Chronic renal failure ( case scenario)

A 56 years old malay housewife from melaka, admitted to the hospital with generalized body weakness and fatigue for 2 days.
She is a known to have diabtes mellitus for past 13 years and hypertension for 1 year.
She was told to have low Hb level and 3 packs of blood have been transfused. She also gave history of frothy urine. No history of oliguria, hematuria. Patient also give history of pedal edema for past 2 months.
No history of breathlessness, dyspnea on exertion.
There is history of polyuria.
She is on insulin for the past 6 months. She is also on treatment for hypertension.
On examination, patient’s vitals sign are stable. She is alert and cooperative. There is no pallor, JVP not raised, there is anarsaca. CVS examination is normal. RS examination also normal.

Diagnosis: chronic renal failure

Discussion:
· Blood pressure in this patient should be maintain below 135/85mmHg. ACE inhibitors or angiotensin receptor blocker are drug of choice.
· Blood glucose level should be well controlled. Insulin therapy will be the drug of choice. Higher dose might be required. Oral hypoglycemic drug should be avoided.
· Associated diabetic retinopathy tends to progress rapidly. Therefore, frequent ophthalmic supervision required.
· She should be follow up regularly.

Chronic kidney disease (CKD) is the progressive loss of renal function. The kidneys try to compensate for renal damage by hyperfiltration (excessive straining of the blood) in the remaining functional nephrons (filtering units consisting of a tubuloglomerular and related). Over time, hyperfiltration causes further loss of function.