignment
Submitted To: Dr. Asad
Submitted By: Dr. Khadija
Bakhtawar

Sap Id: 70059756

Semester: MID 5th
No. Contents

1. Case 1

2. CKD
❖ Definition
❖ Etiology
❖ Clinical features
❖ Pathogenesis
❖ Stages
❖ Diagnosis
❖ Differential diagnosis
❖ Treatment
❖ Complications
❖ Prevention
❖ Prognosis
❖ Risk factors
 CASE 1
History:
❖ The patient is a 41 year-old male who has a longstanding history of hypertension and
diabetes and presents with a complaint of pruritus, lethargy, lower extremity edema, nausea
and emesis. He denies any other medical illnesses.
Investigations
❖ On physical exam the patient is a well-developed, well-nourished male in moderate
distress. Blood pressure 180/110, pulse 80, respirations 24 and he was afebrile. Body
weight 76.5 kg. HEENT was remarkable for fundoscopic findings of A-V nicking and
copper wire changes consistent with hypertensive injury. Cardiac exam had an S1, S2 and
S4. The remainder of the exam was remarkable for 2+ lower extremity edema and
superficial excoriations of his skin from scratching.
❖ GFR=6.6ml/min
Diagnosis;
❖ CKD
CKD
Definition:
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney
function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in
your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid,
electrolytes and wastes can build up in your body
Etiology:
Chronic kidney disease occurs when a disease or condition impairs kidney function, causing
kidney damage to worsen over several months or years.
Diseases and conditions that cause chronic kidney disease include:
❖ Type 1 or type 2 diabetes
❖ High blood pressure
❖ Glomerulonephritis: an inflammation of the
kidney's filtering units (glomeruli)
❖ Interstitial nephritis: an inflammation of the
kidney's tubules and surrounding structures
❖ Polycystic kidney disease
❖ Prolonged obstruction of the urinary tract, from
conditions such as enlarged prostate, kidney stones
and some cancers
❖ Vesicoureteral reflux, a condition that causes urine
to back up into your kidneys
❖ Recurrent kidney infection, also called
pyelonephritis
Clinical features:
Signs and symptoms of kidney disease may include:
❖ Nausea
 ❖ Vomiting
❖ Loss of appetite
❖ Fatigue and weakness
❖ Sleep problems
❖ Changes in how much you urinate
❖ Decreased mental sharpness
❖ Muscle twitches and cramps
❖ Swelling of feet and ankles
❖ Persistent itching
❖ Chest pain, if fluid builds up around the lining of the heart
❖ Shortness of breath, if fluid builds up in the lungs
❖ High blood pressure (hypertension) that's difficult to control
Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by
other illnesses
Pathogenesis
Stages

Diagnosis:
❖ Blood tests. Kidney function tests look for the level of waste products, such as creatinine
and urea, in blood.
❖ Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to
chronic kidney failure and help identify the cause of chronic kidney disease.
❖ Imaging tests. Use ultrasound to assess kidneys' structure and size. Other imaging tests
may be used in some cases.
❖ Removing a sample of kidney tissue for testing. Doctor may recommend a kidney biopsy
to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia
using a long, thin needle that's inserted through your skin and into your kidney. The biopsy
sample is sent to a lab for testing to help determine what's causing kidney problem.
Differential diagnosis
❖ Systemic lupus erythematosus (SLE)
❖ Renal Artery Stenosis
❖ Urinary Tract Obstruction.
Treatment:
❖ Cardiovascular disease (CVD) is the leading cause of death in patients with CKD.
➢ Reducing risk factors for development of CVD is beneficial.
▪ E.g. treatment of hyperlipidemia, lifestyle and dietary changes
❖ Tight blood pressure control:
➢ Reducing damage due to the end organ effects of hypertension on the kidney as
well as the heart.
➢ Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor
blockers (ARBs) block the effects of angiotensin II on sodium and fluid retention,
(ii) vasoconstriction, (iii) stimulating ADH release, (iv) stimulating aldosterone
release, and (v) inducing a sympathetic response.
▪ ACEIs and ARBs also slow down progression of proteinuria in patients with
diabetic CKD.
❖ Diabetes management:
➢ Tight glucose management slows the progression of vascular and heart disease.
❖ Avoidance of IV contrast, NSAIDs, and nephrotoxic drugs:
 ➢ These agents can potentially induce an acute kidney injury (AKI) on the underlying
kidney disease and therefore exacerbate the baseline CKD.
❖ Diet:
➢ Mixed evidence exists whether dietary protein restriction is beneficial in slowing
disease progression.
➢ Proteins affect the renal hemodynamics, raising the GFR, in hypothesized 2 ways.
▪ Hormonal effects – proteins cause secretion of glucagon, IGF-1 and kinins,
all of which have been shown to raise the GFR.
▪ Tubuloglomerular effects – high amino acid (AA) filtration leads to
increased AA and hence the sodium uptake in the proximal convoluted
tubule. A decreased sodium delivery to the distal convoluted tubule leads to
the rennin-angiotensin system activation via the macula densa and these
work to raise the GFR (mechanisms above)
➢ Controlling hyperphosphatemia: Protein restriction also limits phosphorus
consumption. Hyperphosphatemia plays a major role in the progression of renal
osteodystrophy. Phosphate binders are used to reduce phosphate absorption through
the GI tract.
Treatment for end-stage kidney
disease
❖ Dialysis
❖ Kidney transplant

Complications:
Potential complications may include:
❖ Fluid retention,
which could lead
to swelling in your
arms and legs,
high blood
pressure, or fluid
in your lungs
(pulmonary
edema)
❖ A sudden rise in
potassium levels
in your blood
 (hyperkalemia), which could impair your heart's ability to function and may be life-
threatening
❖ Heart and blood vessel (cardiovascular) disease
❖ Weak bones and an increased risk of bone fractures
❖ Anemia
❖ Decreased sex drive, erectile dysfunction or reduced fertility
❖ Damage to your central nervous system, which can cause difficulty concentrating,
personality changes or seizures
❖ Decreased immune response, which makes you more vulnerable to infection
❖ Pericarditis, an inflammation of the saclike membrane that envelops your heart
(pericardium)
❖ Pregnancy complications that carry risks for the mother and the developing fetus
❖ Irreversible damage to your kidneys (end-stage kidney disease), eventually requiring
either dialysis or a kidney transplant for survival
Prevention:
To reduce your risk of developing kidney disease:
❖ Follow instructions on over-the-counter medications. When using nonprescription pain
relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen
(Tylenol, others), follow the instructions on the package. Taking too many pain relievers
could lead to kidney damage and generally should be avoided if you have kidney disease
❖ Maintain a healthy weight.
❖ Don't smoke
Risk factors:
❖ Diabetes
❖ High blood pressure
❖ Heart disease
❖ Smoking
❖ Obesity
❖ Being African-American
❖ Family history of kidney disease
❖ Abnormal kidney structure
❖ Older age