Thread by @Jithukurian6

🔥 Let’s discuss an interesting case . Already discussed in #ECNeph . Trying to consolidate it.

🏥 I was called in for a nephrology consult for a patient admitted under pulmonology 🫁

🩸 Microscopic hematuria ++

🧠 What do we think in a patient with hemoptysis?

🫘 The nephrologist brain in me thought it narrower. The first hit

🧪 what does the lab has to say ?

Numerous 🩸red blood cells in urine and pulmonary haemorrhage .

💡I was sure i hit the right diagnosis 🎯

📺 how can a nephrologist proceed without an Ultrasound kidney

✅Nothing significant

🫘 Now its nephrology time to crack the case .

🛏️ Patient got re admitted

💦 oliguric renal failure

✌️ What is the clinical diagnosis ?

🚨🚨 PR3 ANCA , MPO ANCA Anti GBM - Negative, C3 - Normal

🟢 I told it could still be ANCA negative Paucimmune crescentic GN with pulmonary haemorrhage

❓What next ? Seeing is believing

💊 Empirical steroids

🔫 renal biopsy report 😳😳

😨 quite unexpected

🚨 when things don’t go the way you think its not a bad idea to go back to the patient and the previous reports

🤯 Rechecking the reports

🎯🎯 We got down to the diagnosis at the end ✌️✌️

🧐🧐 but there is a problem 🚨

🌞 We went ahead with CT Angio —> the CT revelation 👌

📈Let’s see how the disease progressed 🔴🔴

🔖 what’s the status of the patient ?

🌞 what could be the reason for renal vein thrombosis ?

🔃 when in doubt get back to the patient and old reports

💡 atypical cells within the lung biopsy —> slide sent for IHC

🚨🚨 The suspected trouble maker

🥇 The final diagnosis

🧭 Approach to rapidly progressive renal failure

🩸 Never forget the vascular cause of RPRF

🚨 RPRF with normal renal biopsy

🩸 Causes and symptoms of RVT

📌 evaluation and treatment of Renal vein thrombosis

⚠️ Do we neglect renal cysts ?

📌 The CT classification of cysts and the chances of them being problematic