IgA Nephropathy Pathogenesis, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagno скачать в хорошем качестве

IgA Nephropathy Pathogenesis, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagno

A 73-year-old man with a complex past medical history, including membranous nephropathy, presents during a severe ice storm with new-onset dark urine, ankle swelling, profound bradycardia, and uncontrolled hypertension in a resource-limited hospital setting. How would you approach this acute nephrology case when essential labs and transport are delayed? What clinical findings and available resources should guide your immediate management decisions? VIDEO INFO Category: IgA Nephropathy Pathogenesis, Immunoglobulin A (IgA) Nephropathy, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Moderate - Intermediate level - Requires solid foundational knowledge Question Type: Legal Pitfalls Case Type: Resource Limited Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 73-year-old man with a history of membranous nephropathy diagnosed by renal biopsy 6 years ago, chronic otitis media with hearing loss, scoliosis, remote hookworm and giardiasis infections, and parvovirus B19 infection in adulthood presents to a critical access hospital in a mountain town with 3 days of dark urine and new ankle swelling. He reports a vegetarian diet.... OPTIONS A. Document shared decision-making and guideline-concordant foundational therapy now: start lisinopril 10 mg by mouth daily (plan to uptitrate as tolerated), add dapagliflozin 10 mg by mouth daily, restrict dietary sodium, arrange same-day tele-nephrology consultation, and defer disease-modifying ag... B. Initiate iptacopan 200 mg by mouth twice daily immediately without meningococcal and other required vaccinations or counseling, and without documenting risks, benefits, and REMS obligations in the chart. C. Begin high-dose prednisone 1 mg/kg/day in the ED without infection screening or gastroprotection, omit discussion of adverse effects, and plan to backfill documentation after transfer is possible. D. Order urgent ground transfer despite closed mountain passes and grounded aircraft, give a heparin infusion for hematuria, and withhold all antihypertensives until he reaches a tertiary center tomorrow. CORRECT ANSWER A. Document shared decision-making and guideline-concordant foundational therapy now: start lisinopril 10 mg by mouth daily (plan to uptitrate as tolerated), add dapagliflozin 10 mg by mouth daily, restrict dietary sodium, arrange same-day tele-nephrology consultation, and defer disease-modifying agents that require pre-vaccination or full serologic screening until vaccines and labs are available after the storm. EXPLANATION "Document shared decision-making and guideline-concordant foundational therapy now: start lisinopril 10 mg by mouth daily (plan to uptitrate as tolerated), add dapagliflozin 10 mg by mouth daily, restrict dietary sodium, arrange same-day tele-nephrology consultation, and defer disease-modifying agents that require pre-vaccination or full serologic screening until vaccines and labs are available after the storm." This is correct because, in a resource-limited emergency with delayed transfer, the safest, guideline-concordant action is to initiate foundational therapy that reduces proteinuria and slows progression (RAS blockade, sodium restriction, and an SGLT2 inhibitor at eligible eGFR) with contemporaneous documentation of shared decision-making. Tele-nephrology ensures specialist input despite closures.... Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------