WEST AFRICAN COLLEGE

OF PHYSICIANS
REVISION COURSE IN
FAMILY MEDICINE
CARE OF RENAL PATIENTS
BY PRIMARY CARE
PHYSICIANS
DR. A. ARIJE
CONSULTANT PHYSICIAN,
DEPARTMENT OF MEDICINE,
UCH, IBADAN.
13th August, 2008
 Renal Diseases : Acute
Chronic
Acute Renal Conditions – those occurring
and remitting within 3 months.
• Examples : Acute urinary tract
infections/pyelonephritis
• Acute GN
• Acute renal failure/tubular
necrosis from various Causes
 Chronic Renal Conditions
• – Those occurring from morphorlogical
damage and/or functional derangement for
> 3 months.

Acute renal diseases constitutes about

30% of registered renal diseases in Ibadan
 CURRENT CLASSIFICATION OF CHRONIC
KIDNEY DISEASE

STAGE 1: Kidney damage with normal, or even elevated GFR; e.g.

early stages of diabetic nephropathy

STAGE 2: Kidney damage, with GFR mildly reduced to between 60-

89mls/min. This is the stage of early renal insufficiency.
 
STAGE 3: Moderate reduction in GFR to between 30-59mls/min
irrespective of evidence of kidney damage. This represents the
stage of chronic renal failure.
 
STAGE 4: Severe reduction in GFR to between 15-29mls/min.
Some symptoms of uraemia may start to appear.
 
STAGE 5: Kidney failure with GFR less than 15mls/min. This is the
stage of end-stage renal disease.
 
Chronic renal disease is assuming
an epidemic magnitude worldwide
GLOBAL BURDEN OF CKD
• 50 million people have progressive kidney
disease
• I million people are on renal replacement
therapy
• Incidence if ESRD has doubled in the past 1o
years
• Annual cost of RRT in the US
>US $25 billion.
 Impact in Nigeria
Population figures not available but
based on hospital figures.
• ESRF accounts for 7-10% of hospital
admission rate
• The mortality is over 90% within 3
months
• Less than 1% are able to afford renal
Transplant.
 Care of Renal Patients
• This is essentially a specialized care,
however there is a role for Pry Care
Physicians.
• The care of renal patients starts from
carrying out relevant investigations to
establish a firm diagnosis that would
enable appropriate treatment
 Relevant Investigations:

- Simple Urinalysis
• - Urine Microscopy
• - Blood chemistry for renal function :
urea, creatinine
• - Radiological imaging : ultrasound,
plain abdominal X-Ray
• I.V.U.
• At the Pry Care level, once a diagnosis
is established, determine if to refer
Cases for Care at Pry Care Level:
Cases for Care at Pry Care Level:
• Community acquired UTI,
• Acute pyelonephritis
• Initial care of acute renal failure
• Others – refer for further assessment. It
has been shown that early referral reduces
mortality and saves resources.
 The role of Primary Care
Physician in Management of
Chronic Kidney disease
Patients
 Established Cases of Renal
Function Impairment (Earlier
Stages of CKD)

• . Monitoring and care of Blood Pressure

– appropriate drugs, appropriate
combination, and appropriate dosing.
Control BP to recommended guideline
levels
• . Drug control – avoid nephrotoxic drugs
and those that compromise renal blood
flow or vasodilatation
• Ensure appropriate dietary management
(if possible with the help of a dietician)
• Prompt fluid management whenever
there is fluid loss – diarrhea, vomiting,
polyuria states, excessive sweating with
reduced or inadequate intake
• Prompt management of infections
• Regular appointment schedules for
nephrologist assessment ( by visiting
nephrologists if possible).
ESTABLISHED CASES OF END STAGE RENAL
DISEASE (ESRD, CKD STAGES 4-5)
• Frequent clinic appointments to check BP
control (as above).
• Fluid balance be careful with diuretics.
• Ensure compliance with dietary control
• Careful drug prescription - avoid use of
nephrotoxic drugs, non-steroidal anti-
inflamatory analgesics
• Anaemia treatment – avoid frequent blood
transfusions. Give hematinics and
erythropoietin according to nephrologist’s
prescription.
• . Regular scheduled nephrologist
assessment. Prompt transfer if there is
problem.
• . For the dialysis patient, avoid tampering
with fistula arm e.g. when checking blood
pressure.
• . For the transplant patient, check BP,
weight, blood sugar, creatinine, lipids
regularly, and get regular advise from the
nephrologists if there is derangement.
• Whenever there is
uncertainty as to what to do,
please refer to the
nephrologist promptly. A
stitch in time, they say,
saves nine ( or ninety!).
THANK YOU FOR LISTENING.