BIMONTHLY ASSESSMENT SEPTEMBER 2020

Q1
 1)Anatomical diagnosis - pedal edema causes
 1) increased hydrostatic pressure
 2) decreased oncotic pressure 
 3) lymphatic obstruction 
?kidney
 ?cardiac
 ?liver.

 Etiological diagnosis - ?long standing CKD ( 6months history of pedal edema) sr creatine and blood urea levels are high ?diabetic nephropathy ? nephrotic pattern hypoalbuminemia ? abdomen distension ? right heart failure

 2)Reasons for
 i) azotemia - ?increased nitrogen in blood ? renal excretion is impaired ?CKD or renal AKI 
 ii) anemia - ?CKD - decreased EPO 
 iii)hypoalbunemia - diabetic nephropathy glomerural disease ? loss of albumin 
 iv) acidosis - acidification of urine is lost H+ is accumulated in CKD 

 3)replacement of bicarbonates to counter metabolic acidosis as it is useful in normal anion gap metabolic acidosis IV BICARBONATE for fast replacement of bicarbonate deficit https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227445/ 

 4)patient was showimg symptoms
 i)refractory anuria 
ii)metabolic acidosis 

 5)glomerulo nephritis
     IGA nephropathy 

 6) high mortality is seen in ckd with hypoalbuminemia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752034/ 

 7)Macrovascular changes accompanying CKD, such as hypertension and arterial stiffening, have been described to contribute to HFpEF development. Furthermore, several renal factors have a direct impact on the heart and/or coronary microvasculature and may underlie the association between CKD and HFpEF. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737277/

 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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293514/

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.

 Q2 Diagnosis ?.PRE RENAL AKI on CKD 

 decreased consumption of fluids due to episode of diarrhoea 10 days back adequate fluids can be given to compensate the volmue loss 

 size of the kidney is increased to more than 3cms in ultrasound abdomen 
 it might be because of 
 1.increase in size 
 2 stenosis with over compensation of the normal kidney

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