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Chronic Renal Failure
Causes
Presentation
- Reason for admission
- new diagnosis
- dialysis problem
- complication
History
- Symptoms renal failure
- lethargy
- fatigue
- anorexia
- nausea
- vomiting
- pruritus
- Anaemia / Hypertension?
- Cause
- Dialysis
- Transplant
PMH
- Cause?
- Vascular disease
- angina
- MI
- TIAs
- CVA
- Claudication
- Complications
- hypertension
- bone disease
- anaemia
- aware of any problems with calcium
- may be awaiting parathyroidectomy
DHx
- Anti-hypertensives
- Vitamin supplements
- Phosphate Binders
- Calcium salts
- Erythropoeitin
FHx
SHx
- probably unable to work
- invalidity benefit
- ? home alterations
- facilitate haemodialysis
- separate room for CAPD
Examination
General
- Anaemic
- Pigmentation
- Excoriation / Pruritus
- Bruising
- AV fistula
- Neck dialysis lines / scars
CVS
- hypertension
- Heaving apex beat
- Loud 2nd Heart sound
Abdo
- polycystic kidneys
- transplanted kidneys
- Tenckhofff catheter
CNS
- fundi
- Peripheral neuropathy
Urinalysis
Investigations
- FBC
- U&Es
- Calcium
- Phosphate
- Alkaline Phosphatase
- Creatinine Clearance
- Intravenous Urogram (IVU)
- Renal Biopsy
Treatment
- Diet
- protein, potassium, phosphate, salt restriction
- restriction on
- coffee
- chocolate
- bananas
- fruit drinks
- dairy products
- Drugs
- antihypertensives
- Calcichew +/- Vitamin D
- antihistamines
- antiemetics
- erythropoeitin
- Dialysis
- Transplant
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