48 yr female with anasarca( internal assessment)

 1) What is your complete anatomic and etiologic diagnosis from the data available in the patient's online record linked above? (ignore the provisional diagnosis on admission mentioned in the case report)

Ans)  glomerular damage( cytokinine mediated podocyte injury) 

Right heart failure

Etiology: CkD due to diabetic nephropathy nd hypertension

2)What are the reasons for her:


Azotemia : renal failure ( decrease excretion of nitrogenous waste) 


Anemia : iron deficiency amemia ( microcytic hypochromic anaemia) nd CKD

As mcv less than 100) 

Decrease iron stores

Hypoalbuminemia ( protinuria basement damanage nd podocyte damage) ndto some extent nutritional cause) 


Acidosis : decrease bicarbonate reabsorption( acidification of urine lost) 

What was the rationale for her treatment plan detailed day wise in the record? 

Day 1  injNaHO3: to control the acidosis  

Normally NaHCO3 given in N anion gap

C/I in high and low anion gap

Syp potchlor for hypokalemia

Day 2: inj Hai acc to sliding scale(DM) 

            Tab telma 40 mg nd nicordia 10 mg(sos)( for Hypertension) 

          Inj lasix for fluid overload

             Tab orofer for anaemia

            Tab shelcal for hypocalcemia due to CKD

             Inj erythropoetin sc for anaemia due to ckd

4) What waes the indication for dialysing her and what was the crucial factor that led to the decision to dialyze her on the third day of admission? 

Ans) acidosis nd sob
 
5)What are the other factors other than diabetes and hypertension that led to her current condition? 
Ans) focal segment glomerulosclerosis
       Minimal change disease
      IGA nephropathy
      Membraneous nephropathy
 Cancers sec to GIt
Primary tumors like RCC

6) What are the expected outcomes in this patient? Compare the outcomes of similar patients globally and share your summary with reference links. 
Ans) outcome depend on age ; hypoalbunemiand other comorbidities
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5261605/

7) How and when would you evaluate her further for cardio renal HFpEF and what are the mechanisms of HFpEF in diabetic renal failure patients?
Ans) microvascular damage
Cornary damage
Ventricular dysfunction due to diabetics nd hypertension 
Activation of RAAS system

8)What are the efficacies over placebo for the available therapeutic options being provided to her for her anemia? 

Ans)mean hemoglobin levels before and after study in rhuepo group we are 8.85+ Or 9.90+or -0.29g/dl , respectively (less than a0. 001) and in control group were 9.00+ Or g/dl and 7.81 + Or g/dl respecticely
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293514/

9)What is the utility of tools like the CKD-AQ that assess the frequency, severity, and impact on daily activities of symptoms of anemia of CKD? Is Telegu among the 68 languages in which it is translated? 
Ans) Anaemia contributes to the impairment of health related quality of lifelife in patients with ckd. It can be assesed by physical burden nd energy level 

10) ans) Malnutition important compliaction in CKD nnd ESRF patients  can be assesed by anthropometry nd biochemical methods

11) 58 male  had only pedal odema nd decreased urine output which is acute of duration 5 daysdaysno similar complaints in past
H/o fever prior to admission
No sob his usg shows normal kidney size nd echotecechotecture ( so can explain his AKI due to sepsis)  pt was on antibiotics nd lasics  
Where as female has sob nd acidosis condition is deteroiting due towhich patient is advised for dialysis

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