ESRF Notes:

History Presentation:
Patient with significant past medical history of hyperlipidemia and poorly
controlled DM who is non-compliance in insulin therapy probably due to poor
eyesight Currently he presents with what seems like a fluid overload as
evidenced by his bilateral lower limbs and scrotal swelling for 2 weeks. Based on
his background of long-standing DM, I highly suspect patient has diabetic
nephropathy complicated by fluid retention resulting in the bilateral pedal
edema.

Management of ESRF:
 Water  peritoneal dialysis
 Blood  hemodialysis
 Transplant
 Palliative Treat symptomatically.

Chronic Kidney Disease:

1. Check for reversible causes (US  Shruken kidney)
2. DM Long standing with complications (retinopathy and neuropathy)
3. Degree of proteinuria (microalbuminuramacroalbuminuria
proteinuria)
4. Progression
5. Physical Examination (signs of uraemia)

Note:
 Patient with CKD requires lower amount of insulin due to decreased
insulin clearance by the kidney