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Chronic Kidney DiseaseBaz 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:

1. Diabetes2. Hypertension - ? cause or consequence?3. Renovascular disease4. Infective, obstructive and Reflux nephropathy 5. Glomerulonephritis6. Pyelonephritis7. Congenital e.g. ADPKD, Fabry, Alport8. Analgesic nephropathy – NSAIDs, 9. Manifestation of systemic disease:

Myeloma, SLE, vasculitides, gout, RCC

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Suffix p to denote proteinuria

+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

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History

+History

BIG BEANS Breathlessness Itch Gout Bone pain Energy Ankle swelling/anorexia Neuropathy Stones

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Examination

+Scars

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

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

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+15 minutes

Helpful to have a structure

Any tips?

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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

+Drop in blood calcium

+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!