Cases in Nephrology Muhammad Rafiqul Alam
INDEX
Page numbers followed by f refer to figure and t refer to table.
A
Abdomen, ultrasonography of 7, 128
Abdominal examination 98
Acid-fast bacillus 47
Activated partial thromboplastin time 7, 57, 62, 101, 107
Acute kidney injury 31, 70, 75, 121
diagnosis of 32
Adenosine triphosphate 51
Adrenal gland 79
Adult minimal change disease 62
Advanced glycation end products 3
Alanine transaminase 101, 107
Aldolase 33
Alport syndrome 7274
Amlodipine 99
Amyloidosis 40, 125
treatment of primary 126
Anemia 56
Angiotensin-converting enzyme 14
inhibitor 3, 60, 64, 70
Angiotensin-receptor blocker 3, 70
Ankylosing spondylitis 35
Anorexia 1
Antibody
antineutrophil cytoplasmic 11, 13, 17, 39
antinuclear 10, 14, 39, 62, 73, 81, 85, 91, 101, 128
antiphospholipid 19
donor-specific 99
mediated rejection 19
Anticardiolipin antibodies 19
Antiglomerular basement membrane disease 17
Antihepatitis C virus 73
Anti-human
immunodeficiency virus 39
leukocyte antigen 20
Antithymocyte globulin 99
Antituberculosis 13
Anuria 106
Arterial blood gas analysis 35
Arteriovenous fistula 27
Atorvastatin 62
Audiological report 74
Autosomal dominant polycystic kidney disease 112
Azathioprine 112
B
Bartter syndrome 37
Biochemical parameters 122t
Biochemical tests 77t
Biopsy report 89
Bisoprolol 89, 99
Bladder 78
CT scan of 78
neck incision 21
region, ultrasonography of 62, 68f
ultrasonography of 57, 68, 91, 118
Bleeding time 101, 128
Blood
biochemistry 24
count 28t
film, peripheral 78, 91
pressure 1, 7, 22, 23t, 26, 56, 61, 66, 113
sugar, random 73, 91, 101, 107
vessel 53, 82, 86
Body mass index 27
Bone marrow examination 78
report 40, 129
Bone tissue 129
Brain, MRI of 8, 8f
C
Calcineurin inhibitor 133
post-transplant 18
Calcium acetate 89
Carbonyl iron 89
Cardiovascular risk reduction 3
Cellular rejection 97
diagnosis of acute 104
Chemoprophylaxis 118
Chest
CT scan of 94f
noncontrast CT scan of 8
X-ray 14, 62, 78
Cholecalciferol 89
Chronic kidney disease 1, 3, 18, 21, 26, 43, 46, 75, 88, 97, 105, 112, 115, 133
Clotting time 101, 128
Cold ischemic time 26
Collagenofibrotic glomerulopathy 88, 91
Complete blood count 2, 28, 57, 62, 68, 73, 73t, 78, 100t, 106t, 116t, 122t, 128t
Computed tomography 35, 47
Concentric left ventricular hypertrophy 125
Congo-red stain 40
Continuous ambulatory peritoneal dialysis 4, 46
peritonitis 46
Cortical echogenicity 73
Corticomedullary differentiation 44, 73, 129
Corticosteroids 83
Cotrimoxazole 97
COVID-19
vaccination 88
vaccine 92
C-reactive protein 77, 101, 117
high-sensitivity 107
Creatine kinase 33
Cyclophosphamide 16
intravenous 16
Cytomegalovirus 18, 26, 28, 93, 99, 101, 112
infection 95
pneumonia 93
Cytoplasmic antineutrophil cytoplasmic antibodies 13, 57, 73, 85, 91, 101, 128
D
Dense deposit disease 59
Diabetes mellitus 35
post-transplant 26
Diabetic foot ulcer 2f
Diabetic nephropathy 1, 3
Diabetic proliferative retinopathy 2f
Diazepam, intramuscular 6
Dimercaptosuccinic acid 44, 111
Direct immunofluorescence 53, 58, 59t, 64t, 69, 82, 86, 123, 125, 132
Dithiothreitol 21
Domperidone 89
Doppler imaging 101
Doppler ultrasonography 108
Down's syndrome 43
Dry cough 13
E
Echocardiography 3
Ejection fraction 7
Endocapillary proliferation 81
Epithelium 8, 86
Erythrocyte sedimentation rate 2, 7, 57, 68, 73, 78, 91, 100, 106, 116, 122, 128
Erythropoiesis-stimulating agent 3
Erythropoietin 89
Estimated glomerular filtration rate 3, 86, 116
Ethambutol 76
F
Famotidine 62
Febuxostat 76, 89
Femoral head, avascular necrosis of 81
Ferritin 73
Fibrin degradation product 18
Fibrosis 86
Flucloxacillin 76
Focal lymphocytic infiltration 82
Focal segmental
deposition 53
glomerulosclerosis 49, 50, 50f, 51, 51f, 53, 62, 131
Foley's catheter, balloon of 79
Foley's urinary catheterization 76
Free light chain 41
Fundoscopic examination 74
Furosemide 62
G
Gastrointestinal survey 50
Gastrointestinal system 27
Gitelman syndrome 35, 36
Glasgow Coma Scale 124
Glomerular basement membrane 8, 57, 63, 69, 74, 82, 86, 123
Glomerular capillary wall, double contour of 81
Glomerular filtration rate 11
Glomerular tufts 40
Glomerulonephritis 11, 45, 93
causes of 131
diagnosis of 105
infection-associated 70
positive 13
secondary causes of 53
Glomerulosclerosis, secondary focal segmental 44
Glomerulus 8, 40, 53, 57, 63, 81, 85, 132
Glyceryl trinitrate 22
Graft function 106t
Granular pattern 53
Granulomatous disease 15
H
Headache 38
Heart 124
disease, ischemic 1
Hematologic dysfunction 114
Hematoxylin 15f
Hematuria 44, 97
Hemodialysis 46, 93
Hemoglobin 2, 19, 73, 78, 91, 100, 106
Hemolytic uremic syndrome 19
Henoch–Schönlein purpura nephritis 10, 66, 70
Hepatitis
B core antigen 91
B virus 72
C virus 19, 28, 101
Herpesvirus 19
High power field 1, 7, 31, 38, 44, 49, 57, 62, 67, 100, 121
Hip joint
MRI of 82
X-ray of 82, 82f, 83f
Histopathology report 129
Human immunodeficiency virus 19
Human leukocyte antigen 99, 117
typing 105t
Hydroureteronephrosis, bilateral 21
Hydroxyurea 130
Hypertension 26, 35, 46, 53, 93, 105
Hypocalciuria 36, 37
Hypochloremia 35
Hypokalemia 3537
Hypokinesia 3
Hypomagnesemia 3537
I
Idiopathic thrombocytopenic purpura 76
Imipenem 76
Immunization, expanded programme on 7, 66
Immunofluorescence 40, 50
Immunoglobulin
A 10, 59, 123
vasculitis 67
G 59, 60, 86, 93, 99, 123
M 28, 50, 53, 59, 99, 123
nephropathy 53, 54
Infarcts, acute 8
Inflammation 58, 86
chronic, mild 8
mild and chronic 64
Inflammatory cells, chronic 58
Influenza 72
A 19
Intact parathyroid hormone 73, 77, 91, 107
Intensive care unit 33, 43
Interstitial fibrosis 82
Interstitium 8, 40, 53, 58, 64, 82, 86, 132
J
Joints, pain in multiple 6
Jugular venous pressure 27, 56, 61, 66, 124
K
Kayser–Fleischer ring 50
Kidney 62, 124, 129
biopsy 40
report, transplanted 103
computed tomography of 78
CT scan of 78
disease, end-stage 3
left 79
right 78
transplant 29, 93
ultrasonography of 57, 62, 68, 68f, 91, 118
L
Laboratory investigations 90t
Laboratory parameters 100t, 107t, 116t
Lactate dehydrogenase 31, 107
Leg swelling
bilateral 13
redness, and blackish area on 113f
Leukocytoclastic vasculitis 70
Leukonychia 56
Levothyroxine sodium 89
Light microscopic examination 57, 63
Lipomyelomeningocele 75, 79
Lipoprotein
high-density 2, 28, 57, 91
low-density 2, 28, 57, 91, 101
Liver 27
Lobar collapse 15f
Lobular accentuation 81
Lower limb 67f
Lower urinary tract abnormality 21
Lupus nephritis 6, 62, 70, 81, 120
class 10f
Lymphocytic infiltration, mild 132
M
Malignancy 19
Masson's trichrome 40
Mean corpuscular hemoglobin 57, 116
Mechanical ventilation 114
Membranoproliferative glomerulonephritis 56
periodic acid-Schiff 58f
Membranous nephropathy 61, 62, 63f, 64, 85, 86, 91
Mesangial proliferative glomerulonephritis 53, 62
Methylprednisolone, intravenous 18
Microscopic appearance 103
Microscopic description 40
Microscopy
electron 89
light 69t, 125
Microvascular thrombi 19
Micturating cystourethrogram 44
Miliary lung lesion 78f
Minimal change disease 91, 131, 133
Mitral regurgitation, mild 125
Mycobacterium tuberculosis 47
Mycophenolate mofetil 97, 121
Mycophenolic acid 93
Myelodysplastic syndrome 127
Myoglobinuria 32
N
Nausea 1
Necrotizing sarcoid granuloma 16
Nephritic urinary sediment 16
Nephropathy 50
treatment of 129
Nephrotic syndrome 51, 70, 85, 127, 128
Nephrotoxic medications 127
Neurogenic bladder 75
Neutrophils 46
Nifedipine 89
Nocturnal dyspnea 124
Noncytotoxic agents 130
Nonsteroidal anti-inflammatory drugs 31, 85
Nucleic acid test 95
O
Obstructive uropathy-neurogenic bladder 118
Oral mycophenolate mofetil 49
P
Parathyroid hormone 116
Parenchyma 118
Parvovirus B19 19
Perinuclear antineutrophil cytoplasmic antibody 62, 68, 73, 85, 101, 128
Periodic acid-Schiff 40, 63f
Periodic Schiff-methenamine 40
Peritoneal dialysis 4
catheter 47
Peritonitis 47
Phenytoin, intravenous 6
Plasma cells 40
Pleural effusion, bilateral 124
Pneumococcus 72
Polyangiitis, granulomatosis with 15
Polymerase chain reaction 101
Ponticelli regimen, modified 62
Positive perinuclear antineutrophil cytoplasmic antibody 81
Positron emission tomography 13
Potassium supplementation 37
Prazosin 89, 99
Prednisolone 89, 99, 132
Proliferative diabetic retinopathy 1
Proliferative lupus nephritis, diffuse 82
Prostate 79
Protein
kinase C, activation of 3
reabsorption 8
Proteinuria 44, 51, 97
Prothrombin time 68, 101, 107, 128
Puffy face 56
Pulmonary tuberculosis 27
Pus cell 67
Pyelonephritis, chronic 118, 115
Pyrazinamide 76
R
Rabeprazole 89
Ramipril 62
Randomized controlled trial 86
Rash 66
Recipient and donor workup 99t
Red blood cell 7, 14, 44, 46, 57, 67, 69, 83, 100, 116, 121, 123, 127
Red cell
cast 81
concentrates 106
Reflux nephropathy 118
Refractory lupus nephritis 120
Renal abscess 115
Renal allograft recipient 97, 112
Renal amyloidosis 38
Renal angiogram, computed tomography 109
Renal biopsy 8, 18, 40, 120
report 57, 63, 69, 122t, 131
Renal disease
end-stage 44, 74, 93
modification of 35
Renal dysplasia 118
Renal failure, acute 31
Renal function test 73, 73t, 100t, 116t, 122t
Renal impairment 46
Renal injury 51
Renal parenchymal disease, bilateral 73
Renal replacement therapy 26, 44, 46
Renal transplant 75, 114
Renal transplantation
pre-emptive 26
vascular complication after 105
Renin-angiotensin-aldosterone system 3
Respiratory rate 56
Respiratory system 98
examination of 27
Respiratory tract 16
Rhabdomyolysis 32
Rimactazid 76
Rituximab 16, 130
S
Sclerosis 63
Sepsis 112
Serological tests 117t
Serum 100
albumin 57, 73
calcium 73
creatinine 68, 77
electrolytes 68, 77
free light chains 39t
glutamic pyruvic transaminase 28, 57, 91, 107
phosphate 73
urea 68
uric acid 73
Skin biopsy report 69
Slit-lamp examination 74
Sodium bicarbonate 99
Spleen 27
Stable angina, chronic 46
Stable proteinuria 132
Subendothelial widening, severe 19
Sugar 47
Swelling 1
generalized 61
Systemic amyloidosis 124
Systemic lupus erythematosus 10, 81, 83, 120
T
Tacrolimus 29, 99
Telmisartan 89
Tethered cord syndrome 75
Thrombotic microangiopathy 19
post-transplant 18, 19
Thrombotic thrombocytopenic purpura 19
Thyroid-stimulating hormone 73
Toes, clawing of 77f
Total cholesterol 57
Total iron binding capacity 2, 29, 77, 91, 107
Transferrin saturation 7, 29, 73, 107
Transplant kidney
color Doppler of 102
CT renal angiogram of 110f
Doppler ultrasonography of 101
ultrasonography of 102f
Trephine biopsy 129
Tricuspid regurgitation 125
Tuberculosis 7, 75
disseminated 75
Tuberculous meningitis 58, 103
Tubular atrophy 8, 58, 81, 133
Tubular basement membrane 8, 86
Tubular injury, acute 81
Tubule 40, 53, 58, 64, 81, 132
distal convoluted 36
Tubulointerstitial nephritis 92, 129
U
Ulcer, nonhealing 1
Ultrasonography 29
Upper gastrointestinal endoscopy 50
Ureter 78, 118
CT scan of 78
ultrasonography of 57, 62, 68, 68t, 91, 118
Urinalysis 27t, 121t, 127t
Urinary bladder 79
Urinary total
protein 13, 49, 53, 57, 62, 67, 73, 77, 82, 85, 100, 121, 131
volume 67, 100, 121, 125
Urinary tract infection 21, 38, 75, 115
Urine 27, 49
albumin to creatinine ratio 2
dark red color 67f
output 23t
protein 81
test 100t
volume 85
Uroflowmetry 117f
V
Valganciclovir 97
Vasculitis 17
necrotizing 16
Vesicoureteric reflux 115, 118
Vessels 40
Viral infections 19
Viral markers 28t
Visual acuity 72
W
Warm ischemic time 26
Wegener's granulomatosis 15
White blood cell 1, 7, 31, 46, 73, 100, 122, 128
total count 78
Wilson's disease 49, 50, 52
Wire loop lesion 81
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Cases in Nephrology
Cases in Nephrology
Editor Muhammad Rafiqul Alam MBBS MD FCPS Professor of Nephrology and Ex Pro vice Chancellor Bangabandhu Sheikh Mujib Medical University President, Bangladesh Renal Association President, Association of Physicians of Bangladesh Vice President, Society of Organ Transplantation, Bangladesh Member, Editorial board of Bangladesh Renal Journal Forewords Harun-Ur-Rashid Md Sharfuddin Ahmed
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Cases in Nephrology / Muhammad Rafiqul Alam
First Edition: 2023
9789354659577
Printed at
My Students
They are Like my Children.
FOREWORD
Internal medicine has got many distinct subspecialties; Nephrology is one of them. Postgraduate courses in Nephrology is conducted by Bangabandhu Sheikh Mujib Medical University and also by Bangladesh College of Physicians and Surgeons for a long time. More recently, medical officers are getting interested to obtain training in Nephrology and also to do postgraduate degrees in this specialty. However, there are always scarcity of recent textbooks of Nephrology in our region. In these circumstances, necessity of a short comprehensive problem oriented book is felt by trainee to acquire knowledge about Nephrology.
In this regard, I congratulate Professor Dr Muhammad Rafiqul Alam for compiling a short problem-oriented book in the form of case reports in Nephrology—“Cases in Nephrology”. The author has discussed different nephrological cases, some of which are common and some are rare.
The way the cases are presented and discussed, will be helpful for medical officers, fellows, and residents in Nephrology all together.
I wish the book will get popularity among the readers.
Harun-Ur-Rashid
Founder President, Kidney Foundation, Bangladesh
ISN Pioneer Nephrologist of South Asia Region
FOREWORD
I feel privileged to write the foreword of the book “Cases in Nephrology” by Professor Dr Muhammad Rafiqul Alam. I used to encourage our faculties to get more and more involved in research activities, publish papers in reputed journals, and write book or chapter in a book. This enriches our knowledge armamentarium and at the same time, elevate the position of the University in the QS World University ranking.
My colleague, Dr Muhammad Rafiqul Alam, is involved in teaching nephrology discipline for a long time. In this book, Dr Muhammad Rafiqul Alam discussed thirty cases in a manner which will be helpful for fellows in nephrology, MD residents in nephrology for their preparation for fellowship examination, and MD Phase B residency examination. Fellows and residents in internal medicine will also be benefitted by the book.
I wish the book all success.
Md Sharfuddin Ahmed
Vice Chancellor
Bangabandhu Sheikh Mujib Medical University
Dhaka, Bangladesh
PREFACE
Cases in Nephrology” is the compilation of the real-life clinical cases presented in the nephrology seminar room of the Bangabandhu Sheikh Mujib Medical University by the residents of MD Nephrology. Residents and fellows in Nephrology have to undergo summative examinations for obtaining their degree/diploma. Long case presentation and discussion is a very important part of their examination. Keeping this in mind, this book has been compiled.
Thirty cases have been discussed which I believe will help postgraduate trainees, residents, and fellows in Nephrology during their preparation for final examination.
Hopefully, deficits and mistakes will be corrected in future editions.
Finally, all praises go to Almighty!
Muhammad Rafiqul Alam
ACKNOWLEDGMENTS
Many people are involved in production of this book. It is difficult to mention all names. I would however like to thank Professor Dr Asia Khanam, Professor Dr Ferdousy Begum, Professor Sultana Gulshana Banu, Dr Shahjada Selim, Dr Mahbuba Shirin, and Dr Amit Bari and all the teachers, medical officers, residents of the department of Nephrology, Bangabandhu Sheikh Mujib Medical University, for their valuable contribution.
I owe particular thanks to my wife, my daughters, and my son-in-laws, granddaughters, and grandson who have provided emotional support and encouragement and patience during the writing process.
Finally, I must thank KM Haque, Md Towhidul Islam, and HM Arif Ur Rahman for the wonderful service in preparing the manuscript.
Finally, all praises go to Almighty!
Muhammad Rafiqul Alam