Internal medicine hub

📈 Intervention to slow renal decline: Non-pharmacological interventions 1- Low protein diet: mainly delay the onset of symptomatic uremia 2- Smoking cessation: no proven prospective studies Pharmacological intervention 1- ACE inhibitors/ARBs 2- SGLT2 inhibitors and GLP-1 in diabetics patients 3- MRAs “Finerenone” mainly DM patients 4- Bicarbonate 5- Control HTN

man presents with a 4-month history of progressively worsening dyspnea, decreased appetite, weight loss, and nagging discomfort. He has a history of peptic ulcer disease treated with over-the-counter antacids and a 20-pack-year smoking history. Physical examination reveals fingernail clubbing and bibasilar end-inspiratory crackles on lung auscultation. Chest X-ray shows atelectasis and bilateral pleural plaques over the diaphragm. Chest CT reveals reticular opacities in the lower lung fields, multiple pleural plaques, and a round 6cm cavity mass in the right lower lung field. A CT-guided biopsy of the mass is planned.

🗿 9As in Ankylosing Spondylitis: - Axial pain: sacroiliac joints and spine. - Arthritis - Ankylosis: Fusion of vertebrae leading to decreased spinal flexibility. - Anterior uveitis: pain, redness, and photophobia. - Aortitis - Aortic regurgitation - Apical fibrosis - Achilles tendon enthesitis - Amyloidosis

💡 Today tips: In patients with CKD, serum biomarkers for myocardial ischemia such as cardiac troponins may be chronically elevated due to decreased renal clearance. Serial troponin measurements and other markers such as creatine kinase-MB can help distinguish acute ischemia from chronic elevations.

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🙄 NOTE: This calculation assumes the patient is White. If the patient were identified as African American in the question, the ASCVD risk would be 22%.

🤰🏻Physiological changes in kidneys during pregnancy: - Increase GFR by 50% - Increase proteinuria up to 200mg/day and worsening of prepartum proteinuria (but more than 300 is abnormal) - Increase kidneys size by 1-1.5 cm with hydronephrosis hydroureter (takes weak to resolve postpartum) - increase risk to Pyelonephritis due to urinary stasis (this is why we screen & treat Asx bacteruria in pregnancy) - increase pH (chronic respiratory alkalosis with Pco2 27-32) - Decrease serum Creatinine - Decrease BP - Decrease Na 4-5 mEq/L leads to mild hyponatremia not requiring treatment (this can cause transient gastational DI)

🫵🏻 Remember: - Pregnancy is a state of volume expansion and vasodilation. augmenting renal blood flow and increasing glomerular filtration rate (GFR) by up to 50%. - With the GFR increase, serum creatinine levels decrease. Therefore, high normal serum creatinine levels may indicate significant kidney impairment.

World Health Organization (WHO) Report on Waist Circumference and Waist-Hip Ratio:

💡 Today tips: Henoch-Schönlein purpura can be diagnosed empirically in pediatric settings (as Ddx of vasculitis in children is extremely limited) where is adult required tissue biopsy (kidney or skin) for diagnosis - skin biopsy said to be adequate to make diagnosis when lesion less than 24 hours old in appearance