pace your MRCP-PACES

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Nandhakumar* For passing *PACES MRCP ( UK )* from India. He was with us in our batch of April 22 online course for PACES. We wish him the best for his future.

👉 *IMPORTANT 533* 👈 *Pharmacology pearls important for clinical judgement* Avoid Beta blockers in treating Cocaïne induced chest pain or Acute MI Good Luck

👉 *IMPORTANT 532* 👈 *Pharmacology pearls important for clinical judgement* Avoid Sotalol, Adenosine, Verapamil and Digoxin in WPW Good Luck

👉 *IMPORTANT 531* 👈 *Pharmacology pearls* Avoid Nitrates, ACE inhibitors and Inotropes in HOCM Good Luck

Photo from Dr Tanzeel Bukhari

Photo from Dr Tanzeel Bukhari

👉 *IMPORTANT 530* 👈 *Important steps in management of AKI* Treat sepsis Stop nephrotoxic medication—NSAIDS, ACE-i, ARB, aminoglycosides Stop drugs that may increase complications: diuretics (especially K+-sparing), metformin, antihypertensives Check all drug dosages are appropriate for renal impairment Consider gastroprotection (H2 antagonist, PPI) and nutritional support Avoid radiological contrast Good Luck

👉 *IMPORTANT 529* 👈 *Important investigations in AKI* Urine dipstick (pre-catheter) and quantification of any proteinuria. Haematuria/proteinuria may suggest intrinsic renal disease USS within 24 hours (unless cause obvious or AKI improving). Small kidneys (<9cm) suggest CKD. Asymmetry may suggest renal vascular disease Check liver function (hepatorenal) Check platelets—if low need blood fi lm to check for haemolysis (HUS/TTP) Investigate for intrinsic renal disease if indicated: immunoglobulins, paraprotein, complement, autoantibodies (ANA, ANCA, anti-GBM) Good Luck

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Ew Ju Vern* For passing *PACES MRCP ( UK )* from Malaysia. She was with us in our batch of June-July 22 online course for PACES. We wish her the best for her future.

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Laxmikant Chavan* For passing *Part 1 MRCPI ( Ireland )*. He has been a keen participant in our group for part 1 prepration. We wish him the best for his future.

👉 *IMPORTANT 528* 👈 Please monitor in AKI • Fluid balance—consider urinary catheter and hourly urine output • K+ —check response to treatment and at least daily until creatinine falls • Observations—minimum every 4 hours • Lactate if signs of sepsis • Daily creatinine until starts decreasing (the levels lag ~24 hours behind clinical response) Good Luck

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

👉 *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 Good Luck

✌️✌️ *HEARTIEST CONGRATULATIONS* ✌️✌️ To *Dr. Mohamed Muslim* For passing *PACES MRCP ( UK )* from Malaysia. He has been a keen participant in our group for PACES prepration. We wish him the best for his future.

👉 *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 Good Luck

👉 *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 Good Luck

👉 *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. Good Luck

Here is the recording of today's session. Please try to listen the recording in 1 day as Zoom provides limited space and it automatically deletes the old recordings to keep space for new ones ..so the recording will not be available after 1 day☝️☝️☝️

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