In provided with an information booklet or leaflet, containing

In order to effectively provide a screening programme that will be able to identify patients with early stage CKD, while remaining finically conscious, a convenience sample approach is most effective. Additionally, enforcing a criteria to minimize testing of healthy or low risk individuals is also wise.┬áThese criteria should reflect those who are most at risk of kidney disease, and those who show risk factors should be admitted for a serum creatinine test to calculate eGFR.┬áThe criteria are those with a history, or are at risk of: kidney disease/problems, diabetes, vascular disease, heart disease and hypertension. Participants must be above 18 years of age. And need to be at risk, or have a familial history presenting at least one or more of these conditions to be considered for screening.The screening would be broken up into a three step protocol to ensure the above standards are met.1. Eligible participants must complete a data form which will require information about history of disease in the family relating to CKD (of the above criteria), risk factors to the participant such as diagnosed conditions like diabetes or hypertension. Presenting symptoms of kidney disease or other risk factors of the above criteria. Health and lifestyle information, as well as other basic details such as sex, age and ethnic origin (since those of Asian, Hispanic or African decent could be at greater risk).In addition, consent to perform a basic background health check would be required by the eligible participant before step 2.2. Those who do not full full any of the criteria to be considered for a test should be provided with an information booklet or leaflet, containing information about CKD and ways to prevent CKD through lifestyle and dietary changes.Those that do meet the criteria for a screening should have a blood sample taken and tested using a point-of-care creatinine analyzer (Minnings et al., 2015).3. Those who are at severe risk of developing CKD, or who show symptoms; should be provided with a referral to their current GP for immediate advice and/or treatment.Those who present with no risk or symptoms, should be provided with the aforementioned leaflet/booklet on how to prevent CKD.Due to the incredibly high concentration of Troponin I in the blood, which is an indicator that there has been damage to the cardiac myocytes; we can conclude that this patient has almost certainly suffered a myocardial infarction (MYTHILI and MALATHI, 2015). This is supported by the presence of Creatine Kinase (CK) which is an enzyme that’s found primarily in cardiac and skeletal muscle, as well as the less specific aspartate aminotransferase (AST) (Lofthus et al., 2012). The presence of CK and AST are merely supporting biomarkers for the diagnosis of an MI. Additionally, the patient is mostly likely suffering from an Acute ST-Elevation MI due to the presence of gamma-glutamyl transpeptidase (GGT) and Alanine transaminase (ALT) within the blood (Emdin, 2001).WHO defines an MI as having two or three of the criteria present to diagnose an MI. These three criteria are:1. Serial ECG changes2. Rise or fall of relevant cardiac biomarkers3. Presence of chest pain of an ischemic nature.The patient presents 2 and 3 of these criteria from the presence of high Troponin I within the blood, and in combination of the other relevant biomarkers as previously discussed. And the patient complained of chest pain, which fulfils two of the three criteria for a myocardial infarction.This patient is most likely suffering from mid stage Chronic Kidney Disease (CKD), which may explain why the patient is asymptomatic. The low eGFR is a clear indicator that there is a reduced rate of flow through glomeruli, and therefore the filtration rate is stunted (Astor et al., 2011). The exact GFR of 35 suggests that the patient is in stage 3b of CKD. This is supported by the high blood urea nitrogen, which is also due to the low filtration rate of the kidneys and their subsequent lacking ability to remove urea from the blood at a normal rate (Mula-Abed, Al Rasadi and Al Riyami, 2012).A urine test to check the levels of creatinine and Albumin could would be useful to gauge how functional the kidneys are. In addition an ultrasound, MRI or CT scan could check for any blockages or malformations. Depending on those results, and considering the patient is in late stage 3 of CKD, a kidney biopsy could also be performed.

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