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  #1  
Old 08-01-2013
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Kidney Nephro Question:1 (goodluck)

a 60 y/o male presents with a high creatinine and Nephrotic range proteinura. He has chronic back pain for which he uses ibuprofen and he also started using penicillin 3 weeks ago for a an infection which is treated now. Patient was admitted to the hospital 6 weeks ago for a coronary angiography which was done successfully. His Urinalysis shows eisinophilluria and eisinophil casts. He has a fever and a rash on his legs. Whats the cause of his renal problems.

A: Interstitial Allergic Nephritis
B:Atheroembolic ARF
c: Analgesic Induced ARF
D: Crystal Induced ARF
E: IgA Nephropathy
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  #2  
Old 08-01-2013
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Originally Posted by Kais_MD View Post
a 60 y/o male presents with a high creatinine and Nephrotic range proteinura. He has chronic back pain for which he uses ibuprofen and he also started using penicillin 3 weeks ago for a an infection which is treated now. Patient was admitted to the hospital 6 weeks ago for a coronary angiography which was done successfully. His Urinalysis shows eisinophilluria and eisinophil casts. He has a fever and a rash on his legs. Whats the cause of his renal problems.

A: Interstitial Allergic Nephritis

B:Atheroembolic ARF
c: Analgesic Induced ARF
D: Crystal Induced ARF
E: IgA Nephropathy
He has 3 risk factors for this.
One he takes NSAIDS.
two he takes penicillin.
three the urianalysis and rash are virtually diagnostic.

This is not cholesterol emboli because that presents with livedo reticularis and/or gangrene, specially on the lower extremities, also it presents with GI and CNS manifestations.
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Old 08-01-2013
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Originally Posted by Kais_MD View Post
a 60 y/o male presents with a high creatinine and Nephrotic range proteinura. He has chronic back pain for which he uses ibuprofen and he also started using penicillin 3 weeks ago for a an infection which is treated now. Patient was admitted to the hospital 6 weeks ago for a coronary angiography which was done successfully. His Urinalysis shows eisinophilluria and eisinophil casts. He has a fever and a rash on his legs. Whats the cause of his renal problems.

A: Interstitial Allergic Nephritis
B:Atheroembolic ARF
c: Analgesic Induced ARF
D: Crystal Induced ARF
E: IgA Nephropathy
A: Interstitial Allergic Nephritis
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  #4  
Old 08-01-2013
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guys....the devil is in the details lol....Look again
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guys....the devil is in the details lol....Look again
What do you mean with details? are you saying because of chronic back pain he could have crystal induced or nephrolithiasis?
Analgesic induced renal failure? nope.

The urianalysis screams 2 things, either cholesterol emboli tot he kidneys OR Allergic interstitial nephritis, I already explained why it cant be cholesterol emboli, which could be the 2nd best answer here.

Iga nephropathy doesnt present like this, he is also NOT in the age group.
Either the question is poorly worded or an option is missing. From what you are saying this is not A so it can only be B because of the angiography which could have dislodged an emboli... Again if this is the answer then the question writer missed a shitload of details and the question is vague
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What do you mean with details? are you saying because of chronic back pain he could have crystal induced or nephrolithiasis?
Analgesic induced renal failure? nope.

The urianalysis screams 2 things, either cholesterol emboli tot he kidneys OR Allergic interstitial nephritis, I already explained why it cant be cholesterol emboli, which could be the 2nd best answer here.

Iga nephropathy doesnt present like this, he is also NOT in the age group.
Either the question is poorly worded or an option is missing. From what you are saying this is not A so it can only be B because of the angiography which could have dislodged an emboli... Again if this is the answer then the question writer missed a shitload of details and the question is vague
Ok so the answer is Analgesic nephropathy. If you notice the presentation between allergic interstitial nephritis and analgesic nephritis is only one things...>NEPHROTIC Range Proteinuria< Everything else is the same just because the indication is there doesnt mean he should have interstitial nephritis. Allergic Intersitital nephritis is by nature (NEPHRITIC).
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Old 08-01-2013
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cmon guys..I even capitialized Nephrotic Range Proteinuria in the question

I had a curve ball like this on my NBME :/
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yeah it could be atheroembolic ARF if livedo retuicularis is misinterpreted as rash
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cmon guys..I even capitialized Nephrotic Range Proteinuria in the question

I had a curve ball like this on my NBME :/
Then what is the answer? C? because of focal segmental glomerulosclerosis (caused by NSAIDS?)
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haha ya C. if there was a mention of embolic phenomenon it could be atheroembolic but that would be more acutely so time matters alot too.

the presentation of acture interstial nephritis and Analgesic nephropathy is the same from urinalysis to cast to blood. The only difference is analgesic nephropathy has nephrotic range protienuria.....

FYI i got this question right only because i had heard in archers videos. So apparently they do help thank god.
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  #11  
Old 08-01-2013
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haha ya C. if there was a mention of embolic phenomenon it could be atheroembolic but that would be more acutely so time matters alot too.

the presentation of acture interstial nephritis and Analgesic nephropathy is the same from urinalysis to cast to blood. The only difference is analgesic nephropathy has nephrotic range protienuria.....

FYI i got this question right only because i had heard in archers videos. So apparently they do help thank god.

Mmmm I see, it is kind of gay that they put it like this .. but after your analysis I do agree, the key here is the NEPHROTIC clue.

thanks!
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Mmmm I see, it is kind of gay that they put it like this .. but after your analysis I do agree, the key here is the NEPHROTIC clue.

thanks!
i know you have a lot of time. So here is a piece of advice. When you read MTB the usual things we just graze over to read the big points like diagnosis and treatment and test. well apparently step 3 focuses on the little things and that why the questions are sooooooo hard. So repeat repeat repeat repeat...
FYI thanks buddy...for the questions..>keep them coming

and we'll start work up for ccs cases too
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  #13  
Old 08-01-2013
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i know you have a lot of time. So here is a piece of advice. When you read MTB the usual things we just graze over to read the big points like diagnosis and treatment and test. well apparently step 3 focuses on the little things and that why the questions are sooooooo hard. So repeat repeat repeat repeat...
FYI thanks buddy...for the questions..>keep them coming

and we'll start work up for ccs cases too
You are correct, I will follow your advise.

Will continue posting questions wont let you down, will post at least 10 peds questions before starting OB/GYn and then Internal Medicine (my source is gonna be a hard as F..K one you will see)
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  #14  
Old 08-01-2013
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You are correct, I will follow your advise.

Will continue posting questions wont let you down, will post at least 10 peds questions before starting OB/GYn and then Internal Medicine (my source is gonna be a hard as F..K one you will see)
haha cant wait.
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Old 08-07-2013
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Mtb 2 says that epsinophils are not found in nephropathy due to nsaids. So shudnot the ans be ain
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