Sunday, September 26, 2010

Renal Specialist Report

PROBLEMS
End stage renal failure (ESRF) - cause unknown
• Renal biopsy revealed marked glomerulosclerosis, 10/10 glomeruli almost completely sclerosed
• No diabetic changes identified but severely scarred kidney (possibly end stage diabetic
nephropathy/electron microscopy results unknown (biopsy 31 May 210)
• Symptomatic end stage renal failure with lethargy and anaemia
Diabetes mellitus
• Poor control now with good HbA1c of 6.6%, 49mmol/mol
Hypercholesterolaemia total cholesterol 6.7mmol/L
Height 1.81m, weight 117kg, BMI 35.7kg/m2; waist 130cm.
Anaemia
Severe diabetic retinopathy
• Functionally blind in left eye; and shapes only seen through right eye
Bilateral cataracts
Non-resident
Asthma as a child
Pneumonia (about 2005 in the US)
Peripheral vascular disease with weak pulses in the lower limbs

OPINION/PLAN
Larry has end stage renal failure and needs to start dialysis now. I will attempt to get a Tenckhoff catheter in next week. He may not last without haemodialysis until a month’s time when we can start to train him in PD but we will assess this next week following his surgery and his results. I have given him a laboratory form today for monthly blood tests when he returns to Hastings.

EXAMINATION
Pale and needing help with his escort and mobility. Height 1.81m, weight 117kg, BMI 35.7kg/m2, waist 130cm. Blood pressure 134/70mmHg sitting right arm. Pulse 76bpm regular. He has no pulses in his lower limbs except the left popliteal. His femoral are equal and normal. Dual heart sounds and no murmurs.
Clear chest. JVP +3cm. He has mild leg oedema.

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