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Transcript of Renal Medicine
Name: Mdm. R.
Admission for low Hb(5.0)
Left upper limb tremors
Hazy bilateral vision
Takes recormon 1/7 instead of prescribed 2/7
1. ESRF 2º Glomerular Nephritis
3. High Cholesterol
4. DM (poor control)
5. R. Hip AVN
6. UTI (Klebsiella) (03/11)
7. Passed CBD stone (06/11)
8. Salmonella GE (06/12)
9. R. femur fracture from fall (11/12)
Boderline cellular rejection with global scelerosis
Central Bile Duct Stone passed out
Caused by fall
Right Distal Femur Fracture
Underwent LISS plating
Cadeveric Renal Transplant
Delayed Graft Function
Acute Tubular Necrosis
Admission for high Creatinine
Renal biopsy uneventful
V/S: bp 130/80
SpO2: 99% (Room Air)
H:S1S2, soft ESM over Aortic Region
A: Soft non-tender, graft non-tender
DRE: no masses, no PR bleed/malaena, Anal tone intact
Left UL coarse tremors
Fine tremors over R UL
No sensory loss
1. NCNC Anaemia with Stool OB+
2. Multi-focal CVA
3. Failing Graft
Blood -FBC, PBF, GXM, Stool OB x3, Hepatoglobin
Graft function -LDH, LFT, CK
Heart -ECG, CXR
Age 65 or older
Family history of kidney disease
African-American, Native-American or Asian-American race
2 pint RBC
4/24 V/S + SpO2
H/C TDS +10
Prepare Mdm. R. for PD
Iron & Folic Acid
Risk for falls
Rest in Bed
Remove obstacles around Mdm. R's bed
Easily accessible handrails
Nutritional education for failed graft
Counselling and preparaton for PD/ESRF
Show Mdm. R. examples of other patients who undergo similar therapy
Sharing session/Support group with patients undergoing PD
Risk for Infection
Encourage food and nutrition
Assess for pressure ulcers
Encourage hygiene practices
Educate on the importance of medication consumption
Manage side effects
+ve Stool Occult Blood
"I would rather die than undergo dialysis"
American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2011 Jan;35 Suppl 1:S11-63.
Dean, B. B., Dylan, M., Jr, A. G., Knight, K., Ofman, J. J., & Levine, B. S. (2005). Erythropoiesis-stimulating protein therapy and the decline of renal function: a retrospective analysis of patients with chronic kidney disease. Current Medical Research and Opinion , 21 (7), 981-987.
World Health Organisation. (2008). Worldwide prevalence of anaemia 1993-2005. WHO Global Database on Anaemia. Geneva: World Health Organisation.
(Dean et al, 2005)