Summarizing nephrology

SUMMARIZING NEPHROLOGY

DR SAIMA NAQVI

LEARNING OBJECTIVES

BY THE END OF THIS LECTURE STUDENTS OF FINAL YEAR MBBS WOULD BE ABLE TO• IDENTIFY HOW TO APPROACH PATIENTS WITH PROTEINURIA AND HEMATURIA.

• APPLY THEIR KNOWLEDGE FOR DIAGNOSING AND MANAGING COMMON NEPHROLOGICAL DISORDERS IN CHILDHOOD.

CHRONIC RENAL FAILURE

DEFINITION OF CHRONIC RENAL FAILURE

• EVIDENCE OF STRUCTURAL OR FUNCTIONAL KIDNEY ABNORMALITIES (ABNORMAL URINALYSIS, IMAGING STUDIES, OR HISTOLOGY) THAT PERSISTS FOR AT LEAST 3 MONTHS, WITH OR WITHOUT A DECREASE IN GFR, AS DEFINED BY A GFR OF <60 ML/MIN PER 1.73 M2 ” 

TREATMENT OF CRF

• NUTRITION.• RENAL OSTEODYSTROPHY. 0.01-0.05 ΜG/KG/24 HR OF CALCITRIOL. PARICALCITOL AND

DOXERCALCIFEROL• ADYNAMIC BONE DISEASE.• FLUID AND ELECTROLYTE MANAGEMENT. HYPERKALEMIA: ORAL ALKALINIZING AGENTS, AND/OR

TREATMENT WITH KAYEXALATE. • ACIDOSIS. SODIUM BICARBONATE TABLETS• GROWTH. RECOMBINANT HUMAN GROWTH HORMONE (RHUGH). TREATMENT MAY BE INITIATED WITH

RHUGH (0.05 MG/KG/24 HR) SUBCUTANEOUSLY• ANEMIA. ERYTHROPOIETIN. DARBEPOETIN ALFA

• HYPERTENSION. A SALT-RESTRICTED DIET (<2 G/24 HR), THIAZIDE DIURETICS, ACE INHIBITORS (ENALAPRIL, LISINOPRIL) AND ANGIOTENSIN II RECEPTOR BLOCKERS (LOSARTAN), CALCIUM CHANNEL BLOCKERS (AMLODIPINE), Β-BLOCKERS (PROPRANOLOL, ATENOLOL), AND CENTRALLY ACTING AGENTS (CLONIDINE

• IMMUNIZATIONS. IT IS CRITICAL, HOWEVER, TO MAKE EVERY ATTEMPT TO ADMINISTER LIVE VIRUS VACCINES FOR MEASLES, MUMPS, RUBELLA AND VARICELLA BEFORE KIDNEY TRANSPLANTATION.

• ADJUSTMENT IN DRUG DOSE. • PROGRESSION OF DISEASE.

WHAT IS THIS?

PICTURE DIAGNOSIS?