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    Case Presentation CKD

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    Sapna thakur
    This case report describes a 35-year-old male with chronic kidney disease (CKD) stage 5 undergoing hemodialysis who presented with abdominal pain and shortness of breath due to fluid accumulation. Physical examination found abdominal swelling and fluid waves, and imaging showed shrunken kidneys and free intraperitoneal fluid. The patient was diagnosed with CKD stage 5, ascites, and anemia. He received oxygen supplementation, abdominal tapping to remove fluid, and was advised to continue hemodialysis and see a nephrologist for management of his conditions.

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    Case Presentation CKD

    Uploaded by

    Sapna thakur
    4K views27 pages
    This case report describes a 35-year-old male with chronic kidney disease (CKD) stage 5 undergoing hemodialysis who presented with abdominal pain and shortness of breath due to fluid accumulation. Physical examination found abdominal swelling and fluid waves, and imaging showed shrunken kidneys and free intraperitoneal fluid. The patient was diagnosed with CKD stage 5, ascites, and anemia. He received oxygen supplementation, abdominal tapping to remove fluid, and was advised to continue hemodialysis and see a nephrologist for management of his conditions.

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    This case report describes a 35-year-old male with chronic kidney disease (CKD) stage 5 undergoing hemodialysis who presented with abdominal pain and shortness of breath due to fluid accumulation. Physical examination found abdominal swelling and fluid waves, and imaging showed shrunken kidneys and free intraperitoneal fluid. The patient was diagnosed with CKD stage 5, ascites, and anemia. He received oxygen supplementation, abdominal tapping to remove fluid, and was advised to continue hemodialysis and see a nephrologist for management of his conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    4K views27 pages

    Case Presentation CKD

    Uploaded by

    Sapna thakur
    This case report describes a 35-year-old male with chronic kidney disease (CKD) stage 5 undergoing hemodialysis who presented with abdominal pain and shortness of breath due to fluid accumulation. Physical examination found abdominal swelling and fluid waves, and imaging showed shrunken kidneys and free intraperitoneal fluid. The patient was diagnosed with CKD stage 5, ascites, and anemia. He received oxygen supplementation, abdominal tapping to remove fluid, and was advised to continue hemodialysis and see a nephrologist for management of his conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    Case Presentation

    Felix Hansen (1015101)


    Amanda Padma (1015058)
    Indra Josua (0715092)
    Identity of Patient
    Name : Tn. R
    Age : 35 years old
    Gender : Male
    Occupation : Not working
    Status : Single
    Room/Bed : Gideon/4
    Date : 09-06-2014
    Diagnose : CKD Stage 5 on Hemodialysis
    + Acites
    Resume
    A male 35 years old came with pain in all
    parts of abdomen. The pain wasn’t
    radiate and patient also complained having
    breathless because of fluid in abdomen
    that press the chest. Patient confessed
    having treatment with the kidney
    disease and had hemodialysis for
    almost a year. Patient also complained
    having swolen in pair of feet.
    Past medical history : UTI on 2010 =>
    progress to renal disease on 2012 =>
    having hemodialysis since then, asthma
    (-), diabetes mellitus (-), hypertension (-)
    Family medical history : -
    Allergic history : -
    Physical Examination
    Vital Signs
    BP : 120/80 mmHg
    Heart rate : 120 x/minute
    Respiration : 32x/minute
    Temperature : 36,9°C
    Skin : cyanosis (-), jaundice (-)
    Head
    Eye : Conjunctiva anemic (+/+), sclera jaundice (-/-)
    ENT : secretions (-)
    Neck : lymph node not palpable, trachea
    central
    Thorax
    Heart : heart sound S1S2 regular, murmur (-)
    Pulmo : move symetric, vbs (+/+), ronchi (-/-),
    wheezing (-/-)
    Abdomen : raised, soepel, gut sound (-), palpable
    pain
    (-), shifting dullness (+), fluid wave (+)
    Extremities : swolen in pair of feet, non pitting,
    muscle atrophy in pair of feet.
    Lab Result (09-06-2014)
    Hb : 9,4 gr/dl (<<)
    Ht: 28,5 % (<<)
    Leucocyte : 6.560 / mm3
    Thrombocyte : 340.000 / mm3
    Erythrocyte : 3.8 million / mm3 (<<)
    MCV : 75 fl (<<)
    MCH : 25 pg/ml
    MCHC : 33 gr/dl
    USG (03-06-2014)
    R-Kidney
    Smaller with length around 70mm, uneven
    surfaces, thin parenchym, higher
    echogenesity
    L-Kidney
    Smaller with length around 77mm, thin
    parenchym, higher echogenesity
    Intraperitoneal free fluid
    Minimal pleural effusion
    Diagnose
    Chronic Kidney Disease Stage 5 + Acites +
    Anemia
    Follow up
    09-06-2014
    BP: 120/80 mmHg Breathless (+), fluid Bed rest, nasal
    HR: 120x/minute intraperitoneal (+), cannule O2 5
    RR: 32x/minute abdominal pain (+) litres/minute,
    T : 36,9°C prepare for ascites
    punction

    10-06-2014
    BP: 110/80 mmHg Breathless (-), fluid Ascites punction +-
    HR: 100x/minute intraperitoneal 2-2,5 litres
    RR: 22x/minute minimal, abdominal
    T : 36,4°C pain (-)
    Chronic Kidney Disease
    Is define as abnormalities of kidney
    structure or function, present for more than
    3 months with implication for help
    Staging of CKD
    Why CKD??
    Because the patient having abnormalities
    structure (from the USG imaging)
    The patient having history of hemodialysis
    for 2 years so we assume he had
    abnormality of renal function more than 3
    months
    Why stage 5??
    We assume he had CKD stage 5 because
    dialysis is typically initiated when eGFR
    falls bellow 10mL/minute/1,73 m2 but in
    this patient we didn’t have the last result of
    eGFR but he had hemodialysis twice a
    week for 2 years
    Why Ascites??
    The etiology of ascites is still uncertain. The pathogenesis
    seems to be multifactorial:

    1. Chronic fluid overload with hepatic congestion resulting


    in increased hepatic vein hydrostatic pressure is usual
    2. Change in the permeability of the peritoneal membrane
    have been shown in patients receiving CAPD
    3. Impaired lymphatic peritoneal reabsorption was
    proposed as a pathogenic mechanism and confirm by
    lymphatic flow rate studies. The fact that the rate of
    removal is much slower in ureamic patients compare to
    non ureamic
    4. Contributing causes include hypoproteinemia, congestive
    heart failure, or liver cirrhosis with portal hypertension
    Why Anemia??
    CKD leads to normocytic anemia due to
    inadequate renal production of
    erythropoietin.
    3.2.1: Diagnose anemia in adult and
    children > 15 years with CKD when Hb
    Concentration is < 13 g/dl in males and
    <12 g /dl
    In Patient Hb is 9,4 g/dl
    Management CKD
    Hemodialysis 5 hours three times a week
    If possible to doing renal transplant
    procedure
    Refer to nephrologist
    Management of anemia
    In general, erythropoiesis stimulating
    agents are used to maintain a hemoglobin
    level of 11 to 12 g/dl.
    In patient receiving this treatment, iron
    stores should be assessed and replenished
    as needed to avoid apparent erythropoietin
    resistance.
    Complication
    Prognosis
    Daftar Pustaka
    http://www.pathophys.org/ckd/#
    Pathophysiology
    http://
    emedicine.medscape.com/article/170907-tr
    eatment
    KDIGO 2012 Clinical Pratice Guideline for
    the Evaluation and Management of Chronic
    Kidney Disease. Kidney Disease
    Improving Global Outcomes. 1, January
    2013, Vol. 3.
      Nephrology Dialysis Transplantation.
    Franz, M. and Horl, W.H. 1997.

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