Megalocytic Interstitial Nephritis Following Acute Pyelonephritis with Escherichia Colibacteremia: a Case Report
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USMLE – What's It
Purpose of this handout Congratulations on making it to Year 2 of medical school! You are that much closer to having your Doctor of Medicine degree. If you want to PRACTICE medicine, however, you have to be licensed, and in order to be licensed you must first pass all four United States Medical Licensing Exams. This book is intended as a starting point in your preparation for getting past the first hurdle, Step 1. It contains study tips, suggestions, resources, and advice. Please remember, however, that no single approach to studying is right for everyone. USMLE – What is it for? In order to become a licensed physician in the United States, individuals must pass a series of examinations conducted by the National Board of Medical Examiners (NBME). These examinations are the United States Medical Licensing Examinations, or USMLE. Currently there are four separate exams which must be passed in order to be eligible for medical licensure: Step 1, usually taken after the completion of the second year of medical school; Step 2 Clinical Knowledge (CK), this is usually taken by December 31st of Year 4 Step 2 Clinical Skills (CS), this is usually be taken by December 31st of Year 4 Step 3, typically taken during the first (intern) year of post graduate training. Requirements other than passing all of the above mentioned steps for licensure in each state are set by each state’s medical licensing board. For example, each state board determines the maximum number of times that a person may take each Step exam and still remain eligible for licensure. -
WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA). -
Focal Segmental Glomerulosclerosis in Systemic Lupus Erythematosus
Relato de Caso Focal Segmental Glomerulosclerosis in Systemic Lupus Erythematosus: One or Two Glomerular Diseases? Glomerulosclerose Segmentar e Focal em Lúpus Eritematoso Sistêmico: Uma ou Duas Doenças? Rogério Barbosa de Deus1, Luis Antonio Moura1, Marcello Fabiano Franco2, Gianna Mastroianni Kirsztajn1 1 Nephrology Division and 2 Department of Pathology - Universidade Federal de São Paulo – EPM/UNIFESP- São Paulo. ABSTRACT Some patients with clinical and/or laboratory diagnosis of systemic lupus erythematosus (SLE) present with nephritis which from the morphological point of view does not fit in one of the 6 classes described in the WHO classification of lupus nephritis. On the other hand, nonlupus nephritis in patients with confirmed SLE is rarely reported. This condition may not be so uncommon as it seems. The associated glomerular lesions most frequently described are amyloidosis and focal segmental glomerulosclerosis (FSGS). We report on a 46 year-old, caucasian woman, who fulfilled the American College of Rheumatology criteria for SLE diagnosis: arthritis, positive anti-DNA, ANA, anti-Sm antibodies, and cutaneous maculae. During the follow-up, she presented arthralgias, alopecia, vasculitis, lower extremities edema and decreased serum levels of C3 and C4. Proteinuria was initially nephrotic, but reached negative levels. The serum creatinine varied from 0.7 to 3.0 mg/dl. The patient was submitted to the first renal biopsy at admission and to the second one, 3 years later, with diagnosis of minimal change disease and FSGS, respectively. No deposits were demonstrated by immunofluorescence. In the present case, we believe that the patient had SLE and developed an idiopathic disease of the minimal change disease-FSGS spectrum. -
Impact of Urolithiasis and Hydronephrosis on Acute Kidney Injury in Patients with Urinary Tract Infection
bioRxiv preprint doi: https://doi.org/10.1101/2020.07.13.200337; this version posted July 13, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Impact of urolithiasis and hydronephrosis on acute kidney injury in patients with urinary tract infection Short title: Impact of urolithiasis and hydronephrosis on AKI in UTI Chih-Yen Hsiao1,2, Tsung-Hsien Chen1, Yi-Chien Lee3,4, Ming-Cheng Wang5,* 1Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan 2Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan 3Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan 4School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan 5Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan *[email protected] 1 bioRxiv preprint doi: https://doi.org/10.1101/2020.07.13.200337; this version posted July 13, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Abstract Background: Urolithiasis is a common cause of urinary tract obstruction and urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with UTI. -
UTI and Pyelonephritis Summary
CHI Franciscan Health UTI & Pyelonephritis Summary UTI/pyelonephritis is one of the most common infectious processes but is also often over-treated. Inappropriate treatment rates vary between 17-26%1,2 and up to 52% in patients with indwelling urinary catheters3. Overtreatment can result in unnecessary medication side effects, the development of Clostridium difficile resistance4, colonization with drug-resistant organisms, and undue costs to the health system. Pharmacists can play and important role in optimizing drug therapy to include the recommendation to stop inappropriate antibiotics when their use is not indicated. Asymptomatic bacteriuria (ASB): the presence of bacteria in the urine without signs/symptoms of infection5 o McGeer Criteria often used to define infection, particularly in the long-term care setting6 Clinical (at least one of the following) Lab (at least one of the following) □ Acute dysuria □ Voided specimen: positive urine culture □ Acute pain, swelling, or tenderness of testes, (> 105 CFU/mL), no more than 2 epididymis, or prostate organisms □ Fever or leukocytosis with one of the following: □ Straight cath specimen: positive urine ○ Acute CVA pain or tenderness culture (> 105 CFU/mL), any number of ○ Suprapubic pain organisms ○ Gross hematuria ○ New or marked increase in incontinence ○ New or marked increase in urgency ○ New or marked increase in frequency □ Two of the preceding symptoms in the absence of fever or leukocytosis o ASB should only be treated in pregnant women and patients undergoing invasive urologic procedures5 o People with ASB also often have WBC in the urine (pyuria) but, in the absence of symptoms, this is not indicative of infection o Caused by: colonization of the bladder or contamination of the sample . -
The Links Between Microbiome and Uremic Toxins in Acute Kidney Injury: Beyond Gut Feeling—A Systematic Review
toxins Article The Links between Microbiome and Uremic Toxins in Acute Kidney Injury: Beyond Gut Feeling—A Systematic Review Alicja Rydzewska-Rosołowska 1,* , Natalia Sroka 1, Katarzyna Kakareko 1, Mariusz Rosołowski 2 , Edyta Zbroch 1 and Tomasz Hryszko 1 1 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; [email protected] (N.S.); [email protected] (K.K.); [email protected] (E.Z.); [email protected] (T.H.) 2 Department of Gastroenterology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland; [email protected] * Correspondence: [email protected] Received: 30 October 2020; Accepted: 9 December 2020; Published: 11 December 2020 Abstract: The last years have brought an abundance of data on the existence of a gut-kidney axis and the importance of microbiome in kidney injury. Data on kidney-gut crosstalk suggest the possibility that microbiota alter renal inflammation; we therefore aimed to answer questions about the role of microbiome and gut-derived toxins in acute kidney injury. PubMed and Cochrane Library were searched from inception to October 10, 2020 for relevant studies with an additional search performed on ClinicalTrials.gov. We identified 33 eligible articles and one ongoing trial (21 original studies and 12 reviews/commentaries), which were included in this systematic review. Experimental studies prove the existence of a kidney-gut axis, focusing on the role of gut-derived uremic toxins and providing concepts that modification of the microbiota composition may result in better AKI outcomes. Small interventional studies in animal models and in humans show promising results, therefore, microbiome-targeted therapy for AKI treatment might be a promising possibility. -
Pyelonephritis (Kidney Infection)
Pyelonephritis (Kidney Infection) Cathy E. Langston, DVM, DACVIM (Small Animal) BASIC INFORMATION urine collected from the bladder to be negative despite infection in the Description kidney. Abdominal x-rays and an ultrasound may be recommended. Bacterial infection of the kidney is termed pyelonephritis . Infection Although culture of a piece of kidney tissue obtained by biopsy may occur within kidney tissue or in the renal pelvis, the area of increases the chance of finding the infection, the invasiveness of the kidney where urine collects before being transported to the the procedure makes it too risky for general use (the biopsy would bladder. need to be taken from deeper within the kidney than the average Causes kidney biopsy). Contrast x-ray studies, such as an excretory uro- In most cases, a urinary tract infection starts in the bladder and gram (intravenous pyelogram), are sometimes helpful. An excre- the bacteria travel upstream to the kidney. Anything that decreases tory urogram involves taking a series of x-rays after a dye (that the free flow of urine, such as obstruction of the urethra (tube shows up white on x-rays) is given intravenously. Other tests may that carries urine from the bladder to the outside), bladder, ureter be recommended to rule out diseases that cause similar clinical (tube that carries urine from the kidney to the bladder), or kid- signs and other causes of kidney disease. ney, increases the risk that the infection will spread to the kid- ney. The presence of stones and growths in the bladder and kidney TREATMENT AND FOLLOW-UP also increases the risk. -
Urinary Tract Infections
Urinary Tract Infections www.kidney.org Did you know that... n Urinary tract infections (UTIs) are responsible for nearly 10 million doctor visits each year. n One in five women will have at least one UTI in her lifetime. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of this last group, 80 percent will have recurrences. n About 80 to 90 percent of UTIs are caused by a single type of bacteria. 2 NATIONAL KIDNEY FOUNDATION n UTIs can be treated effectively with medications called antibiotics. n People who get repeated UTIs may need additional tests to check for other health problems. n UTIs also may be called cystitis or a bladder infection. This brochure answers the questions most often asked about UTIs. If you have more questions, speak to your doctor. What is a urinary tract infection? A urinary tract infection is what happens when bacteria (germs) get into the urinary tract (the bladder) and multiply. The result is redness, swelling and pain in the urinary tract (see diagram). WWW.KIDNEY.ORG 3 Most UTIs stay in the bladder, the pouch-shaped organ where urine is stored before it passes out of the body. If a UTI is not treated promptly, the bacteria can travel up to the kidneys and cause a more serious type of infection, called pyelonephritis (pronounced pie-low-nef-right- iss). Pyelonephritis is an actual infection of the kidney, where urine is produced. This may result in fever and back pain. What causes a UTI? About 80 to 90 percent of UTIs are caused by a type of bacteria, called E. -
What Is Lupus Nephritis
What is lupus nephritis (LN)? Lupus nephritis (LN) is inflammation of the kidney that occurs as a common symptom of systemic lupus erythematosus (SLE), also known as lupus. Proteins in the immune system called antibodies damage important structures in the kidney. ⅱ Why are the kidneys important? To understand how lupus nephritis damages the kidney, it is important to understand how the kidneys work. The kidneys’ main function is to filter out excess waste and water from the blood through the urine. Kidneys also balance the salts and minerals circulating in the blood, help control blood pressure and make red blood cells. So, when the kidneys are damaged or fail, they can’t do their job as well. As a result, the kidneys are not able to filter out waste and water into the urine causing it to stay in the blood. What are the signs and symptoms of LN? Signs to ask the doctor about include blood in the urine or foamy urine which can mean that there is excess protein. Other signs to notice are swelling of legs, ankles, hands or tissue around the eyes as well as weight gain that can be caused by fluid the body isn’t getting rid of. ⅲ Symptoms of lupus nephritis also include high blood pressure, joint/muscle pain, high levels of waste (creatinine) in the blood, or impaired/failing kidney. ⅳ How common is LN? Lupus nephritis is the most common complication of lupus. Five out of 10 adults with lupus will have lupus nephritis, while eight out of 10 children with lupus will have kidney damage, which usually stems from lupus nephritis. -
Pyonephrosis in Paraplegia
PAPERS READ AT THE 1969 SCIENTIFIC MEETING 121 PYONEPHROSIS IN PARAPLEGIA By J. J. WALSH, M.D., F.R.C.S., M.R.C.P. THIS paper is a report on 32 cases of pyonephrosis treated personally and occurring as a complication of paraplegia or tetraplegia over a period of 17 years from 1950 to 1967. Seven further cases treated by colleagues during that time are not in cluded, so that the incidence would appear to be 39, in a total number of admissions of 3,4580r approximately I per cent. My reason for excluding the 7 cases was that time and circumstance did not allow correlation of information. The criterion for inclusion was the finding of frank pus under tension in the pelvis and calyces of one kidney due to ureteric obstruction. There was no case of simultaneous bilateral pyonephrosis due to this cause. Post-morten findings showing pus in both kidneys as a terminal event in fatal pyelonephritis were not included. Cases showing clear or cloudy urine under tension due to ureteric obstruction were also excluded. It was interesting that a few of the latter cases had longer probable periods of obstruction than one or two of the acceptable pyonephrosis, but had not in fact formed pus. Material. In all there were 32 cases of pyonephrosis 27 male and 5 female. Compared with an admission rate of approximately 23 per cent. of females this would appear to indicate a lower incidence in females but the numbers involved are I feel too small to be significant (Table I). TABLE I Material ! I Average time after onset Average probable period I of obstruction Average age I of spinal lesion 1 (years) (years) (2 excluded) I (days) i I Males 27 1 52.2 9"4 11·6 Females 5 29.2 4.8 7 i Total 32 1 38.8 8·7 II The age ranged from 19 to 65 the average being 38.8 years. -
| Oa Tai Ei Rama Telut Literatur
|OA TAI EI US009750245B2RAMA TELUT LITERATUR (12 ) United States Patent ( 10 ) Patent No. : US 9 ,750 ,245 B2 Lemire et al. ( 45 ) Date of Patent : Sep . 5 , 2017 ( 54 ) TOPICAL USE OF AN ANTIMICROBIAL 2003 /0225003 A1 * 12 / 2003 Ninkov . .. .. 514 / 23 FORMULATION 2009 /0258098 A 10 /2009 Rolling et al. 2009 /0269394 Al 10 /2009 Baker, Jr . et al . 2010 / 0034907 A1 * 2 / 2010 Daigle et al. 424 / 736 (71 ) Applicant : Laboratoire M2, Sherbrooke (CA ) 2010 /0137451 A1 * 6 / 2010 DeMarco et al. .. .. .. 514 / 705 2010 /0272818 Al 10 /2010 Franklin et al . (72 ) Inventors : Gaetan Lemire , Sherbrooke (CA ) ; 2011 / 0206790 AL 8 / 2011 Weiss Ulysse Desranleau Dandurand , 2011 /0223114 AL 9 / 2011 Chakrabortty et al . Sherbrooke (CA ) ; Sylvain Quessy , 2013 /0034618 A1 * 2 / 2013 Swenholt . .. .. 424 /665 Ste - Anne -de - Sorel (CA ) ; Ann Letellier , Massueville (CA ) FOREIGN PATENT DOCUMENTS ( 73 ) Assignee : LABORATOIRE M2, Sherbrooke, AU 2009235913 10 /2009 CA 2567333 12 / 2005 Quebec (CA ) EP 1178736 * 2 / 2004 A23K 1 / 16 WO WO0069277 11 /2000 ( * ) Notice : Subject to any disclaimer, the term of this WO WO 2009132343 10 / 2009 patent is extended or adjusted under 35 WO WO 2010010320 1 / 2010 U . S . C . 154 ( b ) by 37 days . (21 ) Appl. No. : 13 /790 ,911 OTHER PUBLICATIONS Definition of “ Subject ,” Oxford Dictionary - American English , (22 ) Filed : Mar. 8 , 2013 Accessed Dec . 6 , 2013 , pp . 1 - 2 . * Inouye et al , “ Combined Effect of Heat , Essential Oils and Salt on (65 ) Prior Publication Data the Fungicidal Activity against Trichophyton mentagrophytes in US 2014 /0256826 A1 Sep . 11, 2014 Foot Bath ,” Jpn . -
Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy
International Journal of Environmental Research and Public Health Article Risk of Renal Function Decline in Patients with Ketamine-Associated Uropathy Shih-Hsiang Ou 1,2,3, Ling-Ying Wu 4, Hsin-Yu Chen 1,2, Chien-Wei Huang 1,2, Chih-Yang Hsu 1,2, Chien-Liang Chen 1,2 , Kang-Ju Chou 1,2, Hua-Chang Fang 1,2 and Po-Tsang Lee 1,2,* 1 Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; [email protected] (S.-H.O.); [email protected] (H.-Y.C.); [email protected] (C.-W.H.); [email protected] (C.-Y.H.); [email protected] (C.-L.C.); [email protected] (K.-J.C.); [email protected] (H.-C.F.) 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan 3 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan 4 Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; [email protected] * Correspondence: [email protected]; Tel.: +886-7342-2121 (ext. 8090) Received: 8 August 2020; Accepted: 29 September 2020; Published: 4 October 2020 Abstract: Ketamine-associated diseases have been increasing with the rise in ketamine abuse. Ketamine-associated uropathy is one of the most common complications. We investigated the effects of ketamine-associated uropathy on renal health and determined predictors of renal function decline in chronic ketamine abusers. This retrospective cohort study analyzed 51 patients (22 with ketamine- associated hydronephrosis and 29 with ketamine cystitis) from Kaohsiung Veterans General Hospital in Taiwan.