set 1

5
common causes of nephrotic $
dm
sle
amyloidosis
drugs/toxins
infection wd hep b,c or sphilis
--------------14
suspect iga nephropathy in a patient presenting with hematuria with
concommitant upper respiratory infection
patients who have significant proteinuria should be treated with ace
inhibitors or arbs to reduce proteinuria nd htn
------------28
gaucher disease
deficiency of enzyme glucocerecbrosidase.. results in progressive
accumulation of glucocerebroside within lysosomes of histiocytes
in the most common adult variant (type 1) , the most severely affected
organs are the bone marrow , liver, spleen
bone marrow involvement accounts for progressive pancytopenia nd bone
fractures
spleenomegaly contributes to thrombocytopenia and anemia
diagnosis: glucocerebrosidase levels in circulating leukocytes
frequent bone marrow biopsies .. to define extent of marrow involvement
gaucer cells: large histiocytes with their cytoplasm engorged with
glycolipid
common among ashkenazi jews (of eastern european origin)
Rx: recombinant glucocerebrosidase : imiglucerase
ERT (enzyme replacement therapy):
symptomatic children: malnutrition, growth retardation, impaired
neurologic development and /or fatigue
severe disease : platelet <60,000 , hepatomegaly> 2.5 times normal ,
massive spleenomegaly >15 x normal size, radiologic evidence of severe
disease
---------------------33
membranous nephropathy .. most common primary nephrotic $ in adults
massive proteinuria, htn, elevated serum creatinine levels
light microscope: slightly enlarged glomeruli, normal cellularity ,
thickened capillary walls nd basement membrane
-----------39
tubulointerstial nephritis (AIN) can be drug induced.
drugs like penicilin and nsaids
acute or chronic renal failure due to decreased gfr
labs: eosinophilia, eosinophiluria, hematuria, proteinuria, increase in
serum ige levels
-------------43
alport $ is an x -linked disease .. triad of hematuria, lenticonus nd
sensorineural deafness
to confirm diagnosis an initial skin biopsy .. monoclonal antibodies
against alpha -5 chain of type 4 collagen
if results are equivocal a renal biopsy is performed
----------------------set 2
20

excessive loop diuretic can lead to metabolic alkalosis

measure urinary chloride
high urinary chloride (but will absorb all bicarbonate)
low serum chloride
ACETAZOLAMIDE is a good alternative in patients who require diuresis but
are heading into metabolic acidosis
------29
a decrease in hb during the course of erythropoietin therapy in a patient
who has crf signifies one of the following
presence of an underlying infection
aluminium toxicity
depleted iron stores
hyper parathyroidism
management includes stopping erythropoietin , treating anemia wd
transfusion nd adressing the underlying cause
------------------------end of kaplan 2012 offline
important concepts (mainly missing in uworld)
15/4/2014
Allah bless u all :)
my notes
Hafiz Bilal Zafar
Sargodha Medical College , Pakistan