Paciente con enfermedad Renal
Excessive cardiovascular morbidity and anemia steming from low Hb levels (Hemoglobina) greatly conribute to risk of progression of kidney disease.
The National Kidney Foundation defines Anemia in CKD patients as an Hb level ,<13.5 /dL in men and <12 in women. More common in patients with declining Hb levels are higher levels of Albuminuria.
Clinicians also measure Creatine and Urine Albumin to calculate GFR and Albumin secretion.
Major causes of Anemia are Iron and Erythropoietin deficiencies.
Usually physicians prescribe Losartan ACE inhibitors and so called Angiotension antagonists. Sandoz and other laboratories market a new generation drug which has a better performance history and fewer side effects than Losartan.
These drugs may help reverse decreases in patient Hb levels.
Early Correction of Anemia was associated with improved renal survival.
Normally low hemoglobin counts
A slightly low hemoglobin count isn’t always a sign of illness — it may be normal for some people. Women who are pregnant commonly have low hemoglobin counts.
Low hemoglobin counts associated with diseases and conditions
A low hemoglobin count can be associated with a disease or condition that causes your body to have too few red blood cells. This can occur if:
- Your body produces fewer red blood cells than usual
- Your body destroys red blood cells faster than they can be produced
- You experience blood loss
Diseases and conditions that cause your body to produce fewer red blood cells than normal include:
- Aplastic anemia
- Certain medications, such as anti-retroviral drugs for HIV infection and chemotherapy drugs for cancer and other conditions
- Hodgkin’s lymphoma (Hodgkin’s disease)
- Iron deficiency anemia
- Chronic kidney disease
- Lead poisoning
- Multiple myeloma
- Myelodysplastic syndromes
- Non-Hodgkin’s lymphoma
- Vitamin deficiency anemia
Diseases and conditions that cause your body to destroy red blood cells faster than they can be made include:
A low hemoglobin count can also be due to blood loss, which can occur because of:
- Bleeding from a wound
- Bleeding in your digestive tract, such as from ulcers, cancers or hemorrhoids
- Bleeding in your urinary tract
- Frequent blood donation
- Heavy menstrual bleeding
Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.
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Kidney Stone Disease
HISTORY AND PHYSICAL EXAMINATION
Initial evaluation of a individual suspected of having a kidney stone consists of a complete history and physical examination. The symptoms of renal colic alone are often highly suggestive of passage of a stones, infection stones, recurrent or bilateral stones, stones in children) a more complete evaluation is kidney stone. A patient may complain of severe flank or abdominal pain radiating to the lower abdomen or groin area. The pain of renal colic is described often as sharp, severe, intermittent, and occurring with abrupt onset. Nausea and vomiting often accompany these symptoms. If infection and obstruction is present, the patient may experience fevers and chills. Stones can, however, present without any symptoms. Frequent urination or the constant urge to urinate are symptoms that are commonly seen as the stone is passing from the ureter into the bladder
Initial laboratory tests include:
- urinalysis to assess for the presence of blood in the urine
- blood tests to determine kidney function, blood count, and concentrations of calcium, phosphate and uric acid
- urine culture to assess for the presence of urinary infection
For patients who are considered high risk stone formers (e.g. genetic predisposition, cystine or uric acid mandated. This includes a 24-hour collection of urine to test for oxalate, calcium, magnesium, citrate, and uric acid levels. In addition, further blood tests including a test to rule out hyperparathyroidism may be performed. All stones that are spontaneously passed in the urine must be collected and analyzed to determine the precise stone composition.