U06-12318 #605635810 71 yo male,ARF (cr~300) RBC casts ++ %g/day proteinuria PANCA +ve.

Slides:

Advertisements

Similar presentations

These are actual cases to –Stimulate your reading –Test your knowledge of the material Look for the sound icon (usually in the top right portion of.

Advertisements

Hematuria Katie Townes MD, PGY2. Case 8 year old male with episodic hematuria, initially thought to be due to trauma, but persisted for weeks and recurred.

U # month history of being unwell Vasculitic lesions on lower limbs ANCA positive Likely Wegener’s vs MPA.

U # y.o. male ARF Creat 350 RBC casts + Active urine sediment.

Hospital Medicine Process Improvement and Care Innovation Resident Noon Conference July 17, 2013 Rajesh Chandra, M.D. Division Chief General Internal Medicine.

Systemic Lupus Erythematosus and Pregnancy Andres Quiceno, MD Rheumatology.

Case Presentation Lance C. Brunner M.D. Assistant Clinical Chief Department of Family Medicine.

Acute Kidney Injury Dr Alexis Missick FY2. Presentation Case Objectives Definition & Aetiology Investigation Management Complications.

Case Conference. History 56 year old African American female Was transferred from outlying hospital for:  B/L LE infected ulcers (due to heating pad)

Glomerular Diseases Dr. Atapour Differential diagnosis and evaluation of glomerular disease.

Dyspnea and Rash Andres Quiceno, MD Rheumatology PHD.

Intracardiac Shunts.

SCLC, Hypertension & Hypokalemia. Is there any correlation?! Wael Batobara.

Case Discussion Dr. Raid Jastania. 19 year old female presents with fever and generalized lymphadenopathy for one month. What are the causes of Fever?

Core Topic UCI Internal Medicine Residency Learning Objectives Review the major causes of upper GI bleeding and important elements of the history.

Department of Medicine Grand Rounds Clinical Vignette Ilana Bragin January 14 th, 2009 NYU Langone Medical Center Internal Medicine Residency Program.

Case Study 3 Presented by: Lisa, Jennifer and Esmeralda.

U Clinical History ( ): Generalized decline in health since Feburary 2005 including: Wt loss/recurrent ‘Pneumonia’/ arthralgia and joint.

Case Discussions Challenges in End of Life Care 15/11/14 MRS B.

Acute Renal Failure Cases. Case 1- HPI 71 yo mw/ fever and dysuria for 2 days Decreased UOP but increased frequency Yesterday vomited 3-4 times and developed.

Unit 7 Treatment of TB: B Family Case Botswana National Tuberculosis Programme Manual Training for Medical Officers.

Resident Noon Conference July 15, 2015 Rajesh Chandra, M.D.

Patient presenting with altered mental status

NYU Medical Grand Rounds Clinical Vignette Laura Van Metre Baum, MD Class of 2013 Tuesday, April 17, 2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

U # y old female with PMH of mild RA, increased LFT, asthma, atypical chest pain, depression Presented late 2004 with chronic abdo.

U and U # U y.o. male ? Wegener’s.

CASE 5 54 yo man HIV positive in 2001 Immune Thrombocytopenia Chronic G1a Hepatitis C Crack use daily Normotensive.

U # yr old woman with sinusitis,arthritis pulmonary hemorrhage,microscopic hematuria Proteinuria 2.5g/day (+) pANCA,Cr 127 ANA(+). Anti.

U # ↑ SG 300. Proteinuria, Vasculitis rash. Native (L) Kidney.

U # Severe nephrotic syndrome with rising creatinine.

U # Creat 250 Nephritic urine ? Crescentic GN.

Extern conference A 1-year-3-month-old boy presented with generalized edema for 1 month 20 December 2007.

M&M Conference Michelle Hamel, PGY-5

NYU Medicine Grand Rounds Clinical Vignette James Kim, M.D., PGY-2 February 26, 2014 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

U # y.o. female with pneumonia  creatinine proteinuria very low C3, C4.

Case Presentation- Hx 36 y.o female Admitted-SPH 11/07/2007 (73 previous visits) Brought in via EHS agitated, spitting, naked and running into traffic.

Academic day 13/02/2014 MUBARAK ALKABEER HOSPITAL.

Acute Renal Failure Internal Medicine Lecture Series August 10, 2005 Julia Faller, D.O.

66 F PMH: HTN, Gout, DVT (Feb/06 and ? Sep/06) PMH: Heterozygous for Prothrombin mutation. FOCAL PROLIFERATIVE IMMUNE COMPLEX GN (toward chronic GN) 

A 57-year-old man presents with fatigue for several months. He underwent a blood transfusion with several units in 1982 after car accident. Physical examination.

U #009N Recurrent edema with most recent episode proteinuria with creat > 300.

HYPOTHERMIA & DELIRIUM Andrew Dawson year old man presents to JHH 1 week history or declining mobility and increased confusion ? associated.

U y old female with PMH of mild RA, increased LFT, asthma, atypical chest pain, depression Presented late 2004 with chronic abdo pain, had.

U # yo Nigerian Canadian, born in Toronto HPI Presented with a several day history of intractable N&V, bilateral flank pain, fever and.

MEERA LADWA ACUTE KIDNEY INJURY. WHAT IS ACUTE KIDNEY INJURY? A rapid fall in glomerular filtration rate (GFR) In practice, since measuring GFR is difficult,

A Practical Approach to Acid-Base Disorders Madeleine V. Pahl, M.D., FASN Professor of Medicine Division of Nephrology.

November 26, HPI 14 month old male seen by PCP intially for fever and nasal congestion with purulent nasal discharge and cough. At initial visit.

54 year old man with 7 grams/day proteinuria Microscopic hematuria and serum creatinine nearly 130. He is HCV positive and had received liver transplant.

This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration.

Diagnostic approach of hematuria

U # ATN 1 year ago with recovery but now proteinuria with DM ?other diagnoses.

Morbidity and Mortality Rounds Dr. Shounak Das July 27, 2007.

U # yr old woman with Serum Cr 202 Urine Pr/Cr 338 mg/mmol,elevated LFTs Weight loss No hematuria SPEP-polyclonal gammopathy (L) Native.

U #EGH No clinical information. 68 YOM Was sent from Norwood for evaluation of Acute Renal Failure and worsening extremities edema. His.

U # Chronic renal failure – secondary to IgA nephropathy. Deceased donor kidney transplant – August Complicated by delayed graft.

우연히 발견된 폐결절환자 증례 호흡기내과 R1 최윤영/ Prof. 박명재

U # Donor kidney biopsy. Donor 25 yrs old female Blood group: A+ Wt 90 Kg, Ht 180 cm S/P MVA 03 Jan 2007: –Subarachnoid and intracerebral.

U History is that of a 12 y/o male presenting with a few day history of vomiting, facial swelling, fatigue and oliguria. Hypertensive only at.

U Clinical History ID - 94 yo M PMHx – remote IHD with CABG in HTN. Active and living independently prior to presentation Sept 22/05 at.

“Monitoring Systemic Lupus Erythematosus” Andres Quiceno, MD Presbyterian Hospital of Dallas.

Diagnosis and Management Pearls

Recurrent hepatitis with Halogenated Anesthetics

Malungon, Sarangani Province

Nephrology Pathology Rounds Oct 21/05

In The Name Of God.

The Presentation of some cases with “Systemic Lupus Erythematosus”

Morbidity and Mortality Conference

Comorbidity NASH/HCV and HCC

AKI – Acute Kidney Injury

Presentation transcript:

U # yo male,ARF (cr~300) RBC casts ++ %g/day proteinuria PANCA +ve

U yo M admitted to CTU medicine (June 13) with confusion, ARF (sCr 285), anorexia, wt loss, weakness PMhx: Htn, dyslipidemia, COPD (80 py smoker), DHS R hip ?osteoporosis, ?Etoh abuse. No documented renal disease. HPI 2 months ago: Visiting BC: picked up by police for driving erratically: admitted to hospital with delirium NYD, treated with risperidone: d/c after 1 week. sCr 170 (May, 2005: sCr=99). No documentation / discharge history available June 12: UAH ER: 1 mo history of anorexia, weakness, poor coordination, tremor, confusion. (Poor historian – separated from wife, few family) Meds: Risperidone, ASA, Coversyl 4mg OD. Physical Exam: 183/84, AFib 180  NSR 80 with fluid. Afebrile. Wasted: 47 kg. Disoriented x 3, agitated, resting tremor. No focal neuro signs. Clinically dry: dry MM, flat JVP, no edema. PPP. Lungs clear. No active joints, rashes, lymphadenopathy, bruits.

Initial Investigations sCr 287, urea 40. U/A: 3+ protein, prot/Cr=469 mg/mmol, RBC, occ WBC, occ hyaline casts. Urine C+S: no growth Na=153, K/TCO2/Cl N. sAlbumin=19, Ca=1.73, Po4=1.63, Mg N. LFTs, NH3, CK N. CBC: Hb 138 (MCV 95), Plt 159, WBC 6.1. Smear: no schistos, no hyperseg PMNs Renal U/S: N sized kidneys, increased echogenicity. No masses/hydro. Course in Hospital -Admitted to CTU with confusion ?EtOH withdrawal, ARF, hypovolemia, AFib. -Supportive care: IV crystalloid, benzos -sCr: 284 (6/12)  316 (6/13)  315 (6/14) -Nephro consult (6/15): suspected pre-renal ARF with underlying intrarenal process. Too combative for biopsy: repeat urine studies and serology -SPEP/UPEP –ve for M-band, C (N ), C4 N, anti-GBM negative - June 20: pANCA +ve, cANCA –ve, ANA+, dsDNA –ve Urine microscopy: ++RBC casts and heme-granular casts Minimal improvement in mental status CT head: non-acute ischemic lesions L frontal lobe and peri-ventricular white matter -June 21 (Wednesday): RENAL BIOPSY (after sedation) June15June16June17June18June19June20 scr

Diagnosis: Renal Biopsy: Arteritis with fibrinoid change and medium sized arteries with consequent tubular damage and membranoproliferative glomerulonephritis with occasional crescent formation.