This document discusses chronic kidney disease (CKD) in 3 sentences:
CKD is defined as kidney damage or decreased kidney function lasting over 3 months that leads to a progressive loss of kidney function and mass over time. CKD has many risk factors including diabetes, hypertension, family history, and is a global epidemic associated with high costs. The management of CKD focuses on monitoring kidney function, preventing progression, treating complications like anemia and bone disease, controlling cardiovascular risk factors, and preparing for renal replacement therapies like dialysis.
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Chronic Kidney Disease Management and caresachintutor
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.
- Recorded videos of this lecture:
English Language version of this lecture is available at:
https://youtu.be/AtiaKPIdzAQ
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https://youtu.be/2cwyPcRDGEY
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- Recorded videos of this lecture:
English Language version of this lecture is available at:
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https://youtu.be/KXlJoMDi3ko
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Chronic Kidney Disease Management and caresachintutor
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2, persisting for 3 months or more, irrespective of the cause.
Chronic kidney disease (CKD) consists of a spectrum of different pathophysiologic processes associated with abnormal kidney function, and a progressive decline in glomerular filtration rate (GFR).
Abstract: Uremia is a clinical manifestation of chronic kidney failure (CKD) and is defined as the elevation of urea levels in plasma associated to fluid, electrolytes and hormonal imbalances and metabolic abnormalities. Uremia even though arises from CKD, it can also occur with Acute Kidney injury (AKI). The terms uremia was first coined by Piorry which translates to urine in blood. Also, Uremia and uremic syndrome have been used interchangeably for a long time. Comparatively, Azotemia is also uremia but the only difference is that the urea elevation in azotemia is not high enough to have manifesting signs or symptoms. Thus, Uremia is pathological and symptomatic manifestations of severe azotemia.
Urea itself has direct and indirect toxic effects on our body; parathyroid hormone (PTH), beta2 microglobulin, polyamines, advanced glycosylation end products, and other middle molecules, are thought to contribute to the clinical syndrome. Patient’s symptoms range from mild bleeds to severe congestive heart failure. If left untreated complications include seizure, coma, cardiac arrest, and death. He most severe is cardiac arrest secondary to electrolyte abnormalities such as hyperkalemia, metabolic acidosis, or hypocalcemia. The patients, who are diabetic, tend to develop severe hypoglycemic reactions if the medications are not adjusted for creatinine clearance. Renal failure and renal osteodystrophy may cause early onset osteoporosis or formation of adynamic bone which predisposes the patient to fractures on mild trauma. Also medications the patient was previously on can lead to unwanted side effects due to impaired clearance e.g. Digoxin toxicity secondary to renal failure, increased sensitivity to narcotics.
Key Words: Uremia, Uremic syndrome, Chronic kidney failure, azotemia, beta 2 microglobulins, congestive heart failure, electrolyte abnormalities, hyperkalemia, hyocalcemia, metabolic acidosis, creatinine, osteodystrophy
Chronic renal failure or chronic kidney disease management, pharmacist role, medical management objectives, goals of the therapy .
What are the risk factors of chronic renal failure, clinical manifestations of chronic renal failure, renal failure complications, pathophysiology of chronic renal failure.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
3. Contents
• Definition
• Risk factors and Etiology
• Pathophysiology
• Clinical features
• Investigations
• Management
-Expected duration-45mins
-Number of slides-
6/30/2020 CKD_dr. anjani 3
4. Definition
• Chronic kidney disease refers to an irreversible
deterioration in renal function that usually
develops over a period of years.
• Initially it manifests only as a biochemical
abnormality but , eventually , loss of the excretory
, metabolic and endocrine functions of the kidney
leads to the clinical symptoms and signs of renal
failure collectively referred to as uraemia.
• When death is likely without RRT ( CKD stage 5)
it is called end stage renal disease(ESRD).
6/30/2020 CKD_dr. anjani 4
5. Contd..
• According to NHRC, Assessment of CKD
support program of GoN 2016 ; CKD is
defined as renal damage or decreased renal
function for 3 or more months along with
progressive destruction of renal mass with
irreversible sclerosis and loss of nephrons.
• It is a global epidemic associated with high
cost and financial burden to the patient
families and health system of any country.
6/30/2020 CKD_dr. anjani 5
9. Epidemiology
• Only 3% people with CKD experiences kidney
failure.
• It has been estimated that at least 6% of the
adult population in united states has CKD at
stages 1 and 2.
• An additional 4.5% of us population is
estimated to have stages 3 and 4 CKD,
cumulatively accounting for >90% of the CKD
disease burden worldwide.
6/30/2020 CKD_dr. anjani 9
10. Risk factors
• Small for gestational
birth weight
• Childhood obesity
• Hypertension
• Diabetes mellitus
• Autoimmune disease
• Advanced age
• African ancestry
• A family history of -
kidney disease
• A previous history of
acute kidney injury
• Presence of proteinuria
• Abnormal urinary
sediments
• Structural abnormalities
of urinary tract
6/30/2020 CKD_dr. anjani 10
11. Etiology
1. Diabetic nephropathy
2. Glomerulo-nephritis
3. Hypertension associated with CKD(includes vascular
and ischemic kidney disease and primary glomerular
disease with associated hypertension)
4. Autosomal dominant polycystic kidney disease
5. Other cystic and tubulo-interstitial nephropathy
6. Systemic inflammatory diseases(SLE, vasculitis)
7. Reno-vascular disease(mostly atheromatous)
8. Congenital (polycystic kidney disease, Alport’s
syndrome)
9. Unknown
6/30/2020 CKD_dr. anjani 11
12. Pathophysiology
• It involves two broad sets of mechanism of
damage:
1)Initiating mechanisms specific to the
underlying etiology( e.g. abnormalities in kidney
development or integrity, immune-complex
deposition and inflammation in certain types of
glomerulonephritis, or toxin exposure in certain
diseases of the renal tubules and interstitium).
6/30/2020 CKD_dr. anjani 12
13. 2)Hyper-filtration and hypertrophy of the remaining
viable nephrons, that are a common consequence
following long-term reduction of renal mass, irrespective
of underlying etiology and lead to further decline in
kidney function.
• This response to reduction in nephron number are
mediated by vasoactive hormones, cytokines and
growth factors.
• Eventually these shorterm adaptations of hyper
filtration and hypertrophy to maintain GFR become
maladaptive as the increased pressure and flow within
the nephron predisposes to distortion of glomerular
architecture, abnormal podocytes function and
disruption of the filtration barrier leading to sclerosis
and dropout of the remaining nephrons.
6/30/2020 CKD_dr. anjani 13
14. Contd..
• Increased intra-renal activity of the RAS
appears to contribute both to the initial
compensatory hyper-filtration and to the
subsequent maladaptive hypertrophy and
sclerosis.
• This process explains why a reduction in renal
mass from an isolated insult may lead to a
progressive decline in renal function over
many years.
6/30/2020 CKD_dr. anjani 14
16. Clinical and laboratory manifestations
of CKD and uremia
Fluid , electrolytes and acid base disorders
Sodium and water homeostasis
Potassium homeostasis
Metabolic homeostasis
Disorders of calcium and phosphate metabolism
Cardiovascular abnormalities
Ischemic vascular disease
Heart failure
Hypertension and left ventricular hypertrophy
6/30/2020 CKD_dr. anjani 16
21. Contd..
• Serum and urine protein electrophoresis looking for
multiple myeloma should be obtained in all patients
more than 35years with unexplained CKD, especially if
there associated anemia and elevated or even
inappropriate normal , serum calcium concentration in
the face of renal insufficiency.
• Serum calcium phosphorous , vitamin D and PTh
measured to evaluate metabolic bone disease.
• Hemoglobin concentration, iron , vitamin B 12 and
folate .
• 24 hour urinary protein.
6/30/2020 CKD_dr. anjani 21
22. Contd..
• USG (bilaterally small sized kidney exception
are diabetic nephropathy, amyloidosis and HIV
nephropathy)
• PCKD (enlarged kidney with multiple cysts)
• Kidney biopsy not advised in patients with
bilaterally small kidneys
6/30/2020 CKD_dr. anjani 22
25. Management
• Initial approach
• History-
– does the patient really have CKD?
– Evidence of chronicity that is more than 3 months, is there a
previous creatinine record?
• Possible causes –
– Ask about history of UTI, LUTS,PMH of hypertension, DM,
IHD, Systemic disorder, renal colic , abnormal urinalysis ,pre-
eclamsia or early pregnancy loss.
• Drug history(NSAIDs , cox-2 inhibitors, antimicrobials,
chemotherapeutic agents, antiretroviral agents , PPIs,
phosphate containing bowel catharteics and lithium.
• Family history( including renal disease and SAH )
6/30/2020 CKD_dr. anjani 25
26. Contd..
• Ask about eyes skin and joints.
• Current status-patient may have symptomatic CKD if
GFR less than 30 , symptoms of fluid overload ( Sob,
peripheral edema), uremic syndrome, loss of appetite,
weight loss, nausea, hiccups, peripheral edema, muscle
cramps, pruritus, restless leg, bone pain , amenorrhea ,
impotence, fatigue .
• Examination-
– periphery (peripheral edema, signs of peripheral vascular
disease or neuropathy , vasculitis rash, gouty tophy, joint
disease , avf fistuLA, signs of immunosuppression(bruising
from steroids , skin malignancy ) . Uremic
flap/encephalopathy if GFR less than 15.
6/30/2020 CKD_dr. anjani 26
27. Contd..
• Face – anemia , xanthelasma, yellow ting(uremia),
jaundice (hepatorenal ),gum hypertrophy (ciclosporin),
cushingoid (steroids), periorbital edema (nephrotic
syndrome), taut skin /telangiectasia(scleroderma),facial
lipodystrophy(glomerulonephritis)
• Neck- JVP , tunnelled line, scar from
parathyroidectomy, lymphadenopathy.
• CVS – BP, sternotomy , cardiomegaly, signs of
endocarditis, TR if right sided heart failure
• Respiratory- pulmonary edema or effusion
• Abdomen- PD catheter or scars from previous catheter
,signs of previous transplant, ballotable polycystic
kidney or palpable liver .
6/30/2020 CKD_dr. anjani 27
28. Treatment
• The aim of management in CKD are to
1. Monitor renal function/appropriate referral to
nephrology
2. Prevent or slow progression of CKD
3. Limit complications of renal failure
4. Treat risk factors for cardiovascular disease
5. Preparation for renal replacement therapy
6/30/2020 CKD_dr. anjani 28
29. Monitor renal function/appropriate
referral to nephrology
• GFR and albuminuria should be monitored.
• Drop in eGFR stage with decrease eGFR more
than or equals to 25% is significant.
• Rapid progression is decreased eGFR > 5per
year.
• Every 6 months in patients with stage 3 CKD
but more rapidly or have stage 4 or 5 CKD.
6/30/2020 CKD_dr. anjani 29
31. Prevent or slow progression of CKD
• Antihypertensive therapy (reducing
intraglomerular hypertension)
• ACE inhibitors and ARBs are effective in slowing
the progression(both in diabetic and non diabetic
CKD)
• SECOND LINES ARE CCBs(diltiazem and verapamil)
• Glycemic control of hba1c-7%
• Lifestyle-exercise, healthy weight, and smoking
cessation,salt intake <2g/day
6/30/2020 CKD_dr. anjani 31
32. • Blood pressure: 140/90 with ckd and no
albuminuria, 130/80 moderately elevated
albuminuria (ACR3-30mg/mmol),125/75 ckd
and heavy proteinuria (pcr >100mg/mmol or
ACR >70 mg/mmol)
6/30/2020 CKD_dr. anjani 32
33. Limit complications of CKD
• Anemia : iv iron therapy and erythropoeitin
stimulating agent if hb<11.
• Acidosis: consider it for eGFR<30 and low
serum bicarbonate <20.sodium bicarbonate
supplements ( 1 gm 8 hourly, increasing as
required.
• Oedema: restrict fluid and sodium intake,high
dose loop diuretics.combination of loop and
thiazide diuretics powerful effect.
6/30/2020 CKD_dr. anjani 33
34. • Ckd bone mineral disorders: ckd causes
increase in phosphate and reduced
hydrocylation of vit dby kidney. Measure
calcium, phosphate, ALP,PTH and 25-oh vitd if
eGFR<30. treat if phosphate >1.5mmol/lwith
dietary restriction and phosphate binders. The
use of vit d supplements( cholecalciferol,
ergocalciferol) if deficeint.if persistently
increasing pth treat with an activated vit d
analogue (1alpha calcidol or calcitriol.)
6/30/2020 CKD_dr. anjani 34
35. • Restless legs/cramps: exclude IDA and then
treat with gaabpentin/pregabalin/dopamine
agonists.
• Dietary advice
• Maintenace of fluid and electrolyte balance.
6/30/2020 CKD_dr. anjani 35
36. • Treatment of risk factors for cvd:
Atorvastatin 20 mg and higher if eGFR> 30 for
primary and secondary prevention of cvd.
Antiplatelets(low dose aspirin) for ckd at risk for
atherosclerotic events unless bleeding risk
outweighs benefit.
6/30/2020 CKD_dr. anjani 36
37. Preparation for RRT
• Temporary relief of symptoms signs of impending
uremia such as anorexia, nausea, vomitting, lassitude,
and pruritus may sometimes be achieved with dietary
protein restriction.
• Clear indications of RRT for patients with CKD include
uremic pericarditis, encephalopathy, intractable muscle
cramping,anorexia and nausea not atrributable to
reveersibel causes such as PUD, evidence of
malnutrition and fluid and electrolyte abnormalities,
principally hyperkalemia or ECFV overload, that are
refractory to other measures.
6/30/2020 CKD_dr. anjani 37
38. • Recommendations for optimal timing for
initiation of RRT
• Patient education
6/30/2020 CKD_dr. anjani 38
39. REFERRENCES
• DAVIDSON’S PRINCIPLES AND PRACTICE OF
MEDICINE 22ND EDITION
• HARRISON’S PRINCIPLES OF INTERNAL
MEDICINE 20TH EDITION
• OXFORD HANDBOOK OF CLINICAL MEDICINE.
6/30/2020 CKD_dr. anjani 39