Chronic Renal failure in primary care

Ae :

DM – kimmerstein Wilson body,

HTN – if no htn other things causing kidney disease will give u htn in the end,

GN, Nephritis - (SLE, drugs, membraneous, hepatitis, all types of GN),

Polycystic kidney (usually pick it up when pt develop HTN, ballot kidney in HTN pt, cyst can rupture..)

Tubular interstitial disease - SLE can develop TID

Surgery - obstructive uropathy eg BPH, stricture, stones, VUR…

Manifestations of kidney disease

Non-specific : tiredness, LOA, generalized ache, polyuria, symptoms of ureamia, fever

Urinary symp : haematuria (rarely, usually pair up with something, eg + HTN, + odema), oedema, asymp
proteinuria, polyuria

Present as other disease : DM, HTN

Head to toes : pallor, sallow, bleeding disorders, pericarditis, cardiomyopathy, HF, ascites, GIT symp,
seizures, retention, hyponatreamia

Management :

Restrict salt, balance fluid intake, weigh themselves everyday

Some drug can cause retention worse, careful with drug use

Potassium : careful with daily intake, ACE-in increase K+, resonium – it takes away K+, acidosis,
hyperparathyroidism,

high phosphorus – reduce intake or give calcitriol

calcium supplements : careful with hypercalcaemia, deposit in heart

Mg

Hb : anaemia of chronic rf - erythropoietin, bleeding, low iron, give artificial erythropoietin

Protein : adequate protein

HTN : ACE-I, ARB use with care

NO NSAIDs, NO PCM
Raised creatinine (not end stage) : adequate fluid, prevent constipation – can lead to UTI, prevent
dehydration, diarrhea and vomiting is worrying – stop from going into pre-renal failure.

Obstructive uropathy : do not let the bladder fill up, frequent voiding

**PCM : necrosis of papillary, max of 1-2kg in whole life time**

Co-morbidities :

Most pt with CKD will die of HD – manage DM, NTH, lipids

Avoid alcohol, little bit of caffeine

Usually metabolic indications for dialysis

Kidney transplant