Osce questions and learning points.

 8th December 2023

Osce questions:

1)  Hypertension causing chronic kidney disease vs chronic kidney disease leading to hypertension?

Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. 

Ckd causing hypertension:

CKD have higher prevalence of traditional risk factors for atherosclerosis, hypertension, diabetes however additional mechanism of cardiovascular diseases may also be implicated. left ventricular hypertrophy is commonly found in patients with CKD secondary to hypertension and anaemia. Calcification of the media of blood vessels also occurs.

The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity.

A target blood pressure of 140/90 mmHg is recommended for patients with ckd.

Hypertension causing ckd:

High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.

Kidneys no longer work properly and are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.

2) At what levels of urea and creatinine diuretics can't work and dialysis is done?

Urea levels-35.7mmol/litre

Creatinine levels- 29% 

As kidneys are severely damaged the urine cannot be excreted so there is no use in taking diuretics for edema so then dialysis is recommended.

References: Davidson's textbook, https://pubmed.ncbi.nlm.nih.gov/2787322

Learning points:

* I have learnt how to differentiate between edema caused due to cardiac failure and chronic kidney disease from the basics.

* I have learnt the mechanisms behind how ckd causes hypertension and cardiac failure and how hypertension causes kidney disease.

* I have learnt the various types of access to the dialysis (central venous catheter, arteriovenous fistula, av graft) and types of av fistulas and regarding dialysis procedure 

* I have developed my communication skills and interpersonal relationship with the patient and her attenders.