Riddler Q9

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Riddler Q9

  1. 1. Riddler #8 <ul><li>24 y/o man who formerly used injection drugs is found to have a blood urea nitrogen concentration of 24mg/dl, a serum creatinine concentration of 2.5 mg/dL, and a urine protein-to-creatinine ratio of 8. Tests are positive for HIV and negative for Hep b and C. Renal U/S shows kidneys of 11cm on Right and 10.5 on left. Renal biopsy is performed. </li></ul>
  2. 2. 8 con’t <ul><li>What is the most likely pattern of glomerular injury in this patient? (2pts) </li></ul><ul><li>A) Minimal change disease </li></ul><ul><li>B) Membranous glomerulopathy </li></ul><ul><li>C) Membranoproliferative glomerulonephritis </li></ul><ul><li>D) Allergic Interstitial Nephritis </li></ul><ul><li>E) Collapsing focal and segmental glomerulonephritis </li></ul>
  3. 3. Riddler #8 answer <ul><li>E) HIV nephropathy with collapsing focal and segmental glomerulosclerosis, manifested by nephritic-range proteinuria, azotemia and normal sized kidneys. </li></ul><ul><li>Minimal change disease is the most common nephrotic syndrome in kids, rare in HIV patients. </li></ul><ul><li>Membranous nephropathy is sometimes assoc with hep b, gold, sle, nsaids, less so with hep c </li></ul><ul><li>Membranoproliferative glomerulonephritis type 1 hep C and HIV, endocarditis. Type 2 seen after renal transplant, Type 3 similar to type 1. </li></ul>
  4. 4. #8 con’t <ul><li>Allergic interstitial nephritis usually does not cause nephritic range proteinuria </li></ul>
  5. 5. Riddler #9 <ul><li>A 76 y/o woman is admitted with 3 hours of crushing substernal chest pain. PMH of PVD (Left carotid occlusion with hemiparesis 3 months ago), HTN, HLD, and DM complicated by neuropathy and retinopathy. BP 120/70, hr 120, sat 92% on RA, S3 and JVD on exam. Meds include warfarin 5mg; atenolol 25mg; pravastatin 20. EKG with 3mm ST- Segment elevation in V2-6. INR 1.8 </li></ul>
  6. 6. Riddler #9 <ul><li>What medications can you give her in the ED to lower her mortality risk? 3pt </li></ul><ul><li>Would you give thrombolytics if the cath lab will not be available for at least 2 hours? why or why not? 3pts </li></ul><ul><li>Assuming that this patient was reperfused within 4 hours what is her 30 day mortality risk? (be as specific as possible) 5pts </li></ul>

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