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Cases of chronic renal failure

Dec 28, 2016
Case summary: patients, male, 35 years of age, due to edema for 5 years, nocturia increased for about 2 years, fatigue, anorexia for 1 months.
In 5 years ago without apparent inducement occurrence morning eyelid edema, no fatigue, anorexia, low back pain, hematuria, local clinic blood pressure 150/90mmHg, not the law of diagnosis and treatment. After edema intermittent, sometimes not, when light weight, does not attach importance to. In the past 2 years, nocturia increased, from 3 to 4 times / night. Patients nearly 1 months without inducement fatigue, anorexia, sometimes accompanied by nausea, bloating, no abdominal pain, diarrhea or fever. Self service domperidone (Motilium) invalid, fatigue anorexia progressive symptoms, and treatment. Patients since the onset of sleep, stool normal, no significant change in urine volume, weight loss in recent 1 years (specific unknown).
Past history: no history of diabetes, no history of drug abuse, no history of drug allergy.
Check body: T36.8 DEG C, P90 times / minute, R20 times / minute, BP160 / 100mmHg. Chronic disease, anemia, mild eyelid edema, skin odor of ammonia, superficial lymph node enlargement, sclera yellow dye. Heart, lung and abdomen were not abnormal. No edema of lower limbs.
Laboratory examination: blood: Hb 88g / L; urine protein (+ +), RBC (+ +); stool (-). Blood biochemistry: Cr900 mol / L, HC0 3- 15mmol / L, elevated serum phosphorus. B ultrasound: double kidney narrowing, left kidney 8.7cm * 4.0cm, right kidney 9.0CM * 4.1cm, double renal cortex echo enhancement, skin medulla boundary unclear.
Analysis steps:
1 diagnosis of chronic renal failure (uremia) renal hypertension renal anemia (moderate) metabolic acidosis hyperphosphatemia chronic glomerulonephritis?
Diagnostic basis (1) middle-aged men, chronic course, occult onset. (2) patients with intermittent morning eyelid edema, found elevated blood pressure for 5 years, the emergence of nocturia increased for about 2 years, anorexia, fatigue progressive exacerbations of 1 months. (3) no special. (4) check the BP160 / 100mmHg, chronic anemia, eyelid skin, mild edema, ammonia odor. (5) Hb / L 88g examination; urine protein (+ +), RBC (+ +); blood biochemistry: Cr900 mol HC0 / L, 3-15mmol / L, elevated serum phosphate; B: kidneys shrink.
2 differential diagnosis
(1) acute renal failure this disease generally onset more urgent, rapid deterioration of renal function, B ultrasound visible kidney size normal or enlarged, inconsistent with the patient, consider the possibility of small.
(2) long term hypertension can lead to renal damage in essential hypertension, but the patient has a history of long-term hypertension, late renal function damage, often accompanied by hypertension and other target organ damage performance. The patient first appeared edema, accompanied by elevated blood pressure, consider the possibility of this disease is small, if necessary, further exclusion of renal biopsy.
3 further examination
(1) etiology screening such as blood glucose, fundus examination, renal vascular ultrasound, autoantibodies, renal biopsy, etc..
(2) complications such as blood routine examination, blood coagulation, blood gas, electrolyte, chest X-ray, echocardiography, glomerular filtration rate, 24 hour urine protein.
4 treatment principles
1) nutritional treatment of low protein diet.
2) antihypertensive treatment
3) correction of renal anemia
4) correct metabolic acidosis, hyperphosphatemia
5) prevention and treatment of complications
6) renal replacement therapy

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