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TheClinicalApproach


1. Make the DX
2. Assess Severity
3. Treat based on Severity
4. Follow patient's response.

7 Questions to bridge gap from textbook to clinical arena:
1. Diagnosis
2. Confirmation
3. Next Step
4. Mechanism
5. Risk Factors
6. Complications
7. Therapy

DDX Generator: http://www.wrongdiagnosis.com/k/kidney_disease/book-diseases-4a.htm
  1. V—Vascular diseases make one think of embolic glomerulonephritis, renal vein thrombosis, and SBE.
  2. I—Infectious causes of hematuria are pyelonephritis (infrequently) and renal tuberculosis.
  3. N—Neoplasms that may present with hematuria are hypernephromas and papillomas and carcinomas of the renal pelvis. Wilms tumors present with hematuria less frequently.
  4. D—Degenerative diseases rarely present with hematuria as in other organ systems.
  5. I—Intoxicants such as sulfa drugs (that lead to nephrocalcinosis), mercury poisoning, and blood transfusion reactions are common causes of hematuria, gross or microscopic.
  6. C—Congenital lesions such as polycystic kidneys and medullary sponge kidneys cause hematuria and predispose to stones and infections that may present with hematuria.
  7. A—Autoimmune conditions such as acute and chronic glomerulonephritis, Goodpasture disease, Wegener midline granulomatosis, and lupus erythematosus commonly present with hematuria.
  8. T—Trauma to any organ causes hemorrhages and the kidney is no exception. Hematuria after automobile or other accidents should signal the need for hospitalization, IVP, and close observation of vital signs. Hematuria may present with a crush injury to any muscle or a burn.
  9. E—Endocrine-metabolic diseases caused by stones. Most calcium stones are not caused by hyperparathyroidism, but it should always be considered a possibility. Urate stones are usually caused by gout and cystine stones are always associated with congenital cystinuria.




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