MEDICINE

1.ANATOMICAL DIAGNOSIS:

LIVER? CARDIAC? KIDNEY? 

ETIOLOGICAL DIAGNOSIS -  ?? NEPHROTIC SYNDROME SECONDARY TO THE 

DIABETIC  NEPHROPATHY OR CKD

 2) REASONS FOR:

 I) AZOTEMIA : IMPAIRED RENAL EXCRETION  OF UREA AND  CREATININE SECONDARY TO CKD. 

 II) ANEMIA : DECREASED ERYTHROPOIETIN 

 III) HYPOALBUNEMIA: CAPILLARY BASEMENT MEMBRANE AND PODOCYTES DAMAGE 

 IV) ACIDOSIS: ACIDIFICATION OF URINE LOST.

 

3. RATIONALE SYRUP. POTCHLOR WAS GIVEN BECAUSE OF HYPOKALEMIA.

INJ. BICARBONATE WAS GIVEN BECAUSE OF METABOLIC ACIDOSIS.

INSULIN AND HYPERTENSIVES ARE GIVEN BECAUSE KNOWN CASE OF DM AND HTN. 

OROFER XT WAS GIVEN BECAUSE OF ANEMIA. 

INJ.LASIX WAS GIVEN BECAUSE TO DECREASE HER VOLUME OVERLOAD.

SPIRONOLACTONE WAS GIVEN BECAUSE IT WAS A POTASSIUM SPARING DIURETIC.

CALCIUM WAS GIVEN TO THE PATIENT BECAUSE OF HYPOCALCEMIA SECONDARY TO CKD.

4. INDICATIONS OF DIALYSIS IN THIS PT :

WORSENING OF SOB SECONDARY TO METABOLIC ACIDOSIS  WITH ANURIA NOT RESOLVED WITH HIGH CEILING DIURETICS 

CRUCIAL FACTOR : PT BECAME SYMPTOMATIC ON 3RD DAY. 

5. CAUSES OF SOME CONDITIONS

MINIMAL CHANGE DISEASE

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

SECONDARY:

DIABETES MELLITUS

SLE

HIV INFECTION

AMYLOIDOSIS

SARCOIDOSIS

DRUGS:NSAIDS

CANCER;HODGKIN'S DISEASE

NON HODGKIN'S DISEASE

RCC LUNG

6. HIGH MORTALITY IS SEEN IN CKD WITH HYPO ALBUMINEMIA 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752034/

7.MACRO VASCULAR 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 MICRO VASCULATURE AND MAY UNDERLIE THE 

ASSOCIATION BETWEEN CKD AND HFpEF.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737277/

8. EFFICACY OF DRUGS OVER PLACEBO IN ANEMIA :117 PATIENTS RECEVIED ORAL 

FERRIC CITRATE AND 115 PATEINTS RECEIVED PLACEBO FOR 16 WEEK RANDOMIZED 

PERIOD . 52.1%PATIENTS RECEIVING FERRIC CITRATE ACHEIVED PRIMARY ENDPOINT OF 

INCREASED HB LEVELS . COMPARING TO 19.1% PATIENTS RECEIVING PLACEBO. OVER 

ALL PTS IN CKD , FOUND ORAL FERRIC CITRATE FOUND TO BE SAFE AND EFFICACIOUS 

TREATMENT FOR IDA ANOTHER TRIAL :BETWEEN FERUMOXYTOL AND PLACEBO FOR 

ANEMIA IN IDA AND GI DISORDERS VS PLACEBO IN PTS WHO FAILED OR WERE 

INTOLERANT TO ORAL IRON THERAPHY 

RESULTS:PTS WITH IDA RECEIVING FERUMOXYTOL RECEIVED A LEVELS OF >20G/DL IN 

HB VS PLACEBO PTS 

https://www.dovepress.com/ferumoxytol-versus-placebo-in-iron-deficiency-anemia-efficacy-safety-a-peer-reviewed-fulltext-article-CEG 

9. ANEMIA CONTRIBUTES TO THE IMPAIRMENT OF HEALTH RELATED QUALITY OF LIFE 

(HRQoL) IN PATIENTS WITH CKD . ITS IMPACT ON PATIENTS HRQoL BURDEN ITS 

EXACERBATED BY REDUCED PHYSICAL CAPACITY AND ENERGY LEVELS AMONG OTHER 

PATIENTS.

10. S. ALBUMIN: IT IS BELIEVED THAT PRINICIPAL NUTRITION MARKER USED TO 

IDENTIFY

 MALNUTRITION PATIENTS WITH CKD BUT ACCORDING TO MDRD STUDY RESTRICTED 

DIETARY PROTIEN INTAKE TO AS LITTLE AS 0.56g/kg/day S.ALBUMIN REMAINED >4mg/dl 

EVEN MORE SEVERE RESTRICTION OF DIETARY PROTIEN (0.3-0.49/kg/day) DIDNOT CAUSE 

REDUCTION IN SERUM ALBUMIN

IF NO. OF OBSERVATIONAL STUDIES,INCLUDING THE ENROLLING HEMODIALYSIS 

PTS,THE LOW S.ALBUMIN LEVELS IN DIALYSIS PATIENTS ARE A/W SYSTEMIC 

INFLAMMATION WITH LITTLE EVIDENCE IMPLICATING INADEQUATE NUTRITION AS 

CAUSATIVE FACTOR

IN SUMMARY A PLETHORA OF CORROBORATIVE CLINICAL EVIDENCE IN 

GEN.POPULATION AND IN PATIENTS WITH CKD SHOWED S.ALBUMIN IS AN INSENSITIVE 

INDICATION OF MALNUTRITION.

file:///Users/SHASHI/Downloads/SGA%20Tool%20EN%20colour_2017(1).pdf

11. 58M HAD HISTORY WITH COUGH AND ELEVATED TLC WITH INDICATES 

ACUTE RENAL INJURY AND ALSO THERE IS NO ALBUMINURIA AND EDEMA 

.WHERE AS IN 45 F HAD A PEDAL EDEMA , FACIAL PUFFINESS , ABDOMINAL 

DISTENSION , ANURIA WHICH CLEARLY INDICATES NEPHROTIC NEPHRITIC 

SYNDROME.. AND INVESTIGATIONS SHOWED THAT THERE IS 

MICROALBUMINURIA , MICRO HAEMATURIA IN THIS PATIENT.