1. + Chronic Kidney Disease Baz Lazar

2. + Overview Introduction Discussion on finals case History Examination Management Last 15 minutes

3. + Background Age standardised prevalence Stage 3-5 8.5% 10.6% in females, 5.8% in males Causes: 1. Diabetes 2. Hypertension - ? cause or consequence? 3. Renovascular disease 4. Infective, obstructive and Reflux nephropathy 5. Glomerulonephritis 6. Pyelonephritis 7. Congenital e.g. ADPKD, Fabry, Alport 8. Analgesic nephropathy – NSAIDs, 9. Manifestation of systemic disease: Myeloma, SLE, vasculitides, gout, RCC

4. + Suffix p to denote proteinuria

5. + Case 60 year old gentleman suffering from renal failure for many years. Has creatinine of 640 umol/L Please take a history from this gentleman, focussing on his chronic renal problem

6. + History

7. + BIG BEANS Breathlessness Itch Gout Bone pain Energy Ankle swelling/anorexia Neuropathy Stones

8. + Examination

9. + Scars http://www.puvs.org/sites/default/files/images/bryscars.jpg

10. + http://www.nejm.org/na101/home/literatum/publisher/mms/journals/content/nejm/2007/nejm_2007.357.issue- 15/nejmicm066807/production/images/large/nejmicm066807_f1.jpeg

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14. + 15 minutes Helpful to have a structure Any tips?

15. + Divide page into 3 Summary and differentials + Problem list Investigations Management Then, if time, try to think on some possible questions and how to answer them

16. + Calcium homeostasis

17. + Drop in blood calcium

18. + GFR and renal function Creatinine Mmol/L % Renal function remaining 6005 50010 40020 30030 20050 15075 Aim to have transplant by this point if possible

19. + Summary BIG BEANS Focussed examination – think about the cause Manage those 15 minutes – plan some answers if possible If stuck on management, think on symptoms and how you could treat them Don’t forget Psychosocial and MDT Good luck!