1 HCV-related liver cirrhosis and chronic kidney disease. Difficulties in diagnostics on the example of a clinical case. Speaker: Oluwasayo M. V.N. Karazin Kharkiv National University School of Medicine, Department of Internal Medicine Scientific adviser: ass. prof. Litvin A.S. Oluwasayo Motunrayo Head of Department: prof. Yabluchansky M.I.
2 Introduction Hepatitis C is an contagious disease caused by the hepatitis C virus (HCV) that primarily affects the liver. During the initial infection have mild or no symptoms Spread by blood-to-blood contact, sexually and perinatally. No vaccine available to prevent hepatitis C. About million persons are infected worldwide. More than people die every year.
3 Extrahepatic manifestations Mixed cryoglobulinemia vasculitis - is a small vessel vasculitis involving mainly the skin, the joints, the peripheral nerve system and the kidneys. Most common are: - Purpura - Arthralgia - Glomerulonephritis - Widespread vasculitis - Diabetes type 2
4 Our patient Name: S. A. B. Sex: Male Age: 53 Years Location: Kharkiv Occupation: Lawyer Name of referral institution: Kharkiv Hospital #13 Date of admission: Patient was treated as inpatient.
5 Complaints Swollen face, lower extremities, abdomen. General weakness, fatigue, malaise. Temperature increase to subfebrile numbers in the evening. Blunt pain in the left flank of abdomen, left flank of the lumbar region.
6 Anamnesis Morbi Considers himself ill since when weakness appeared in combination with dry cough and febrile temperature (up to 39 o C). Was hospitalized to Kharkiv hospital #13 where community acquired right sided pneumonia was diagnosed according to the results of X-ray. Additional investigations revealed signs of renal failure (blood biochemistry: serum creatinine 321 mcmol/l, urea 11,2 mmol/l) and liver pathology (USI of abdomen: Ascites. Hepatomegaly. Parenchymatous dystrophy of liver, II stage).
7 Anamnesis Morbi During staying in hospital haematuria added (urinalysis: RBC 5-10 in HPF). Patient suffers from CKD on a background of chronic pyelonephritis, secondary arterial hypertension for about 15 years. Was treated for many times due to exacerbations. After pneumonia been treated, the patient was directed to Kharkiv Emergency Hospital for further treatment and investigation.
8 Anamnesis Vitae Was born in a full family, developed according to age. Works as a lawyer. Feeds regularly and adequately. Denies malaria, tuberculosis, diabetes mellitus, dermatovenerologic diseases and viral hepatitis. Denies allergic reactions to drugs. Denies smoking, alcohol intake and drug addiction. Parents have history of cardiovascular diseases. Didn t follow doctor s recommendations in treatment and prophylaxis of chronic pyelonephritis.
9 Status Presence Condition is satisfactory, clear consciousness, active and emotionally stable. Hypersthenic type of body constitution (BMI = 28.4 kg/m2) Skin and visible mucous membranes are pale pink and clean. Signs of periorbital edema, shin edema and ascites. Muscoloskeletal system examination unremarkable.
10 Status Presence Respiratory System: Percussion normal lung sound on the left side, slight dullness below VI rib on the right side; Auscultation vesicular breathing on the left side, weakened breathing below VI rib on the right side. Breathing rate = 17/min.
11 Status Presence Cardiovascular system: Heart borders extended to the left on 2,0 cm of midclavicular line, HR = Ps = 73 bpm, regular. No pulse deficiency. Heart sounds are muted, accent of the II tone above the aorta. BPdex = BPsin= 150/90 mm Hg (on the background of antihypertensive therapy due to secondary hypertension).
12 Status Presence Gastrointestinal system: Abdomen is distenced due to ascites, painless. No visible peristalsis. Liver edge is hard, painless, palpated at the costal arch. Spleen and pancreas are not palpable. Stool is normal.
13 Status Presence Urinary system: Kidneys are not palpable. Pasternatsky s sign negative on both sides. Urination is normal.
14 CBC Urinalysis Plan of survey Biochemical panel (bilirubin, ALT, glucose, creatinin, lipids) Coagulogram Chest X-ray ECG EchoCG Abdominal USI
15 CBC ( ) Parameters Result Normal range Hemoglobin 103 M g / l Erythrocytes 3.1 M T / l Color Index Leukocytes ,0 9,0 g/l ESR 23 M 2-12 mm/h Stab neutrophils % Segmented neutrophils % Eosinophils 1 0,5-5,0% Basophils - 1-1,0 % Lymphocytes % Monocytes % Platels g/l Conclusion: anemia, leukocytosis, increased ESR.
16 Serum iron level Parameters Result Normal range Serum Ferrum 8.6 M mcmol/ L Conclusion: decreased serum iron level. serum Fe + RBC = Iron deficiency anemia.
17 Urinalysis ( ) Parameters Result Normal range Specific gravity Reaction Protein g / l Glucose Absent Absent Erythrocytes >50/HPF, unchanged 0-2 Leucocytes 10/HPF 6-8 Epithelium 1-2 Not detected Bacteria Not detected Not detected Conclusion: proteinuria, macrohematuria, leukocyteuria. Massive hematuria + Proteinuria (<3,5 g/l) + ////////////Hypertension = Nephritic Syndrome.
18 Biochemical blood test ( ) Parameters Results Normal range AlAt 51 <41 u/l AsAt 43 <37 u/l Total bilirubin ,7-21,0 mmol/l Creatinine mcmol / L Urea 25.2 <8.3 mmol/ L Total protein g/ L Glucose 5.3 4,2-6,1 mmol / L Conclusion: -increased AlAt and AsAt, bilirubinemia (markers of liver affection); -increased creatinine and urea (markers of renal insufficiency).
19 GFR (Cockrauft-Gault) GFR = 19 ccs/min => CKD 4
20 Coagulogram ( ) Parameters Results Normal range Protrombine index % Fibrine g/ L Recalcification time Conclusion: all parameters are in normal range.
21 Focal and infiltrative changes in the lungs were not identified. Signs of venous hypertension Heart aortic configuration, extended to the left. Aorta is sclerotic in the arcus region. Chest X-Ray
22 ECG Conclusion: Sinus rhythm. Heart rate = 87 bpm. Left ventricle hypertrophy. Diffuse disturbances of repolarization. No acute pathology.
23 Sonography Echocardiography: Aortocardiosclerosis. LV hypertrophy. Dilation of all heart chambers. Signs of pulmonary hypertension. EF = 68% Abdominal USI: Hepatomegaly. Diffuse liver cirrhosis. Signs of portal hypertension. Chronic pyelonephritis. Contracted right kidney. Ascites (up to 3 L).
27 Diagnosis HCV-associated liver cirrhosis, decompensation phase. Ascites. CKD IV, chronic glomerulonephritis. Secondary arterial hypertension. Secondary contracted right kidney. Hypochromic iron deficiency anemia. Ischemic heart disease, cardiosclerosis.
28 Treatment No sense in etiotropic treatment due to late stages of the development of the process. The goal is to compensate organic insufficiency (renal and hepatic).
29 Treatment Lisinopril 10 mg 1 tab per day in the evening p/o under the control of BP. Furosemide 40 mg 2 times per day IV drop. Verorospiron (Spironolactone) 100 mg 1 time per day p/o in the morning. Carboline (sorbent) 1 spoon 2 times per day p/o. Ferrum Lek 1 tab. 3 times per day (protractedly) p/o.
30 Recommendations Supervision of local gastroenterologist, nephrologist, cardiologist. Low-salt and low-protein diet Regular treatment with uroantiseptics (Nitroxolone, Palin, Canephron). Intestinal dialysis with Young s solution. Consultation of infectionist. Consultation in Urologic Centre about hemodialysis and kidney transplantation. Check liver cancer markers.
31 Prognosis Prognosis for life - non-satisfactory The prognosis for recovery - unfavorable
32 Conclusion Our clinical case is an example of the importance of wide diagnostic search and exclusion of all possible pathologies in each case and individual approach to each patient. It s exceptionally important to provide a timely evaluation of such diagnosis and modern appropriate therapy.
33 Conclusion The patient have low compliance, didn t pay enough attention to his health which lead to very late diagnostics of Hepatitis C (after development of Cirrhosis. In case of this patient, early diagnostics of HCV would have prolong his life and significantly increase quality of his life by avoiding such complication as development of Cirrhosis and HCV associated Chronic kidney disease.
THE URINARY SYSTEM The focus of this week s lab will be pathology of the urinary system. Diseases of the kidney can be broken down into diseases that affect the glomeruli, tubules, interstitium, and blood
PROPAEDEUTICS OF INTERNAL DISEASES EXAMINATION SYLLABUS Part I - General 1. History taking plan of history taking, sections, questions. 2. History taking - rules. 3. Current state of health - study plan.
V.N. Karazin Kharkiv National University INTERNAL MEDICINE DEPARTMENT Speakers: students of VI course Orotusin Opeyemi Adeola Oyewo Ifeoluwa Tomilayo Scientific advisers: assos.prof. Shevchuk M.I., assis.
And Renocardiac Syndrome A Vicious Cycle Cardiorenal and Renocardiac Syndrome Type 1 (acute) Acute HF results in acute kidney injury Type 2 Chronic cardiac dysfunction (eg, chronic HF) causes progressive
Definitions Acute Short, relatively severe Analgesic Pain medicine Anemia A low number of red blood cells Anesthetic Medication that dulls sensation in order to reduce pain Acute Tubular Necrosis (ATN)
V.N. Karazin Kharkov National University Faculty of Medicine Department of Internal Medicine Case Study of Renovascular Hypertension Students: Aws Amer Sulaiman Anyasi C. Island Suhaib Al-Shorman Supervision:
Management of Accelerated Hypertension (Updated in 2017) By Salwa Roshdy Prof. of Cardiology Assiut University CardioEgypt 23/2/2017 Agenda Definition of Accelerated HTN Pathophysiology & Etiology Prognosis
Topic Page: congestive heart failure Definition: congestive heart f ailure from Merriam-Webster's Collegiate(R) Dictionary (1930) : heart failure in which the heart is unable to maintain an adequate circulation
RENAL PROBLEMS M Chiume QECH Third Year Teaching 5 April, 2011 Objectives To recognize a child with renal problems To distinguish between nephritic and nephrotic syndrome To name the major causes of nephritic
The Diabetes Kidney Disease Connection Missouri Foundation for Health February 26, 2009 Teresa Northcutt, RN BSN Primaris Program Manager, Prevention - CKD MO-09-01-CKD This material was prepared by Primaris,
2.02 Understand the functions and disorders of the circulatory system 2.02 Understand the functions and disorders of the circulatory system Essential questions: What are the functions of blood? What are
A case of acute liver failure in HIV/HBV co-infection Lukun zhang Department of Infectious Disease The Third People s Hospital of Shenzhen May 12th,2017 History of present illness Patient basic information
Chapter 12 Circulation The circulatory system connects with all body s In many animals, microscopic blood vessels called capillaries Form an intricate network among the Red blood cell song Figure 23.1A
HISTORY 39-year-old woman. CHIEF COMPLAINT: Mild dyspnea on exertion and recurrent palpitations, increasing over the past six months. PRESENT ILLNESS: A heart murmur was first noted during childhood. She
Restrictive Cardiomyopathy in Cats (a Type of Heart-Muscle Disease) Basics OVERVIEW The heart of the cat is composed of four chambers; the top two chambers are the left and right atria and the bottom two
Patient 1001 is a 42-year-old female that is experiencing severe heartburn, abdominal pain, bloating, nausea, and vomiting. Ulcers Bleeding sores in the stomach or intestine Gallbladder Disease Gallstones
Complete Blood Count PSI AP Biology Name: Objective Students will examine how the immunological response affects molecules in the blood. Students will analyze three complete blood counts and create diagnoses
Urinary System Dr. Thorson Lesson Objectives Upon completion of this lesson, students should be able to Define and spell the terms to learn for this chapter. Describe the purpose and function of the urinary
Page 1 of 5 What You Need to Know about a Kidney Transplant This information will help you understand the risks, benefits and possible complications involved in a kidney transplant. Please read it carefully.
Human Body Systems Human Body Project Notes Human Body Organ Systems for the Project Big Idea: Organ systems are composed of organs that are made of more than one type of tissue. Tissues are made of one
Gastrointestinal & Genitourinary Emergencies Lesson Goal Recognize, assess & provide care to patients with abdominal cavity injuries Learning Objectives Discuss different causes of nontraumatic abdominal
Circulatory System Review 1. Know the diagrams of the heart, internal and external. a) What is the pericardium? What is myocardium? What is the septum? b) Explain the 4 valves of the heart. What is their
Purpose: To provide a standard action plan for chart review of pre-admission testing done for scheduled surgical patients. PST will follow these guidelines for review, taking into consideration the patient
Biology 1442 Supplemental Instruction Worksheet Cardiovascular System Jacaruso - 1-2. Organs of a closed circulatory system: A. Have valves a. Arteriole B. Regulate blood flow b. Artery C. Lead to heart
Management of Nephrotic Syndrome 1. Introduction Incidence 2-4/100,000. Boys > girls 3:2; age of onset 2-6 years 80% of cases in children is due to minimal change (MCD) of which 80% will respond to steroid
Chronic Kidney Disease: Optimal and Coordinated Management Michael Copland, MD, FRCPC Presented at University of British Columbia s 42nd Annual Post Graduate Review in Family Medicine Conference, Vancouver,
Page 1 of 18 Nephritic vs. Nephrotic Syndrome Terminology: Glomerulus: A network of blood capillaries contained within the cuplike end (Bowman s capsule) of a nephron. Glomerular filtration rate: The rate
Diagnosis and Management of Acute Myocardial Infarction Acute Myocardial Infarction (AMI) occurs as a result of prolonged myocardial ischemia Atherosclerosis leads to endothelial rupture or erosion that
Heart Failure with Johnny Crash: Joan E. King, PhD, ACNP-BC, ANP-BC Melissa Smith, DNP, ANP-BC Vanderbilt University School of Nursing HEART FAILURE: Heart Failure (HF): a complex clinical syndrome resulting
August 10, 2007 To: From: RE: Primary Care Physicians and Clinicians XXX on behalf of the Upper Midwest Fistula First Coalition Chronic Kidney Disease (CKD) Resources Caring for patients with chronic kidney
Peptic Ulcer Disease 58 year old male complaining of 3-week history of increasing epigastric pain Has had dyspepsia in the past for which he took Tums, but this is much worse and only partially relieved
The Circulatory System The circulatory system includes the Heart, Blood Tissue and the Blood Vessels. The Circulatory System-Transport The absorption and circulation of materials throughout an organism
Educational Goals & Objectives The nephrology rotation will provide the resident with an opportunity to evaluate and manage patients across the spectrum of renal disorders in both the inpatient and outpatient
Guideline on the clinical management of Henoch Schonlein Purpura (HSP) Purpose To ensure a standardised approach in the management of children with HSP in southern Derbyshire. Scope The scope of this guideline
Ministry of Health of Ukraine Kharkiv National Medical University Case history scheme. Inquiry of patient: present complaints and their detailing, questioning on organs and systems. Methodical instructions
Elevated Serum Creatinine, a simplified approach Primary Care Update Creighton University School of Medicine. April 27 th, 2018 Disclosure Slide I have no disclosures and have no conflicts with this presentation.
Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot
VASCULITIS Case Presentation The patient is a 24 year old woman who presented to the emergency room with left-sided weakness. She was confused and complained of a severe headache. She was noted to have
Learn About Kidneys and Kidney Disease www.kidney.org Know Your Kidneys Where are they? Your two kidneys are under the lower ribs in the back of the body above the waist. They are about the size of your
Assessment and Management of the Cardiovascular Patient Dave Baird, FF, Paramedic Primary Assessment Focused Exam Secondary Assessment Treatment Objectives Bledsoe/Porter/Cherry, Essentials of Paramedic
Case Study TheScientificWorldJOURNAL (2009) 9, 1035 1039 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2009.112 Ascites, a New Cause for Bilateral Hydronephrosis: Case Report D. Jain*, S. Dorairajan, and
BATES VISUAL GUIDE TO PHYSICAL EXAMINATION Vol. 13: Abdomen So tell me a little bit about the abdominal pain that you ve been experiencing. Your learning objectives for mastering the abdomen examination
Chronic Kidney Disease (CKD) and egfr: Decision and Dilemma Dr Bhavna K Pandya Consultant Nephrologist University Hospital Aintree Topics CKD background egfr background Patient with egfr Referral Guidelines
CHEST PAIN IN CHILDREN AND ADOLESCENTS Quek Swee Chye, Wong May Ling Chest pain, previously a symptom prevalent in the elderly, is becoming an increasingly common complaint in children and adolescents.
January 19, 2012 Bugante De Gracia OBJECTIVES Identify pertinent findings from the history and physical examination that would contribute to the diagnosis of renal failure Provide a systematic approach
CHAPTER 5 The Anatomy and Physiology of the Circulatory System The Circulatory System Blood Heart Vascular System THE BLOOD Formed Elements of Blood Table 5-1 Cell Type Erythrocytes (Red Blood Cells, RBCs)
Viral Hepatitis Background Hepatitis or inflammation of the liver can be caused by infectious and noninfectious problems. Infectious etiologies include viruses, bacteria, fungi and parasites. Noninfectious
Transmission of HCV in the United States (CDC estimate) Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong
NURSING PROCESS FOCUS: Patients Receiving Amphotericin B (Fungizone, Abelcet) ASSESSMENT Prior to administration: Obtain complete health history including allergies, drug history, and possible drug interactions.
Kerry Cooper M.D. Arizona Kidney Disease and Hypertension Center April 30, 2009 DR. KERRY COOPER IS ON THE SPEAKER BUREAU OF AMGEN, ABBOTT, GENZYME, SHIRE, AND BMS DR. COOPER IS ALSO INVOLVED IN CLINICAL
Approach to patient with hypertension Dr. Amitesh Aggarwal Definition A systolic blood pressure ( SBP) >139 mmhg and/or A diastolic (DBP) >89 mmhg. Based on the average of two or more properly measured,
RESTRICTIVE CARDIOMYOPATHY Restrictive cardiomyopathy (RCM) is a rare form of heart muscle disease that is characterized by restrictive filling of the ventricles. In this disease the contractile function
Adult Listings 5.01 Category of Impairments, Digestive System 5.02 Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood
Chapter 23 Circulation Standards CORE: I can describe the components and function of blood. I can describe structure and function of blood vessels. I can compare and contrast systemic and pulmonary systems.
CHILDREN S SERVICES Henoch Schonlein Purpura Definition A vasculitic syndrome of small vessels classically characterised by a purpuric rash, abdominal pain, arthritis, and nephritis. Platelet count and
What Is Cirrhosis? Cirrhosis occurs when the liver is permanently scarred or injured by chronic conditions and diseases. Common causes of cirrhosis include: Long-term alcohol abuse. Chronic viral hepatitis
Clinical case: primary sclerosing cholangitis Prof. N.B. Gubergrits (Donetsk, Ukraine) Every evil, which could be foreseen, is so hard to prevent. Pierre Boiste, French philologist T.J. Weismüller et al.,
Nutritional status The nutritional status of the patient may be an important marker of disease and is often overlooked in physical examination. General physical appearance Note the patient s overall body
The Role of the Primary Physician and the Nephrologist in the Management of Chronic Kidney Disease () By Brian Young, M.D. Assistant Clinical Professor of Medicine David Geffen School of Medicine at UCLA
Blood and Defense Chapter 11 Functions of Blood 1. Carry nutrients from the small intestine and oxygen from the lung to tissues in the body 2. Transport wastes from tissues to the kidneys and carbon dioxide
Chapter 3 Diseases of the Blood and Bloodforming Organs and Certain Disorders Involving the Immune Mechanism D50-D89 Presented by Jennifer Kurkulonis 1 FOUR MAJOR TYPES OF BLOOD CELLS White blood cells
DIABETES AND CHRONIC KIDNEY DISEASE Stages 1 4 www.kidney.org National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation's Kidney Disease Outcomes
PATIENT EDUCATION patienteducation.osumc.edu Your heart pumps the blood in your body through a system of blood vessels. Blood delivers oxygen and nutrients to all parts of the body. It also carries away
AN APPROACH TO HEMATURIA Dr Saima Ali Definition Microscopic hematuria hematuria is defined as the presence of 5 or more RBCs per high-power field in 3 of 3 consecutive centrifuged specimens obtained at
OMICS GROUP SURGERY ANESTHESIA CONFERENCE November 2014 CHICAGO U.S.A THE REAL CAUSE OF A PATIENT WITH ABDOMINAL PAIN Original case report Manuela Stoicescu, Consultant MD, PhD, Assistant Professor University
Mosby,, an affiliate of Elsevier Normal Cardiac Anatomy Impaired cardiac pumping Results in vasoconstriction & fluid retention Characterized by ventricular dysfunction, reduced exercise tolerance, diminished
ARE YOU AT INCREASED RISK FOR CHRONIC KIDNEY DISEASE? www.kidney.org National Kidney Foundation s Kidney Disease Outcomes Quality Initiative Did you know that the National Kidney Foundation s Kidney Disease
INFORMATION SHEET HEALTH ASSESSMENT FOR NEW ZEALAND VISA APPLICANTS Health assessments of New Zealand visa applicants are conducted by the International Organization for Migration (IOM) on behalf of Immigration
Chapter 23 Micturition and Renal Insufficiency Voiding Urine Between acts of urination, the bladder is filling. detrusor muscle relaxes urethral sphincters are tightly closed accomplished by sympathetic
Ontario s Referral and Listing Criteria for Adult Pancreas-After- Kidney Transplantation Version 2.0 Trillium Gift of Life Network Adult Pancreas-After-Kidney Transplantation Referral & Listing Criteria
1 7.L.1.4 Circulatory System Guided Study Notes Circulation Sect. 1: The Body s Transport System Sect. 2: A Closer Look at Blood Vessels Sect. 3: Blood and Lymph Sect. 4: Cardiovascular Health Sect. 1: