OSCE question for chronic kidney disease , maintenance hemodialysis with anemia and Hypertension.


I presented the case of 
A 60 year  old male, who is a resident of Nalgonda ,farmer by occupation came with 

 Chief complaints
-Pedal edema since 3 months
-shortness of breath since 20 days
- decreased  urine output since 15 days

History of presenting illness

-The patient was apparently asymptomatic 3 months back then developed bilateral pedal edema initially extending to ankle Gradually progressed up to thighs which worsened during last 15 days.
-Decreased urine output since 15 days, not associated with frequency, urgency burning micturation.
-Grade 3 shortness of breath, no aggravating and relieving factors.
- previously patient underwent eight sessions of hemodialysis.

PAST HISTORY
-Known case of hypertension since 6 months.
- history of fall from toddy tree 6 months ago .

Personal history:
-Occasionally consumes alcohol 
- smokes tobacco.


My OSCE question: 

question: ROLE OF NSAIDS in AKI or CKD :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034033/

Answer : NSAIDs Role in AKI 

-Adverse renal effects from the NSAIDS are caused by two distinct pathologies .
1).AKI from NSAIDS is due to reduced renal plasma flow caused by decrease in prostaglandins,which regulates the vasodilation at the glomerular level.NSAIDS disrupt the compensatory vasodilation at glomerular level.


2).AKI is acute interstitial nephritis,which is characterized by the presence of inflammatory cell infiltrates in interstitium of kidney .Acute interstitial nephritis caused by immunological reaction after NSAID exposure of about a week.

 
2). Dialysis pts landing in anuria duration

3). Approach to back ache .

from Harrison's 19 th edition.

4). Compressive myelopathy.



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