Medicine an Surgery notes

Apr 24th, 2015
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Diabetes and the Kidney.Dr. J.K.KayimaBackgroundAcute renal failure.Chronic kidney disease.Acute renal failureJust like in other patients.Issues to think of:Pre-renal [ dehydration-DKA,hypotensionMI,sepsis]Intra-renal [ ATN-drugs,contrast. AINdrugs(NSAIDS).AGN-rare.]Post-renal [ bladder outlet obstruction]Chronic kidney diseaseDiabetic glomerulopathyObstructive uropathydynamicneurogenicChronic pyelonephritisIschaemic nephropathyUnexplained ?drugsOther glomerulopathiesDiabetic glomerulopathyStaged according to type 1DMTimeUrinalysis (proteinuria)BPGFRHistologic changesStaging glomerulopathyStage1Time (yr) 0UrineBPNGFRhighHistol-23450-7NN+7-12micro+N++12-20 >20macro +++++++decl<20++?Management principalsStage 1 Meticulous glucose controlStage 2 Meticulous glucose controlBP, lipids?Stage 3 Add ACEI, ARBsStage 4 Add: All modalities to slowprogression of CKD; prep forESRD; support Rx for CKD.Stage 5 Offer RRT (dialysis, transplantation)ChallengesMajority are type 2 with high CV morbidityand mortality Elderly Multi-system involvement Multi-causal derangements Think broadly Spend wisely(cost vs benefit)Name: Medicine an Surgery notesDescription:

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