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History An 85-year-old woman is investigated by her general practitioner (GP) for increasing tiredne

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History An 85-year-old woman is investigated by her general practitioner (GP) for increasing tiredness which has developed over the past 6 months. She has lost her appetite and feels constantly nausea She has lost about 8 kg in weight over the past 6 months. For the last 4 weeks she has also complained of generalized itching and cramps. She has been hypertensive for 20 years and has been on antihypertensive medication for that time. She has had two cerebrovascular accidents which have limited her mobility. She is an AfricanCaribbean, having emigrated to the UK in the 1960s. She lives alone but uses a ‘meals on wheels’ service and goes to a day hospital twice a week. She has two daughters. Examination Her conjunctivae are pale. Her pulse is 88/min regular, blood pressure 190/110 mmHg; mild pitting oedema of her ankles is present. Otherwise, examination of her cardiovascular and respiratory systems is normal. Neurological examination shows a left upper motor neurons facial palsy with mild weakness and increased reflexes in the left arm and leg. She is able to walk with a stick. Funduscopy shows arteriovenous nipping and increased tortuosity of the arteries. Hemoglobin. 7.2g/dL Mean corpuscular volume (MCV) 84fL White cell count. 6.3 % 10°/L Platelets. 294 % 109/L Sodium. 136 mmol/L Potassium. 4.8 mmol/L Urea. 46.2 mmol/L Creatinine. 769&mol/L Glucose. 4.1 mmol/L Albumin. 37 g/L Calcium. 1.94 mmol/L Phosphate. 3.4 mmol/L Bilirubin 15mmol/L Alanine transaminase 23 IU/L Alkaline phosphate 423 IU/L Normal 11.7-15.7 g/dL 80-99 fL 3.5-11.0 % 10%/L 150-440 % 109/L 135-145 mmol/L 3.5-5.0 mmol/L 2.5-6.7 mmol/L 70-120 &mol/L 4.0-6.0 mmol/L 35-50 g/L 2.12-2.65 mmol/L 0.8-1.45 mmol/L 3-17 mmol/L 5-35 IU/L 30-300 IU/L Urinalysis: 1 protein; 1 blood Blood film: normochromic, normocytic anaemia 1. What may be the cause of her impaired renal function? 2. What is the most likely diagnosis for this patient? 3. What were the evidences for the diagnosis? 4. Which stage may this patient present with?
SCIENCE
HEALTH SCIENCE
NURSING
BIOS S-162B

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