CKD ward updates
CKD ward updates
Day 1
Starting from the last bed:
1. 53 year old housewife, was diagnosed with CKD and Hypertension 10 months back when she presented with the only complaints of SOB. Has been receiving 2 sessions of HD since then.
Got one session of HD done yesterday.
https://srakeshkumarrollno153.blogspot.com/2021/12/53-year-old-female-patient.html?m=1
2. 53 year old man
Working as a farmer at Nalgonda and a father of 4 children.
He was apparently doing alright 3 months back then he developed high grade fever for which he was taken to an outside hospital. They were told he required hemodialysis because of kidney injury and they were also told that he had high BP. His serum creatinine was 7mg/dl back then. He was taken up for 5 sessions of HD outside. And later started getting HD in our hospital.
His recent serum creatinine is 2.5mg/dl according to his attendant.
He was complaining of leakage from the site of AV fistula and patient went to review with their vascular surgeon.
He was also smoke 1 pack of beedi per day along with everyday 90ml of whiskey consumption.
He also would consume NSAIDs on days he experienced body pains after working.
3. 37 year old man auto driver
- daily consumes 90ml of whiskey everyday and 1 pack of beedi everyday.
5 years back - went to the hospital for pain abdomen. Unclear history of why he was taken up for 2 sessions of HD then. He was told he didn't require any further HD and was discharged.
6 months back - he developed no urine output along with generalized anasarca. He was restarted on HD in our hospital. He was even told his BP was high.
4. 47 year old man
Currently symptomatically better
http://viharreddy127.blogspot.com/2021/12/ckd-ward-21221-update.html
His last HD was on Saturday
His serum creatinine post HD - 4.7
Blood urea - 152
5. 58 year old man
http://jyothsna113.blogspot.com/2022/01/58year-old-male-with-ckd-on-mhd.html
is still complaining of upper back ache
Ortho opinion was taken yesterday
They said there are degenerative changes at multiple areas of spine
And they advised Tab Ultracet BD
6. 60 year old man
Who was diagnosed with CKD 2 months back
Complaining of neck pain since 1 month
http://nehapurohit115.blogspot.com/2022/01/general-medicine-case-discussion.html
It was discussed on rounds yesterday that it could be fluorosis induced OPLL
7. 55 year old man
Presented with the complaints of
Bilateral lower limb edema since 20 days
Facial puffiness since 20 days
Reduced urine output since 20 days
Loss of appetite since 20 days
Sr creatinine- 12.7
Bl. Urea - 241
Yesterday during our morning rounds, his JVP was examinated and we decided to get his 2decho
http://muskaanmenghwani.blogspot.com/2022/01/a-55yr-old-male-patientdaily-wage.html
YouTube link to his 2decho here
8. 15 year old boy
Synptomatically doing better
Last HD done 4 days back
Planning for HD at 10 am
https://vijaykumarkasturi.blogspot.com/2021/10/15-year-old-male-with-acute-kidney.html
9. 57 year old woman
Was admitted in December with
Dyspnea
Productive cough
Generalized anasarca
Reduced urine output
? AKI
Was taken for HD 4 sessions
Now has come for follow up
Serum 2.8
Bl urea 67
Advising that no further HD is required and to be on followup
http://varaprasad108.blogspot.com/2021/12/57-year-female-with-decreased-urine.html
10. 58 year old man
Complaining of chills post every HD session
Last HD done 1 day back
Creatinine - 6.5
Bl urea - 79
TLC is 11,000
Awaiting his culture reports
http://shubhasri98.blogspot.com/2022/01/48-yr-old-patient-ckd.html
11. 32 year old day care nephrology patient
Was diagnosed of CKD 1 year back.
His HD was done yesterday night.
He is complaining of reduced appetite.
Sending his post HD renal function test
https://meghana140.blogspot.com/2021/12/32-year-old-male-with-ckd-on-mhd.html
Some points we discussed during our rounds
The current World Health Organization Guideline recommendation on fluoride in drinking water is 1 ppm.
Fluoridation of drinking water and chronic kidney disease: absence of evidence is not evidence of absence
https://academic.oup.com/ndt/article/23/1/411/1927240
"A small and inclusive amount of research suggests that fluoridation of community water actually causes kidney disease. Kidney damage to tubular function and structure, and reduction in glomerular filtration rate occurred in residents of endemic fluoride areas.
A recently published study suggested that drinking water contains fluoride levels over 2.0 mg/l—half of the fluoride concentration deemed safe by the US Environmental Protection Agency (EPA)—could cause damage to renal tubular structures in children. This conclusion is based on an investigation of 210 children living in areas of China with varying levels of fluoride in the community water (0.6–5.7 ppm). Children drinking water with more than 2 ppm fluoridewere found to have increased levels of NAG and yGT in their urine—both markers of renal tubular damage.
Moreover, a fairly substantial body of research indicates that patients with chronic renal insufficiency are at an increased risk of chronic fluoride toxicity. Patients with reduced glomerular filtration rates have a decreased ability to excrete fluoride in the urine. These patients may develop skeletal fluorosis even at 1 ppm fluoride in the drinking water. Whether or not the body burden of fluoride may further damage the diseased kidneys is unknown. The National Kidney Foundation in its ‘Position Paper on Fluoride—1980’ as well as the Kidney Health Australia express concern about fluoride retention in kidney patients. They caution physicians to monitor the fluoride intake of patients with advanced stages of kidney diseases.
Another cross-sectional study conducted on 239 adults (18–77 years old) by monitoring four early kidney injury biomarkers (ALB, Cys-C, KIM-1, and OPN) related to environmental fluoride exposure, indicated possible tubular dysfunction due to fluoride exposure, that might increase susceptibility to the future development of CKD.
Dr John Yiamouyiannis, who was a leading authority in biological effects of fluoride, has written in his book titled Fluoride: The Aging Factor (1986), “Fluoride exposure disrupt the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lung, kidney and trachea.” Therefore, the breakdown of collagen in the kidneys due to excess fluoride should certainly be damaging the kidneys leading to dysfunction of kidneys, paving the way to CKD. Further, inhibition of kidney enzymes by fluoride was shown by in vitro studies using kidney enzymes extracted from animals."
https://journals.sagepub.com/doi/10.1177/0960327118814161
Some of this animal studies showing the effect of excess fluoride on kidney.
https://journals.sagepub.com/doi/10.1177/0960327118814161
2. "Abdominal epilepsy (AE) is an uncommon syndrome in which gastrointestinal complaints, mostly abdominal pain, are a result of a seizure activity.
It is characterized by paroxysmally diverse abdominal symptoms, definite EEG abnormalities and favourable response to the introduction of epilepsy drugs. Gastrointestinal signs and symptoms may occur as the sole manifestation of a simple partial seizure or as the initial manifestation of a complex partial seizure. In the absence of impaired consciousness, the epileptic cause of these episodes can be difficult to diagnose and may lead to exhaustive gastrointestinal investigation. "
"A 14-year-old girl was referred to our hospital because of attacks of recurrent abdominal pain for the past 4 years. This intense pain was almost always accompanied with pallor and dizziness. Several times, she reported occurrence of nausea, vomiting and diarrhea after these attacks of pain.
She underwent an EEG examination, which revealed repetitive spikes, sharp waves over the right central and temporal electrodes with secondary generalization."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088003/
Regarding the case in our ward currently with history cva 3 years back and known case of epilepsy since 6 years. He is also complaining of abdominal pain since one month, which is mainly involving the right lateral part of his abdominal and he says this pain lasts for 2 hours and he has been having these episodes every 2 times per day.
So we discussed on rounds today the possibility of it being an abdominal seizure.
Criteria for the diagnosis of AE are: (1) otherwise unexplained, paroxysmal gastrointestinal complaints, (2) symptoms of a CNS disturbance; (3) an abnormal EEG with findings specific for a seizure disorder and (4) improvement with anticonvulsant drugs.
3. " Approximately 1 in 4 patients receiving maintenance dialysis for end-stage renal disease eventually stop treatment before death. Little is known about the association of stopping dialysis and quality of end-of-life care.
P - 3369 patients who were treated with maintenance dialysis
C -
Patients who stopped dialysis were more likely than those who continued treatment to have been receiving hospice services at the time of death (544 patients [58.1%] vs 430 patients [17.7%]), less likely to have been admitted to the ICU (435 patients [46.4%] vs 1386 patients [57.0%]) or to have undergone an intensive procedure(263 patients [28.1%] vs 1143 patients [47.0%]) in the last 30 days of life, and less likely to have died in the ICU (167 patients [17.8%] vs 1123 patients [46.2%]).
Families were more likely to rate overall quality of end-of-life care as excellent if the patient had stopped dialysis (P = .002) or continued to receive dialysis but also received hospice services (P < .001)."
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752817
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752817
Day 2
1. 55 year old man
With CKD and Heart Failure
Patient says his dyspnea has reduced and his urine output has improved
Yesterday ascitic tap was done
His ascitic protein is 2.1
SAAG 2.07
No SBP
Planning on keeping him on conservative treatment and not initiating hemodialysis
http://muskaanmenghwani.blogspot.com/2022/01/a-55yr-old-male-patientdaily-wage.html
2. 58 year old man
HD done 3 days back
Complaining of epigastric burning type of pain since several months
His Hemoglobin is 5.9g/dl
Planning to get his next HD with 1 PRBC blood transfusion
Also Planning for a gastro opinion tomorrow morning
3. 48 year old man
CKD and on regular hemodialysis in an outside hospital
Only came for central line placement to our hospital
No patient has no complaints
Planning for his discharge today http://http://yashwanthmynenirollno111.blogspot.com/2022/01/a-55-yr-old-malekco-ckd-with-htn-with.html
4.58 year old man
Still complaining of upper back pain
Giving the patient Tab Ultracet half Tab QID
He has multiple spinal levels of degenerative changes
Secondary to renal osteodystrophy
CKD on Hemodialysis
https://jyothsna113.blogspot.com/2022/01/58year-old-male-with-ckd-on-mhd.html?m=1
5. 5.
55 year old
With polycystic kidney disease and multiple hepatic cysts
The link to his blog has a nice video to his renal cysts
Complaining of productive cough since 1 month
Loss of appetite after initiating HD
His serum last creatinine was on 6.1
Blood urea of 130
Done 2 weeks back
He is currently getting his dialysis done https://harikrishnarollno55.blogspot.com/2021/11/55-yr-old-male-with-polycystic-kidney.html
6. 42 year old man
Currently getting his HD done
Complaining of intermittent fever since the past 10 days
Recent serum creatinine is 3.3
Blood urea is 142
Will be sending his post HD RFT and Hemogram
http://ramprasad116.blogspot.com/2022/01/this-is-online-e-log-book-to-discuss.html
Day 3:
CKD ward:
1. 48 year old man
With type 2 DM since 10 years
Hypertension since 3 years
Uremic gastropathy
Got hemodialysis done yesterday with 1 PRBC transfusion
Planning for Gastroenterology opinion today in view of constant epigaatric pain and nausea
http://shubhasri98.blogspot.com/2022/01/48-yr-old-patient-ckd.html
2. 58 year old man
With CKD
Heart failure secondary to CAD and left
And multiple spinal levels with degenerative changes
With left AV fistula
Still complaining of pain in his upper back, currently giving him Tab Ultracet half tab QID
His last HD was on Tuesday
Planning for HD today
3. 29 year old man
He used to work in brand factory as a salesman
In April on routine investigations he found out his serum creatine was 8.9. To confirm he visited another hospital in Hyderabad where again he found out that his serum creatinine was raised and he was told he required HD.
In June he came to our hospital and received 24 sessions of HD for the months of June, July, August.
For the next 2 months he withheld HD.
In December- he presented 4 episodes of GTCS after which he was got to our hospital and he was dialysed
Sezuires secondary to uremia
https://elogformedicalcasebyintern.blogspot.com/2021/12/28m-with-uremic-seizures-with-ckd-on-mhd.html
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