INSUFICIENTA RENALA CRONICA (IRC) caz clinic

Caz clinic

INSUFICIENTA RENALA CRONICA (IRC)

B.A, barbat, 55ani, Iasi

Antecedente heredo-colaterale:

Ø    & 14114p153o nbsp; Mama:

§    & 14114p153o nbsp;    HVA

Ø    & 14114p153o nbsp; Tata:

§    & 14114p153o nbsp;    Sanatos

Antecedente personale:

Ø    & 14114p153o nbsp; Nu se stie cu nici o boala

CVM:

Ø    & 14114p153o nbsp; Croitor

Ø    & 14114p153o nbsp; Nefumator

Ø    & 14114p153o nbsp; Nu consuma alcool

Motivele internarii:

Ø    & 14114p153o nbsp; Alterarea starii de sanatate generale

Ø    & 14114p153o nbsp; Cresterea TA

Ø    & 14114p153o nbsp; Tulburari digestive: anorexie

Ø    & 14114p153o nbsp; Greturi

Ø    & 14114p153o nbsp; Varsaturi

Examen obiectiv:

Ø    & 14114p153o nbsp; Cresterea TA

Ø    & 14114p153o nbsp; Alterarea starii de sanatate generale

Ø    & 14114p153o nbsp; Tulburari digestive

Ø    & 14114p153o nbsp; Sdr. anemic sever

Ø    & 14114p153o nbsp; Poliurie + nicturie

Examen paraclinic:

Ø    & 14114p153o nbsp; Ecografie renala:

§    & 14114p153o nbsp;    Rinichi mici simetrici

Ø    & 14114p153o nbsp; Ex. sg:

§    & 14114p153o nbsp;    GR: 3,5 mil / mm³

§    & 14114p153o nbsp;    RA: 10 mEq / l

§    & 14114p153o nbsp;    K: 110 mEq / l

§    & 14114p153o nbsp;    Uree: 60 mg %

§    & 14114p153o nbsp;    Creatinina: 3 mg %

§    & 14114p153o nbsp;    Clearance-ul de creatinina: 55 ml / min

§    & 14114p153o nbsp;    Ca: 1,3 mmol / l

Ø    & 14114p153o nbsp; Ex. urinei:

§    & 14114p153o nbsp;    Proteinurie

§    & 14114p153o nbsp;    Hematurie

§    & 14114p153o nbsp;    Leucociturie

Diagnostic pozitiv:

Ø    & 14114p153o nbsp; IRC stadiul II, pe baza examenului de laborator si chimie

Tratament:

Ø    & 14114p153o nbsp; Regim igienico-dietetic

Ø    & 14114p153o nbsp; Evitarea eforturilor fizice mari / sustinute, variatiile mari si bruste de temperatura, efortul fizic scade fluxul sangvin renal si creste catabolismul proteic

Ø    & 14114p153o nbsp; Evitarea pe cat posibil a interventiilor chirurgicale

Ø    & 14114p153o nbsp; Dieta normocalorica: 35 cal / kgcorp / zi

Ø    & 14114p153o nbsp; Aport scazut de proteine: 0,6 g / kgcorp / zi

Ø    & 14114p153o nbsp; Aport hidric: diureza + 500 ml (apa endogena) + pierderile extrarenale

Ø    & 14114p153o nbsp; Dieta liposodata

Ø    & 14114p153o nbsp; Carbonat de Ca: 6-12 g / zi

Ø    & 14114p153o nbsp; Furosemid: 40 mg / zi

Ø    & 14114p153o nbsp; SF: 1000-2000 ml i.v

Ø    & 14114p153o nbsp; Ca Gluconic 10 %: 2-4 f i.v lent

Ø    & 14114p153o nbsp; Glucoza 10 %

Ø    & 14114p153o nbsp; EPO: 50-100 U / kgcorp, s.c * 3 / saptamana