Immunofluorescence patterns in glomerular diseases notes and mnemonics

Immunopathologic patterns of immunoglobulins (Igs) and/or complement components deposited in glomerular diseases notes and mnemonics

Linear deposition:

Anti-GBM disease (mainly IgG)

unspecifically IgG in diabetes mellitus

Granular deposition: 

membranoproliferative GN

post-infectious GN

membranous GN

IgA, IgM, C1q, C3

Pauci immune deposition:

Granulomatosis with polyangiitis (Wegener) PR3-ANCA/c-ANCA

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

Microscopic polyangiitis MPO-ANCA/p-ANCA

Love,

IkaN 

Fact of the day - hypercalcemia in sarcoidosis

 Hi!

Hypercalcemia and hypervitaminosis-D is seen in patients with sarcoidosis and other granulomatous inflammatory conditions. This is because the granulomatous macrophages have high 1-alpha hydroxylase activity --> high levels of 1,25-OH2 vitamin D (calcitriol), produced in addition to this enzyme's normal activity in the kidneys.

That's all

- Jaskunwar Singh

Glomerulonephritis associated with infectious diseases mnemonic

Hepatitis B: Membranous glomerulonephritis

Hepatitis C: Membranoproliferative glomerulonephritis

HIV: Focal segmental glomerulosclerosis

By IkaN

Creatinine clearance in elderly - basic notes

 Hi!

Elderly people have a decrease in creatinine clearance (CrCl), which means an increase in serum Cr. It is observed that annual rate of this decrease in CrCl is approximately 1 ml/min. after the age of 50 years.

Therefore, it is important to calculate the dose and dosing intervals of nephrotoxic drugs (eg., aminoglycosides) in these patients in order to prevent the precipitation of ARF.

In general,

CrCl <100 ml/min is abnormal.

However, CrCl <10 ml/min signifies the onset and worsening of acute renal failure.

Note -

• GFR is directly proportional to CrCl.

• GFR decreases by age, but not always accompanied by rise in Cr.

• Cockcroft-Gault formula is commonly referred to for calculating CrCl.

CrCl = (Ucr × V)/Pcr (~GFR)

• Double the Cr = Half the GFR.

Note that those patients with signs of worsening diabetes and resulting glomerulopathies, an increase in both GFR and CrCl is seen, which thus causes hyper filtration injury. 

That's all

- Jaskunwar Singh

Cystinuria VS Cystinosis - know the difference!

 Hi!

Cystinuria is an AR disorder that is characterized by defective absorption of cysteine and other di-basic amino acids from PCT and intestinal lumen.

Cystinosis, on the other hand, is a lysosomal storage disease characterized by accumulation of amino acid cystine.

Note :

Cysteine + Cysteine = Cystine.

Fact :

Cystinosis is one of the most common cause of Fanconi's syndrome in pediatric age group.

Also, check hexagonal crystals seen in

That's all

- Jaskunwar Singh

Guidelines for management of gout by ACR 2020

 Hi!

Long time..

Urate-lowering therapy indications and important guidelines for management of gout, as updated by ACR in 2020:

When should you start sodium bicarbonate in CKD patients? Mnemonic

When should you start sodium bicarbonate in CKD patients?

Classification and causes of hyponatremia mnemonics + notes

Hi!

Classification and causes of hyponatremia mnemonics + notes:

1. Hyponatremia with low osmolality :

     (i) reduced effective blood volume

              (A) increased ECF volume -

                               - Edematous kidney (nephrotic syndrome)

                               - Cirrhosis of liver

                               - Failure of heart

              (B) REduced ECF volume -

                                - Renal loss of Na ( Diuretics, Ketonuria, Addison's disease)

                                - Extrarenal loss of Na ( sweating, diarrhea, vomiting, peritonitis, pancreatitis)

    (ii) Normal/ increased EBV

                - Inadequate ADH syndrome

                - Constant thirst

                - Renal failure (chronic)

2. Hyponatremia with raised osmolality :

( H & M)

- Hyperglycemia 

- Mannitol administration 

Note -

- Hyponatremia per se does not produce any significant clinical features. The low osmolality that it causes is responsible for various features.

- Slow correction of hypotonicity produces gradual rise in osmolality without any significant risk. But rapid correction of hyponatremia produces loss of brain water resulting in brain damage!

- The rate of correction should be around 0.6 mEq/L/hr. In severely symptomatic patients, total correction in a day should not exceed 8-10 mEq/L/hr.

That's all

Hope it helps

- Jaskunwar Singh

Hyperkalemia and hypokalemia causes mnemonics

Hi!

Fact of the day - BUC in UGI bleed

Hi!

Blood urea levels are positively associated with upper GI bleed. But here's the fact:

Urinary neutrophil gelatinase-associated lipocalin (NGAL)

Neutrophil gelatinase-associated lipocalin (NGAL) is an iron-transporting protein.

Lifestyle modifications for managing hypertension

Hey guys,

Happy New Year!

Let's get started on lifestyle modifications for treating or managing hypertension.

We Decide to Eat less Salt & drink less Alcohol!

Weight loss: Reduce BMI to <25 
DASH: Diet high in fruits and vegetables and low in saturated fat and total fat
Exercise: 30minutes/day for 5-6 days/week
Dietary Sodium: <3 g/day
Alcohol: 2 drinks/day in men and 1 drink/day in women

The effect of these interventions is in descending order, with weight loss having an impact of about 5-20 mmHg lowering per 10 kg weight loss and reducing alcohol intake can lower BP by 2-4 mmHg!

Remember: If a patient's BMI is already lower than 25, you don't have to ask them to reduce weight any further for this therapeutic effect. Instead, you ask them to switch over to DASH diet!

Hope this is helpful!

Stay awesome!
-Rippie

Dietary Risk Factors For Calcium Stones

1) Fluids:
A lower fluid intake will lead to lower urine output, thereby promoting stone formation by increasing the concentration of calcium and oxalate.

True or False #3

1. A high potassium diet, decreases risk of kidney stone. T or F

2. Increase Sodium intake  for reducing kidney stones. T or F

ANSWERS

1. True

A high potassium diet decreases urinary calcium excretion.

Foods rich in potassium enhance urinary Citrate excretion, likely from urinary alkalization, forming soluble calcium Citrate and thereby preventing stone formation

2. False

Decrease the sodium intake

So that when sodium is reabsorbed by the nephron, calcium is also passively reabsorbed and hence decreased calcium in urine.

You are your own Kingdom, pick up the Crown.

Bhopalwala. H

Euvolemic hyponatremia algorithm

Just happened to create this image so I thought of sharing with you guys :)

-IkaN

Crystal Induced Kidney Injury

Drugs responsible :

SAME Piiiiii (Peeeeee)

Sulfonamides

Acyclovir

Methotrexate

Ethylene glycol

Protease inhibitors

Renal Causes of Hypertension : A Summary

Hypertension in a young individual needs specific evaluation to rule out Non Essential Hypertension (Secondary Hypertension). The Most Common cause of this is Renal Hypertension.

Renal causes of Hypertension can be summarized as follows  -

A. Reno-vascular ( Atherosclerotic/ Fibromuscular Dysplasia - FMD)
(Uncommon = Vasculitis , AV Malformation)

B. Parenchymal Renal Diseases like Glomerulonephritis.

Typical Presentations :

• FMD =
- A young 20-30 year old female , with Hypertension and possibly asymmetrical pressures in both limbs, and associated with a Renal Artery bruit.

- Typically have history of some form of Cranial vessel involvement in the form of Strokes in a Young Female , TIA's , other transient neurological phenomena.

- Carotidynia may be + (Due to carotid dissection).

- Ix =  Rule out Atherosclerosis;
Angiography -  String of beads appearance.

- Rx = Anti Platelets , Anti HT .
May need Endovascular clot treatment.
________________________________________

• GN = 
- A 10-25 year old male or female with cola colored urine , fever and periorbital puffiness. Older adults may have more atypical features like Hypertensive Encephalopathy and may develop Uremia.

- H/O antecedent Streptococcal infection - 3-4 weeks prior.

- Ix - Urine report shows Hematuria, RBC Casts and Nephritic range proteinuria.
Renal profile and Urine output to be done and monitored regularly.
Get ASO titers for previous strep infection.

- Rx - Symptomatic. IV fluids.
May need Renal Replacement if Uremia sets in.
________________________________________

In Addition to routine , the extra Investigations to rule out Renal cause in a young patient with Hypertension -

1. Urine Routine and Microscopy
( Look for Hematuria,  RBC Casts, dysmorphic RBCs )

2. Renal Function Testing -
( Look for rise in S. Creatinine, BUN and electrolyte imbalances)
(Also gives a clue to the Adrenal cause of Hypertension with Sodium and Potassium changes).

3. Imaging -
• Pelvic Ultrasound for any structural abnormality of urological tract - due to Congneital or Acquired causes.
• Angiography (Digital Subtraction Angiography) - to look for renal artery stenosis. (Always with a pre procedure creatinine)
• MRI if needed. 

4. Serology -
• ASO Titres
• Anti DNAse B Ab's ( not done commonly)
• Complement levels - may be reduced.
• Antibody panel for various Vasculitis - ANCA , ANA and AMA.

5. Lipid profile for Atherosclerotic vascular disease. 

That's all for this post !
Hope this helps - both on the wards and the boards.
Happy Studying!
Stay Awesome !
~ A.P. Burkholderia

Alport syndrome mnemonic

Hello,

This mnemonic is on Alport syndrome!

Well, the 'Port' in alPORT reminds me of 'Pirate ship' (port - a port in the sea - pirate ship).

1. The pirate flag has cross bones which kinda reminds me of X for X - linked disease. 

2. ‎Number 4 in the port side for type 4 collagen defect.

3. ‎'Bloody' pirates reminds me of haematuria and glomerular basement membrane damage. 

4. ‎Captain shouting, "AAARGH" for crew members who can't hear (Sensory neural hearing loss)
S for sensory, S for sailor, the deaf sailor kinda reminds me of it.

6. ‎Eye patch - for cataract.

That's all!
Stay awesome!

This mnemonic was written by our Medical Student Guest Author, Nikhil.

The image was illustrated by our Medicowesome author, Chaitanya Inge.

Henoch Schonlein purpura

HSP is also known as Anaphylactoid purpura.

• Most common vasculitis in children.
• Most common Leucocytoplastic vasculitis.
  It predominantly affects small vessels (venules, capillaries, arterioles).
  It is usually self limited but may progress to end stage renal disease.
 
Clinical features:
1) Skin: rash, palpable purpura (non-thrombocytopenic purpura).
2) Joints: arthritis, arthalgia.
3) Kidneys: glomerulonephritis (proteinuria, hematuria).
  ° Severe renal failure occurs in about 1-2%, characterized by crescenteric glomerulonephritis which is treated with intravenous methyl prednisolone.
4) GIT : colicky abdominal pain.

   On investigation: total Ig A increases.
Renal biopsy: mesangial Ig A deposits.

Treatment: conservative treatment
    Oral prednisolone may be given.

Thanks for reading.

Madhuri Reddy.

High tHcy associated with mortality from acute stroke!

Hey Awesomites

Various prospective studies in the past years have concluded that high levels of total Homocysteine ( tHcy ) are an independent risk factor for increased mortality from ischemic stroke, after adjustment of confounding factors!

This association is only significant in the large vessel atherosclerosis stroke subtype, and is relatively not significant in small vessel occlusion subtype.

The question that now arises is - Do elevated plasma tHcy levels cause more serious strokes or is it that more serious strokes result in higher tHcy levels?

Studies have found that elevated tHcy levels induce oxidative injury to vascular endothelial cells and impair the production of NO, thus increasing the arterial pressure and risk of stroke.
Also, tHcy enhances platelet adhesion to endothelial cells, promotes the growth of vascular smooth muscles, and is associated with higher levels of prothrombotic factors such as Beta- thromboglobulin, tissue plasminogen activator, and factor VII C.

Whether the more serious strokes increase  levels of tHcy and the changes in the levels before and after the acute episode needs further studies for clarification.

Note : High tHcy is not a cause of stroke and is not associated with stroke severity. Patients in the highest tHcy quartile ( >18.6 umol/L ) with Acute ischemic stroke  in large vessels of brain are in increased risk of Long - term mortality.

Therapy to control and lower tHcy levels with vitamin B supplements has been shown to reduce the risk of stroke and other acute cardiovascular events.
Metabolic B12 deficiency is present in 30% of vascular patients over the age of 70 years, while higher doses of B12 are required in elderly people than younger ones.
However, renal function tests should be done before starting the supplementation because high doses of cyanocobalamine increase cyanide levels in patients with renal impairment ( GFR <50 ml/min ).

( Source  )
That's all
- Jaskunwar Singh