GM

 Anatomical diagnosis -? Glomerulosclerosis                                                                        Etiological diagnosis -  ? Nephrotic syndrome secondary to diabetic nephropathy/ CKD.   


 2)Reasons for 
I)Azotemia : impaired renal excretion of urea and creatinine secondary to CKD.

 II) Anemia : decreased erythropoietin. 

III) Hypoalbunemia:due to damage to capillary basement membrane and podocytes.

 IV)  acidosis: acidification of urine is lost.                                      

3) Rationale : syrup potchlor was given to correct hypokalemia. Inj. NaHCO3 was given for metabolic acidosis.Insulin and antihypertensives are given because of known case of DM and HTN. T.Orofer XT was administered to treat anemia.. Inj. Lasix was given to decrease her volume overload. Spironolactone was given as it is a potassium sparing diuretic.Calcium was given to the patient  because of hypocalcemia secondary to CKD. 
Indications of NaHCO3:metabolic acidosis in cardiac arrest, Tricyclic antidepressants, aspirin and phenobarbitone overdoses, Hyperkalemia, Crush injuries, C/I  in certain conditions because of adverse reactions like Hypernatremia, metabolic alkalosis, cellulitis, seizures, Tetany, sodium retention, peripheral edema.             

   4) indication of dialysis in this pt: worsening of SOB secondary to metabolic acidosis with Anuria which did not resolve with high ceiling diuretics...Crucial factor: pt became symptomatic on 3rd day....          

   5) Causes of same condition :
 primary : Minimal change disease, Focal segmental glomerulosclerosis, Membranous nephropathy.   
 Secondary : DM, SLE, HIV , Viral hepatitis, malaria, amyloidosis,  Sarcoidosis, Drugs : Nsaids, gold, pencillamine Cancer: Hodgkin's and non Hodgkin's, solid tumours of GIT, RCC and lung.

6)expected outcomes of ckd patients depend upon age,genes,associated co morbidities.  This patient's condition may deteriorate due to pleural effusion





7)association of ckd with hrpef:

Activation of raas system

Anemia 

Hypercalcemia 

Hyperphosphatemia

Uremic toxins .these critically discuss the potentail contribution to coronary dysfunction, left ventricular stiffening  and delayed left ventricular relaxation

8)mean Hemoglobin levels,before and after study,in rhuepo group we’re 8.85+ or - 1.01g/do and 9.90+ or - 0.29 g/dl,respectively(p less than 0.001) and in control group were,9.00+ or -g/dl and 7.81 + or - g/dl,respectively


9)Anaemia contributes to the impairment of health-related quality of life (HRQoL) in patients with CKD [7]. Its impact on patients’ HRQoL burden is exacerbated by reduced physical capacity and energy levels among these patients.

10)Malnutrition is an important complication in CRI patients and ESRD patients on dialysis. SGA is a reliable method of assessing nutritional status. Most important is the fact that it can detect the changing trend of nutritional status, which may be missed by one-time anthropometry and biochemical methods.

11)this 58M had history of fever with cough and elevated TLC which indicates acute kidney injuryand also there is no albuminuria,no edema

In 45M with pedal edema ,facial piffiness,abdominal distention,anuria which clearly indicates nephrotic nephritic syndrome.and investigations showed that there is microalbuminuria,micro haematuria.Therapy in is patient  

Etilogy of renal failure in 58M could be fever associated with cough which might have increased leucocyte count and caused renal aki

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