Chandana vishwanatham

 26year old male patient  Patient was apparently asymptomatic 10years ago 10years ago he had polyuria when he was diagnosed to have type 1 diabetes mellitus,from then he was started on insulin For 9  years he was fine and 1year ago when he went for his regular check up for his diabetes he was also diagnosed with hypertension and is on regular medications for his diabetes and hypertension. He developed pedal edema 6months ago for which he used some medications (no records  availabe e)pedal edema subsided 3months ago had severe vomitings for which he came to the hospital  No h/o pedal edema,sob,facial puffiness 3months back He was diagnosed with chronic kidney disease  3months ago and was started on dialysis Pt is on T arkamine,T met xl,T lasix He is on dialysis since 3months weekly twice K/c/ o hypertension and diabetes  From 25/9/20 to 27/10/20 He underwent 9sessions of dialysis 2injections iv iron sucrose 100mg were given on 25/9/20,7/10/20 2injections EPO 2000 units s.c given on 25/9

CHANDANA VISHWANATHAM KAMINENI INSTITUTE OF MEDICAL SCIENCES,NARKETPALLY Study on management of renal anemia in chronic kidney disease patients on maintainance hemodialysis in a rural medical hospital  PROBLEM STATEMENT Anaemia is almost an inevitable consequence of CRF. Nearly everyone with end-stage renal disease (ESRD) have anaemia. Consequences of anaemia include decreased cognitive function, decreased exercise tolerance and a feeling of inadequate wellbeing as well as increased left ventricular hypertrophy that result in increased cardiovascular morbidity and mortality. Hence, anaemia is associated with increased morbidity and mortality in chronic renal failure patients, and early correction of anaemia will improve the outcomes in these patients. Proper management of anaemia in patients with renal failure can lead to a reduction in left ventricular hypertrophy, enhanced quality of life, improved cognitive function, greater capacity to work or exercise and improved sexual function.

  1) What is the reason for this patient's ascites?  Cirrhosis of liver is the cause of ascites in this patient  1 Chronic alcoholism since 40 years 180g of alcohol per day for 25years increases the risk of cirrhosis by 25 times   2. Truncal obesity  3 B/L pedal edema 4.black stools 5.icterus 4.asterexsis 5.raised bilirubin levels 6.alterted echotexture on usg  All these localise the pathology to liver Cause of ascites in cirrhosis  1. portal Hypertension:increased portal vein hydrostatic pressure causing extravasation of fluid from plasma  into peritoneal cavity 2.decreased synthetic function of liver causing hypoalbuminemia leading to decreased oncotic pressure causing extravasation of fluid 3.splanchnic vasodilation and hyperdynamic circulation :it reduces systemic arterial blood pressure, activates renin angiotensin aldosterone system with development of secondary hyperaldosteronism..Failure of liver to metabolize aldosterone intensifies secondary hyperaldosteronism. This can l