scenario

A 45-year-old man came to a polyclinic with complaints of both swollen

limbs since 3 months ago, accompanied by itchy complaints, weakness,
nausea and vomiting. Previous history of hypertension and diabetes mellitus.
On physical examination we found 76.5 kg body weight, blood pressure
180/110 mmHg. Pulse 80 times per minute, breath frequency 24 times per
minute. The afebrile temperature at normal thoracic and abdominal
examinations. Edema 2+ in the lower limb is accompanied by excoriation of
the superficial skin due to scratching.
Laboratory tests show that sodium is 133 mmol / L. Potassium 6.2 mmol / L,
chloride 100 mmol / L, BUN 170 mg / dL, creatinine 16 mg / dL, glucose 108
mg / dL, calcium 7.3 mg / dL, phosphate 10.5 mg / dL, Hb 8.6 Mg / dL,
hematocrit 27.4%. Urinalysis: pH 6, specific gravity 1.010, protein 1+,
negative glucose, negative ketone, negative erythrocyte, negative leukocyte,
bile negative, waxy casts +.
On renal ultrasound investigation, the right kidney size was 9x6 cm, the left
kidney was 9.2x.5.8. Both are hyperecogenic and there is hydronephrosis.
Difficult word
1. Excoriation: scratching scar
2. hyperecogen: white solid area
Keywords
1. Male 45 years old
2. Both limbs swollen since 3 months ago
3. Itching
4. Nausea and Vomiting
5. Previous history of hypertension and diabetes mellitus
6. Weight 76.5 kg
7. Blood pressure 180/110 mmHg
8. Pulse 80 times per minute
9. Frequency of breath 24 times per minute
10. Edema 2+ in the lower limb accompanied by excoriation of the superficial skin due to scratching.
11. Hyponatremia
12. Hyperkalemi
13. Hb down
14. Proteins +1
15. BUN rises
16. The kidneys shrink
17. Acidosis
18. Hematocrit decreases
Learning Objective
1. Be able to explain the diagnosis of scenarios
2. Able to explain the etiology of the diagnosis
3. Be able to explain the pathogenesis of the diagnosis
4. Be able to explain the complications of the diagnosis
5. Be able to explain the management of the diagnosis
 Diabetes
hypertension mellitus
Mind mapping
Glucose filtration
Arteriosclerosis
in kidney increase

Diabetic
Nephrosklerosis
nephrosis

Kidney function
decreased
Edema
Itching, excoriation
Electrolyte
disturbance
Increased BUN
Anemia
Metabolic acidosis
CKD
management
HYPOTHESES
Based on anamnesis, physical examination, and investigation of patient
supposedly experience chronic renal failure et causa hypertension and
diabetes mellitus.
CONCLUSION
In the case of the scenario, the patient had a history of hypertension
and diabetes mellitus. It can damage blood vessels and nephrons in the
kidney resulting in a decline in kidney function that ends in acute
kidney failure. Many aetiology and risk factors of CRF, but hypertension
and diabetes mellitus the most dominant. Edema and itching are
typical signs of CRF, the management of GGK aims to relieve symptoms
and prevent complications.