Internal Medicine

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5). Management Inflammatory and serological markers Check erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP), antinuclear antibodies, anti-doublestranded DNA (dsDNA) antibodies and complement levels. The typical pattern of active lupus is a raised ESR with a low CRP, low levels of complement C3 and C4, antinuclear The managment of lupus is complex and depends on the precise clinical situation. Agents used for renal disease include steroids and cytotoxic drugs, principally azathioprine, mycophenolate mofetil and cyclophosphamide.

Also examine the patient for inguinal hernias (or evidence of previous repair) since these are associated with polycystic kidney disease. If asked whether you would like to extend your examination of the patient, say that you would want to check BP and perform fundoscopy looking for signs of end-organ hypertensive damage. The most likely finding is bilateral abdominal masses, in which case it is essential to have a logical technique for distinguishing between bilateral polycystic kidneys and hepatosplenomegaly.

Once the need for renal replacement therapy becomes clear, usually in the context of oliguria and worsening renal function, there is no point delaying its commencement until there is an emergency indication. • Always consider sepsis and set a low threshold for commencing broad-spectrum (non-nephrotoxic) antibiotics. • There is very little evidence that prognosis is altered by measures such as loop diuretics and dopamine, which increase urinary flow in people with normal kidneys. • Nutritional support is frequently required and should be commenced early in ARF.

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