NRE Step 1: Renal Made Simple – Pass with Precision

Kidney Problems

• Nephrotic Syndrome:
  • Lots of protein in pee (more than 3.5 grams a day).
  • Low protein in blood.
  • Swelling, especially around the eyes.
  • High fats in blood.
  • Higher chance of blood clots.
  • Can be caused by some infections or diseases.
  • One type is called Minimal Change Disease, where the kidney looks normal but has problems.
  • Another type is Focal Segmental Glomerulosclerosis.
  • Membranous Nephropathy is another type, where the kidney tissue looks “spiky.”
  • Kidney problems can also happen with long-term diabetes, causing Kimmelstiel nodules.
• Nephritic Syndrome:
  • Less protein in pee (less than 3.5 grams a day).
  • High blood pressure.
  • Peeing less.
  • Blood in pee (dark urine).
  • Can happen 2-3 weeks after a sore throat infection.
• Vasculitis: Swelling of blood vessels that can hurt kidneys and lungs.
  • Wegener’s: Affects kidneys, lungs, and sinuses.
  • Microscopic Polyangiitis: Affects kidneys and lungs.
  • Churg-Strauss Syndrome: Affects kidneys, lungs, and causes asthma.
• Anti-GBM Disease (Goodpasture Syndrome):
  • Antibodies attack kidneys and lungs.
  • Causes blood in pee and coughing up blood.
  • Treated with plasma exchange.
• Alport Syndrome: Inherited problem with collagen, leading to kidney disease, hearing loss, and eye problems.
• Polycystic Kidney Disease (PKD):
  • Many cysts (fluid-filled sacs) in the kidneys.
  • AR PKD: Starts in childhood, rare, often serious.
  • AD PKD: Starts in adulthood, common, usually not as serious.
  • Can cause high blood pressure and cysts in the liver.
  • Can be linked to brain aneurysms.
• Hydronephrosis: Swelling of the kidney because pee can’t get out.
  • Can be caused by blockage in the bladder or an enlarged prostate.
• Renal Tubular Acidosis (RTA): Kidney has trouble balancing acids in the body.
  • RTA Type 1: Urine pH is high. Can cause kidney stones and soft bones.
• Acute Kidney Injury (AKI): Kidneys suddenly stop working well (GFR changes in less than 3 months).
• Chronic Kidney Failure: Kidneys stop working well for a long time (GFR changes for more than 3 months).
  • Causes: High blood pressure, swelling.
  • Can cause heart problems (uremic pericarditis) and bone problems.
  • Can cause low red blood cells (anemia).
  • Treated with medicines, or dialysis, or a kidney transplant.

Other Important Stuff

• Acid-Base Balance (ABGs):
  • Tells if your blood is too acidic or too basic.
  • Normal pH is 7.35-7.45.
• Electrolyte Imbalance (Potassium and Calcium):
  • High Potassium: Can make heart waves look tall.
  • Low Potassium: Can cause a special “U” wave on heart tests.
  • High Calcium: Can make heart beats shorter.
  • Low Calcium: Can make heart beats longer.
• Diuretics (Water Pills): Make you pee more.
  • Some can cause hearing problems.
  • Some can keep calcium in the body.
  • Some can cause male breast growth.

Head Injuries

• Glasgow Coma Scale (GCS): A way to check how awake and responsive someone is after a head injury.
  • Eyes: How they open their eyes (4 = open on their own, 1 = no response).
  • Verbal: How they talk (5 = normal, 1 = no sound).
  • Motor: How they move (6 = obeys commands, 1 = no movement).
• Epidural Hematoma: Blood clot on top of the brain’s covering.
  • Often from a specific blood vessel (MMA).
  • Person might seem fine at first, then get worse.
  • Looks like a round shape on a scan.
• Subdural Hematoma: Blood clot under the brain’s covering.
  • From small veins.
  • Looks like a curved shape on a scan.
  • Can be linked to drinking alcohol.
  • Treated with a medicine called Nimoodipine.

Neck Lumps

• Lymphadenitis: Swollen lymph nodes, often from infection.
• Dermoid Cyst: A lump you are born with, usually in the middle or upper part of the neck.
  • Needs surgery to remove.
• Sebaceous Cyst: A lump filled with pus or other oily stuff.
• Lipoma: A fatty lump.
  • Can be painful.
  • Can be linked to Hashimoto’s thyroiditis (a thyroid problem).
• Thyroglossal Duct Cyst: A lump in the middle of the neck that moves when you stick out your tongue.
• Ectopic Thyroid: Thyroid tissue in the wrong place, like under the tongue.
• Thyroid Cancer:
  • Papillary CA: Most common type (70-80%).
    • Can be caused by radiation as a child.
    • Spreads through lymph nodes.
    • Good outcome.
  • Follicular CA:
    • Common in people aged 40-60.
    • Spreads through blood.
    • Good outcome if found early.
  • Medullary CA:
    • Has a special marker called Calcitonin.
    • Can cause muscle spasms.
  • Anaplastic CA:
    • Very serious, poor outcome.
    • Rare, usually in people over 60.
• Thyroid Scan: If a lump doesn’t absorb much radioactive iodine (less than 20% after 24 hours), it might be cancer and needs a biopsy.
• Thyroid Surgery Problems:
  • Hematoma: Blood swelling that can make it hard to breathe.
  • Hoarseness: Rough voice from nerve damage.
  • Parathyroid removed: Can cause problems with calcium.

Breast Lumps

• Location: Often in the upper, outer part of the breast.
• Risk Factors: Older age, family history (BRCA1, BRCA2 genes), lots of estrogen, drinking alcohol.
• Alarming Signs: Breasts look different, fluid from breast, new lump, dimpled skin.
• Types of Lumps/Issues:
  • Fibroadenoma: Common in young women (15-35 years old).
    • Soft, not painful, can move around.
    • Not cancer.
    • Found with ultrasound.
  • Phyllodes Tumor: A lump with a “leaf-like” shape.
  • Mastitis: Breast discharge, fever, chills.
  • Abscess: A pocket of pus.
  • Paget Disease: Affects the nipple.
  • Fat Necrosis: Breast tissue dies after an injury.
  • Invasive Ductal CA: A type of breast cancer.
• Gynecomastia: Enlarged male breast tissue.
  • Can be caused by liver problems, Klinefelter syndrome, testicular tumors, or some medicines.