23 B.Divya

 General Medicine Assignment.

        Renal Failure Cases.

2019 Batch (3rd semester)

B.Divya

Roll no:23

I, Divya student from 3 rd semester holding the roll number 23 was given the following assessment to review and analyse the elogs and the clinical cases.This system of learning in healthcare system purely reflects the theme "scholarship  of integration in the medical education and research."

Question 1) peer review

Link:

https://bommakantivaishnavi.blogspot.com/2021/07/formative-assessment.html

             I chose my friend Bommakanti Vaishnavi,roll no :22 as reference for reviewing a blog. The cases which was reviewed by my friend were  very well explained.The necessary questions were posed and checked,reviewed and assesed appropriately taking into the consideration of patients history, diagnosis and also the treatment partof the diagnosed  disease.The pathophysiology of the patients disease,it's symptoms and clinical features are relevantly show with required pictures and videos.

           

               She has thoroughly examined all the system by taking and choosing different patients with different diseases.She has individually choosen cardiology, nephrology, pulmonary,enterology, urology and also infectious Diseases and studied the cases properly to actually know the cause and how to diagnose them and as well she tried to learn the treatment part also.

                The efforts made by my friend were really admirable.I really appreciate her work in understanding and making the elog appropriately.

Question 2)

Link:

I haven't yet got the chance to do the elog.Ill try best to do the elog when I get a chance.

Question 3)

Link:

1)https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

           The patient was diagnosed as ACUTE KIDNEY INFECTION secondary to URINARY TRACT INFECTION.He was presented with sudden onset of pain in the abdomen by burning micturation with high fever associated with chills and rigor and he also complained of decreased  urination which all these are suggestive of some kidney failure problems.The clinical presentation was given properly with all the relevant pictures and laboratory test results.

2)http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html

                  The patient came to op with cheif complaints of  lower backache, dribbling of urine,pedal edema and increased involuntary movements.The lower backache and dribbling of urine suggests that he has some kidney related disorders .He was finally diagnosed having ACUTE RENAL FAILURE (ARF).The examination and the presentation was done very good,eloberated clearly with appropriate test reports and scans.Its very neat that the day to day medication  was aslo clearly mentioned.

3)https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1

                This is a case of chronic intestinal nephritis secondary to plasma cell dyscariasis.The patient was apparently asymptotic and she has past history of muscle pains for which she has been using NSAIDS but 

the diagnosis can be made correctly through the laboratory test reports and the scans that were done .It's difficult to identify an asymptotic patient but it has become possible due to the laboratory tests that were suggested by the Doctor.so from this clinical presentation by inferring the reports and checking the results we can come to the conclusion of acute nephritis in the patient.

4)http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1

                    The presentation deals about the case of pancreatitis  in a chronic alcoholic with Acute Kidney Infection.The patient presented with pain in the abdomen in the epigastric region .All the investigations,images,are clearly mentioned along with the summary which shortly reviews the presentation.Its neat and clean presentation.

5)https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1

                       A 60 year old female came to op with complaints of pedal odema since 10 days along with decreased urinary output.The presentation shows all the laboratory tests reports coherently .The appreciable thing is detailed description of the patients treatment and her clinical features.The presentation is very accurate and apparently mentioned.

6)https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1

             The patient was alcoholic and  presented to hospital with loose stools and pedal odema since 20 days along with abdominal distention.The alcohol consumption of the patient led to hepatitis of the liver .All the detailed investigations led to diagnose the Acute Kidney Infection secondary to Acute gastroenteritis.The presentation  is very good and great along with all the required documents and the day wise treatment history and all the day to day clinical features.

7)https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1

            The patient presented to the hospital with cheif complaints of fever since 4 days and pus in the urine.dribbling of urine, decreased urinary output was also there since an year back.All the investigations done on him revealed that AKI  secondary to urosepsis with b/L hydroureteronephrosis.All the relevant pictures are mentioned but the treatment details should have been more detailed.

8)https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1

       

   The presentation is one of my fellow mate and it was presented very clearly and effectively such that the overview of the patient details can be clearly understood.I really admire her work and itvwas very good and great presentation.

Renal Failure

9)https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html

 

               The patient was a known case of Diabetes mellitus type 2 along  with ketoacidosis since 3 yrs.The came to op with fever and pain in the lower abdomen which led to further investigations.All these investigations led to diagnosis as Acute Kidney Infection.

All the reports were clearly presented along with reports and videos  which makes the understanding still more clear.I really liked the presentation and it's very well done.

https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1

Question 4)

Acute Kidney Diseases:

        These are sudden in onset and are primarily these develop rapidly over a few hours or days and these are the conditions where the functional capacity of the kidney is completely failed or partially decreased.Generally the patients come to op p with c/o decreased urinary output,oliguria,lower abdominal pain, burning micturation,SOB,fever, vomittings -billious, sometimes bilateral pedal edema.

These above all can be the general clinical features of these patients but checking  the laboratory levels of  serum creatinine, low albumin levels gives clearcut problem that the patient is suffering with.Sometimes AKI is associated with other clinical features like Hepatology, pancreatitis,CHF.In case of acute Kidney Diseases there is not need for the transplantation of the kidney but the patient must  be put on dialysis for few days.

Chronic Kidney Diseases:

             These may be a result of prolonged acute Kidney Diseases which remained untreated or  may be developmentally chronic either due to infections or other causes.These are present over a long period and and predominantly irreversible.In these the symptoms develop slowly and are not that specific.Generally the patients complain of muscle aches, generalized weakness, vomittings-billious n, normal or increased output of urine generally no pedal odema but if present it would be associated with periorbital edema

which indicates severe kidney damage,SOB is absent.There would be reduction in the size of the kidney, decreased hemoglobin concentration,anemia, changes in the lipid profile..In these Cases, Transplantation of the kidney is neccessary along with appropriate immunosuppressants to avoid graft rejections and dialysis is aslo required repeatedly in some Cases.

Acute On Chronic Kidney Diseases:

      

                         Rapid decline in the renal function is highly likely to be due to an acute deterioration of Chronic kidney disease which is termed as acute on chronic kidney disease.Here,there will be marked fall be Glomerular Filtration rate which can be taken as a key point in diagnosing the acute on chronic kidney disease.Some patients may have pre existing kidney injury leading to CKD.here dialysis should be done along with the appropriate medications that are required.

        

✱Case 1
Diagnosis : AKI  secondary to UTI, associated with Denovo - DM -2 
Treatment : 
1)IVF : -RL  @ UO+ 30ml/hr -NS
2)SALT RESTRICTION  < 2.4gm/day
3)INJ    TAZAR    4.5gm  IV/TID
                                 |
                             2.25gm IV/ TID
4)INJ     PANTOP 40mg  IV/OD
5)INJ     THIAMINE  1AMP  IN  100ml   NS   IV/TID

✱Case 2
Diagnosis : Hyperuricemia 2° to Renal failure 
Treatment:
• IVF -    NS-0.9%  @100ml/hr
• Inj. Tazar 2.25gm I.V -TID 
• Inj. Lasik 40mg I.V -BD 

✱Case 3
Diagnosis:  Chronic interstitial nephritis secondary to plasma cell dyscariasis
Treatment:   
- T. PAN 40mg /PO / OD
- oral fluids upto 1.5 - 2 lit / day
- Protein - x ( plant based ) 2 tablespoon   in 1 glass of  milk  

✱Case 4 
Diagnosis: DKA with AKI 
Treatment:
Inj. NORAD 2amp in 50ml NS
Inj. PIPTAZ 2.25gm.
Inj. DOPAMINE 2amp in 50ml
Inj. HAI 1ml in 39ml NS

✱Case 5
Diagnosis:INFECTIVE ENDOCARDITIS
Treatment:

1. Inj. Monocef 1gm IV/BD
2. Inj. Vancomycin 500mg IV/BD in 100ml NS over 1hr
3. Procto clysis enema
4. Inj. Pan 40 mg Iv/OD

✱Case 6 
Diagnosis: Renal AKI secondary to urosepsis with b/L hydroureteronephrosis
Treatment: 

Injection PANTOP 40mg IV/OD
Injection PIPTAZ  4.5 stat  and 2.25 gm  IV/ TID
Injection LASIX 40mg IV/BD
Injection optineuron 1AMP in 100ml NS slow IV/OD

✱Case 7
Diagnosis: HFrEF secondary to CAD; CRF
Treatment: 

1. TAB. BISOPROLOL 5mg OD
2.TAB. NITROHART 20/37.5mg 1/2 T/D
3.TAB NICARDIA XL 30mg OD
4.TAB. GLICIAZIDE 80mg BD
5.TAB. NODOSIS 500 mg TD

✱Case 8
Diagnosis: Acute on CKD 
Treatment: 

1. Tab. Augmentin 625 mg ×7 days
2. Tab. Wysolone 40 mg ×10 days.
    30 mg × 10 days 
    20 mg ×10 days
    10 mg ×10 days.
3. Tab . Lasix 20 mg  × 1 month.

✱Case 9
Diagnosis: Alcoholic Hepatitis and aki sec to gastroenteritis

Treatment: 

• INJ THIAMINE 100 mg in 100 ml NS slow IV / TID

• INJ OPTINEURON 1AMP in 100 ml NS slow IV / OD

• INJ LASIX 40 mg  

     

✱Case 10
Diagnosis: Acute Kidney Injury secondary to Urosepsis
Treatment:

 Inj LASIX 40mg (8am- 2pm -8pm)
IVF - NS @ UO + 50 ml/hr

✱Case 11
Diagnosis: pancreatitis in a chronic alcoholic 
Treatment:
IV lasix  40 mg BD .
Tab Nodosis .
IV PIPTAZ 4.5 Gms. BD 
Iv 25%Dextrose. 100 ml BD 
Iv fluids : NS 40 ml /hr.

Question 5)

       

During really a very difficult pandemic situation the learning process has become a hectic problems to both the students and the faculty.But this learning process need to be continued without any interruptions,due to this  our institution and faculty are putting lots of efforts making online e learning classes to proceed regularly and perfectly, accordingly by which a student can understand and learn the clinical features of the patients.Our faculty,interns,and pgs are all putting lots of efforts to make this possible.Though it is aslo difficult task for us(students) we are trying our best to understand the subject.These case presentations and elogs are all  difficult to undertake right now for us but, they are also helping us to learn some history taking, diagnosis,causes and  clinical features to a little extent.I really thank for all the efforts made by our institution and hoping this pandemic ends soon and we are eagerly willing to have our offline classes.

   

             THANK YOU.