00:01
So that's vascular disease,
let's move on to another case.
00:05
So you're asked to see a 62-year-old woman who was
admitted with nausea, fatigue, lethargy and hemoptysis.
00:12
Her physical exam is remarkable for hypertension,
she's 160/98 (mmHg) on her blood pressure result.
00:18
Her imaging shows a chest x-ray
demonstrating bilateral interstitial infiltrates
and on her laboratory data her serum
creatinine is elevated to 3.6 (mg/dL)
so we can see that that's quite high.
00:31
And her urine analysis
shows proteinuria on dipstick
and on microscopy she has
dysmorphic red blood cells
That means those red blood cells look
very funny underneath the microscope,
the membrane is getting
deformed; and red blood cell cast.
00:46
So the question is, what type of acute
kidney injury does this woman have?
Let's go through the history and
let's see if we can figure this out.
00:54
So importantly on the actual history,
this patient is coming in with hemoptysis
and taken together with her renal
failure, her hematuria and proteinuria,
highly suggestive of nephritic syndrome.
01:09
The other thing I think that's very
important is her imaging results.
01:13
She's got bilateral
interstitial infiltrates.
01:16
That again along with renal failure, very suggestive
of what we call a pulmonary renal syndrome
which are seen on glomerular
diseases and nephritic syndromes.
01:26
And finally, just that we've
been talking about, that hematuria
with specifically funny red blood cells or
dysmorphic-shaped red blood cells seen on microscopy
along with those red blood
cell casts and proteinuria,
really clinches that diagnosis that
this woman has nephritic syndrome
and in this particular case, she
actually has microscopic polyangiitis.