Manual of Clinical Nephrology by Rafiqul Alam
Manual of Clinical Nephrology by Rafiqul Alam
Manual of Clinical Nephrology by Rafiqul Alam
Manual o f
Clinical
Nephrology
Muhammad Rafiqul Alam
V
v
C B S D e d ic a te d to E d u ca tio n
CBS P u b lish e rs & D is trib u to rs Pvtua
Manual o f
Clinical
Nephrology
Muhammad Rafiqul Alam mbbs md fcps
Professor
D epartm ent o f Nephrology
B angabandhu Sheikh Mujib M ed ica l University (BSMMU)
Dhaka, Bangladesh
CBS
Matiur Rahman
Founder of nephrology discipline in Bangladesh
j Preface
1. Short Cases______________________________________________________ 1
Index 101
Short Cases,
Scenario
Scenario
Instruction: Examine the abdomen and relevant.
Inspection
• There is an oblique scar mark in the right iliac fossa
• Left brachiocephalic arteriovenous fistula with development of aneurysm
• Bruising over the A-V fistula
Palpation
There is a bean-shaped mass in right iliac fossa, surface is smooth, margin is ill defined,
no tenderness, no organomegaly, kidneys are not ballotable, no ascites, bowel sound
present and no added sound.
Q l. What are the relevants you want to see?
To assess graft function
• Anaemia
• Edema (other feature of fluid overload)
• A-V fistula: Whether it is active (prick mark) and functioning (thrill and bruit)
Differential Diagnosis
Most common:
• Immunosuppressive drugs particularly MMF induced
• CMV colitis
• Post-transplant lymphoproliferative disease (PTLD)
Other differentials:
• Bacterial infection: C. difficle, C. jejuni, E. coli
• Viral infection: Norovirus, adenovirus
• Fungal and parasitic: Microsporidia, Cryptosporidia, isospora belli, amoebiasis and
giardiasis, Strongyloides stercoralis
• Also, non-immunosuppressive medication should be considered.
> 500 m l/hr Give 50 ml less to the output D A/H S/N S/H S
*5% dextrose in aqua (DA) then 0.9% normal saline (NS) then 5% dextrose in aqua (DA) then 0.9% normal
saline (NS). HS: Hartmann’s solution
B POST-TRANSPLANT_____________________________________________________
Administering antimicrobial therapy to all at-risk patients immediately after
transplantation for a defined duration dependent on the perceived duration of risk
and net state of immunosuppression.
P ro p h y la x is R e g im e n C o m m e n ts
CMV Acyclovir, ganciclovir, or valganciclovir Acyclovir for HSP and VZV prophylaxis
for patients not on CMV prophylaxis