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  #1  
Old 09-07-2011
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Kidney Improving the prognosis of Chronic Renal Failure?

A 45-year-old man with advanced chronic renal failure comes to the physician because of edema of his feet. His temperature is 37C (99F): blood pressure is 150/100 mm Hg, pulse is 78/min, and respirations are 15/min. Examination shows bilateral ankle edema. Laboratory studies show BUN of 62 mg/dL, serum creatinine of 4.2 mg/dL, serum potassium of 5.6 mEq/L, serum sodium of 146 mEq/L and total plasma cholesterol of 260 mg/dL. Which of the following is most likely to improve the prognosis of his disease?

A. Captopril.
B. Simvastatin.
C. Protein restriction.
D. Salt restriction.
E. Potassium restriction.
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Old 09-07-2011
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C. Protein restriction?
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  #3  
Old 09-07-2011
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E, potassium restriction
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Old 09-07-2011
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I think B. Simvastatin

Reason: Pt. with CKD are inc risk of dying with heart disease.
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  #5  
Old 09-07-2011
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protein
hiiiiiiiiiiiiii
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Old 09-07-2011
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Default potassium restricition

i think hyperkalemia will kill this man before his other problems (uremia and hypercholesterolemia)
potassium restriction, i think
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Old 09-07-2011
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protein restriction..
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  #8  
Old 09-08-2011
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D.Salt Restriction.
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  #9  
Old 09-08-2011
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I m with E. Potassium restriction...All important but i think E is the first we have to do..
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  #10  
Old 09-08-2011
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E.pottasium restriction ?
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Old 09-08-2011
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Default docnok

A- Captopril???
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  #12  
Old 09-09-2011
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Quote:
Originally Posted by laurier View Post
A 45-year-old man with advanced chronic renal failure comes to the physician because of edema of his feet. His temperature is 37C (99F): blood pressure is 150/100 mm Hg, pulse is 78/min, and respirations are 15/min. Examination shows bilateral ankle edema. Laboratory studies show BUN of 62 mg/dL, serum creatinine of 4.2 mg/dL, serum potassium of 5.6 mEq/L, serum sodium of 146 mEq/L and total plasma cholesterol of 260 mg/dL. Which of the following is most likely to improve the prognosis of his disease?

A. Captopril.
B. Simvastatin.
C. Protein restriction.
D. Salt restriction.
E. Potassium restriction.
please tell the answer ????????
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  #13  
Old 09-09-2011
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A.captopril
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Old 09-10-2011
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Answer is Protein restriction
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  #15  
Old 09-10-2011
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Quote:
Originally Posted by jaimin View Post
Answer is Protein restriction
can u pls explain the answer thnx
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  #16  
Old 09-24-2011
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The answer is C.


Factors that improve the prognosis in a patient with chronic renal failure are protein restriction and the use of ACE inhibitors.
But ACE inhibitors are likely to worsen renal failure when serum creatinine levels are greater than 3-3.5 mg/dL.
HMG-Co A reductase inhibitors, like simvastatin. may be used to treat hyperlipidemia in a patient with CRF, but it is not going to alter the prognosis of the underlying disease.
Salt restriction is important when the patient is edematous, but it will not alter the course of disease.
Potassium should be restricted when it is elevated in a patient with renal failure, but this will not improve the prognosis.


Here is the reason how protein restriction improve the mortality benefit is a patient with CKD...
Lowering protein intake protects against the development of glomerular scarring (called glomerulosclerosis) in diabetic nephropathy or a patient with subtotal nephrectomy. This effect is mediated, in part, by changes in glomerular arteriolar resistance, leading to a reduction in intraglomerular pressure and decreased glomerular hypertrophy.

Dietary protein restriction may also be beneficial by exerting non-hemodynamic effects.

In focal segmental glomerulosclerosis, for example, a very low protein diet can markedly reduce glomerular scarring in conjunction with decreased expression of the cytokines transforming growth factor (TGF) beta-1 and platelet-derived growth factor (PDGF), and of glomerular genes regulating the synthesis of excess matrix that contributes to the sclerotic lesions. The mechanism by which protein intake affects cytokine expression is unclear, but the net effect may be preserved glomerular filtration due to diminished matrix accumulation.

posted by torukmakto in another forum
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  #17  
Old 09-24-2011
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Thanks laurier for posting the answer,I appreciate your effort
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  #18  
Old 09-24-2011
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u r welcome and good luck!
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