2.asama Flashcards
What is the most probable cause of nephrotic syndrome in a patient with a history of rheumatoid arthritis, enlarged kidneys, and hepatomegaly?
Amyloidosis is the most probable cause of nephrotic syndrome in this patient. Clues to this diagnosis include a history of rheumatoid arthritis (that predisposes to amyloidosis), enlarged kidneys, and hepatomegaly (from amyloid infiltration).
What are the typical findings on renal biopsy in a patient with amyloidosis-associated nephrotic syndrome?
The typical findings on renal biopsy in amyloidosis-associated nephrotic syndrome include amyloid deposits that stain with Congo red and demonstrate a characteristic apple-green birefringence under polarized light. These amyloid deposits are seen in the glomerular basement membrane, blood vessels, and interstitium of the kidneys and can be seen on electron microscopy as randomly arranged thin fibrils.
What are the two main types of amyloidosis associated with nephrotic syndrome, and what conditions are commonly linked to each type?
AL amyloidosis is most commonly due to multiple myeloma.
AA amyloidosis generally occurs in response to chronic inflammatory diseases, with rheumatoid arthritis being the most common cause of AA amyloidosis in the United States.
What is the characteristic renal histological finding in rapidly progressive glomerulonephritis?
Crescent formation on light microscopy is the characteristic finding in rapidly progressive glomerulonephritis.
What is the histological finding in hypertensive nephropathy that affects both afferent and efferent arterioles?
Hyalinosis that affects both afferent and efferent arterioles is seen with hypertensive nephropathy.
What are the typical findings on immunofluorescence microscopy in antiglomerular basement membrane disease (e.g., Goodpasture’s syndrome) and immune complex glomerulonephritis (e.g., lupus nephritis, IgA nephropathy, postinfectious glomerulonephritis)?
In antiglomerular basement membrane disease (e.g., Goodpasture’s syndrome), linear deposits are typical on immunofluorescence microscopy. In immune complex glomerulonephritis (e.g., lupus nephritis, IgA nephropathy, postinfectious glomerulonephritis), granular deposits are usually present.
What do normal light microscopy findings in a patient with nephrotic syndrome usually suggest?
Normal light microscopy findings in a patient with nephrotic syndrome usually suggest minimal change disease.
What is the most likely diagnosis for the patient in this clinical vignette, presenting with fever, rash, arthralgias, peripheral eosinophilia, hematuria, sterile pyuria, and eosinophiluria?
The patient is most likely suffering from drug-induced interstitial nephritis, which can occur with drugs such as penicillins, cephalosporins, and sulfonamides.
What are the common clinical features of drug-induced interstitial nephritis?
Common clinical features of drug-induced interstitial nephritis include fever, rash, and arthralgias. Other features include peripheral eosinophilia, hematuria, sterile pyuria, and eosinophiluria. WBC casts may be present in the urine, but red cell casts are rare.
What is the recommended treatment for drug-induced interstitial nephritis?
The recommended treatment for drug-induced interstitial nephritis is discontinuing the offending agent.
How can steroids affect the course of drug-induced interstitial nephritis?
Steroids may hasten recovery in cases of drug-induced interstitial nephritis, but they may aggravate the underlying infection
What is the treatment for acute pyelonephritis?
Acute pyelonephritis is typically treated with oral ciprofloxacin or IV ampicillin and gentamicin
pyelonephritis triad of symptoms
fever, loin/back pain, nausea/vomiting
may also have hematuria, loss of appetite, systemic illness
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urine dipstick shows
blood shows
imaging
tx
dysuria
suprapubic discomfort
increased frequency
dipstick=leukocyte, nitrites, blood
blood=increased wcc and crp
imaging=ultrasound, ct abdomen
tx=cefalexin 7-10 days, co-amoxiclav/trimethoprim/ciprofloxacin(tendon damage)-culture results
in case of sepsis, 3 tests and 3 txs
3 tests: blood lactate/blood culture/urine output
3 txs: oxygen, iv antibiotics, iv fluids
