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👉 *IMPORTANT 527* 👈 Please examine in AKI Heart rate BP JVP capillary refill palpate for bladder paceUrMRCP.

👉 *IMPORTANT 526* 👈 *Post-renal causes of AKI can be :* *Pathophysiology :::::: Examples* Within renal tract : Stone, renal tract malignancy, stricture, clot Extrinsic compression : Pelvic malignancy, prostatic hypertrophy, retro-peritoneal fibrosis paceUrMRCP.

👉 *IMPORTANT 525* 👈 *Renal causes of AKI can be :* *Pathophysiology :::::: Examples* Glomerular : Glomerulonephritis, ATN (prolonged renal hypo-perfusion causing intrinsic renal damage) Interstitial : Drug reaction, infection, infiltration (eg sarcoid) Vessels : Vasculitis, HUS, TTP, DIC paceUrMRCP.

👉 *IMPORTANT 524* 👈 *Prerenal causes of AKI can be :* *Pathophysiology :::::: Examples* Reduced Vascular volume : Haemorrhage, D&V, burns, pancreatitis Decreased cardiac output : Cardiogenic shock, MI Systemic vasodilation : Sepsis, drugs Renal vasoconstriction : NSAIDs, ACE-i, ARB, hepatorenal syndrome paceUrMRCP.

👉 *IMPORTANT 523* 👈 *Commonest causes of AKI :* Sepsis. Major surgery. Cardiogenic shock. Other hypovolaemia. Drugs. Hepatorenal syndrome. Obstruction. paceUrMRCP.

👉 *IMPORTANT 522* 👈 The Kidney Diseases: Improving Global Outcomes (KDIGO) guidelines define AKI as: • rise in creatinine >26μmol/L within 48h. • rise in creatinine >1.5 ≈ baseline (ie before the AKI) within 7 days. • urine output <0.5mL/kg/h for >6 consecutive hours. paceUrMRCP.

👉 *IMPORTANT 521* 👈 *Catheterized patients and UTI* All catheterized patients are bacteriuric. Send MSU only if symptomatic. Symptoms of UTI may be non-specific/atypical. Possible symptoms include fever, flank suprapubic pain, change in voiding pattern, vomiting, confusion, sepsis. Change long-term catheter before starting an antibiotic. Refer to local guidelines for initial antibiotic choice. Where possible use a narrow-spectrum antibiotic according to culture sensitivity. paceUrMRCP.

👉 *IMPORTANT 520* 👈 Avoid using ciprofloxacin, trimethoprim in 1st trimester and nitrofurantoin in 3rd trimester while managing UTI in pregnancy paceUrMRCP.

👉 *IMPORTANT 519* 👈 Please Do not use antibiotics for the treatment of asymptomatic bacteriuria in non-pregnant women, men, and adults with catheters. paceUrMRCP.

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Announcement for Online Session No 116 28 April 2024 DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE: Today we will have an online session on Zoom discussing 1 Clinical Consultation Station regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) WE WILL NOT RECORD THIS SESSION The Candidate for today’s session has been selected. TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 3 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm Sri Lanka : 6 30 pm Somalia : 4 00 pm Zimbabwe : 3 00 pm China ( Beijing ) : 9 00 pm Australia ( Sydney) : 11 00 pm Burundi : 3 00 pm Rwanda : 3 00 pm Morocco : 1 00 pm French Guiana : 10 00 am ( Please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. GOOD LUCK.

Announcement for Online Session No 116 28 April 2024 DEAR DOCTORS : MAY I HAVE YOUR ATTENTION PLEASE: Tomorrow we will have an online session on Zoom discussing 1 Clinical Consultation Station regarding our preparation for MRCP PACES ( UK ) and MRCPI ( Ireland ) WE WILL NOT RECORD THIS SESSION The Candidate for tomorrow’s session has been selected. TIMINGS : Saudia Arabia: 4 00 pm Pakistan : 6 00 pm Bangladesh : 7 00 pm India : 6 30 pm Singapore : 9 00 pm Hong Kong : 9 00 pm Malaysia : 9 00 pm Egypt : 3 00 pm Libya : 3 00 pm Bahrain : 4 00 pm Burma ( Myanmar ) :7 30 pm Sudan : 3 00 pm UAE : 5 00 pm UK : 2 00 pm Ireland ( Dublin ) : 2 00 pm Afghanistan : 5 30 pm Kenya : 4 00 pm Germany ( Berlin ) : 3 00 pm Nigeria : 2 00 pm Japan ( Tokyo ) : 10 00 pm Denmark : 3 00 pm Qatar : 4 00 pm Oman : 5 00 pm Italy : 3 00 pm Indonesia : 8 00 pm Mauritius : 5 00 pm Iraq : 4 00 pm Texas Usa : 8 00 am Kuwait : 4 00 pm Sri Lanka : 6 30 pm Somalia : 4 00 pm Zimbabwe : 3 00 pm China ( Beijing ) : 9 00 pm Australia ( Sydney) : 11 00 pm Burundi : 3 00 pm Rwanda : 3 00 pm Morocco : 1 00 pm French Guiana : 10 00 am ( Please Google for your local time zones to avoid any inconvenience ) Zoom meeting link will be shared 5 minutes before start time. GOOD LUCK.

👉 *IMPORTANT 518* 👈 *Causes of sterile pyuria* *Non infection related* Calculi Renal tract tumour Papillary necrosis Tubulointerstitial nephritis Chemical cystitis Polycystic kidney Recent catheter Pregnancy SLE Drugs, eg steroids paceUrMRCP.

👉 *IMPORTANT 517* 👈 *Causes of sterile pyuria* *Infection related* TB Recently treated UTI Inadequately treated UTI Fastidious culture requirement Appendicitis Prostatitis Chlamydia paceUrMRCP.

👉 *IMPORTANT 516* 👈 Aetiology of AKI can be divided according to site as: • pre-renal: decreased perfusion to the kidney. • renal: intrinsic renal disease. • post-renal: obstruction to urine. paceUrMRCP.

✌️✌️ HEARTIEST CONGRATULATIONS ✌️✌️ To Dr Tharun For passing PART 1 MRCP ( UK ). We wish him the best for his future.

👉 *IMPORTANT 515* 👈 *Sterile pyuria* Increased numbers of white cells in urine but sterile on standard culture paceUrMRCP.

👉 *IMPORTANT 514* 👈 *Common organisms in UTI* Usually anaerobes and Gram-negative bacteria from bowel and vaginal flora. E. coli is the main organism (75–95% in community ). Staphylococcus saprophyticus (a skin commensal) in 5–10%. Other enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumonia. paceUrMRCP.