Outros

Question 1

Doença de Addison -insuf adrenal

Answer 1

astenia, anorexia, perda de peso e distúrbios gastrointestinais

dor abdominal, hipotensão (principalmente postural), avidez por sal, redução da libido e rarefação dos pelos axilares e pubianos apenas nas mulheres.

manifestação específica da DA (não tem na IA secundária) é a hiperpigmentação,

decorre de uma maior concentração de melanina na pele pela elevação do ACTH e seu precursor, a pró-opiomelanocortina (POMC).

Question 2

Nutcracker syndrome

Answer 2

• UnilateralbleedingmakeIgAandTBMunlikely
• Youngwoman,noriskfactors,riskofmalignancy
very low
• Historynotinkeepingwithrenalcolic;nostones seen on imaging.

Compression of the L renal vein between the superior mesenteric artery anteriorly and the aorta posteriorly.
Hilar dilation of the L renal vein, leading to renal vein hypertension

Question 3

Nutcracker Syndrome 2

Answer 3

F > M; 3rd-4th decade
• Varied presentation:
• Frank hematuria
• Flank pain
• Microscopic hematuria/Orthostatic proteinuria
• L sided varicocele
• Pelvic congestion w/ dysmenorrhoea/dyspareunia

Diagnosis:
– Cystoscopy - L ureteric bleeding
– Doppler – peak velocity ratio >4
– CT/MR venography
– Gold standard: Venography with renocaval pullback pressure gradient
Management:
– Severe symptoms/hematuria requiring transfusion
– Surgical reimplantation – Endovascular stenting

Question 4

Warfarin Related Nephropathy (WRN)

Answer 4

patients with unexplained AKI on warfarin therapy.
• Histological characteristics:
• Occlusive RBCs casts in distal nephron • RBCs within Bowman’s space
• Dysmorphic RBCs on EM

AllpatientshadunderlyingCKD(biopsy) • 6/9failedtorecover,4remainedinESKD
Epidemiologic studies:
• PresumptiveDx:UnexplainedAKIwithinoneweek of an INR >3.0, in a warfarinized patient without overt evidence of hemorrhage

• Trueincidenceisunknownduetolackofbiopsies
• Estimatedtooccurinupto20%ofCKDpatients
• Highestriskinfirst8weeksfollowinginitiationof anti-coagulation
• GenerallyobservedwhenINR>4
• AssociatedwithacceleratedprogressionofCKD
• Upto30%mortalitywithinonemonthof diagnosis
• Similarpresentationshavebeenreportedwith novel oral anticoagulants