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Nephrotic vs Nephritic syndromes - Spectrum of Glomerular Diseases #Nephritic #Nephrotic #Syndromes #Spectrum #Classification #Glomerular #Diseases #Nephrology #Diagnosis ** GrepMed Recommended Text: Davidson's Essentials of Medicine - https://amzn.to/3byD97p

Nephrotic Syndrome - Classification - Podocytopathies - Immunocomplex Deposits - Other substances Deposits #Nephrotic #Syndrome #Classification #Differential #Diagnosis #Nephrology #Algorithm

Nephrotic Syndrome - Primary vs Secodary - Differential Diagnosis Algorithm #Nephrotic #Syndrome #Differential #Diagnosis #Algorithm #Primary #Secondary #Nephrology #Causes

Causes of Thrombocytosis - Differential Diagnosis Algorithm Spurious: • Artifact (redo CBC) Autonomous: • Essential thrombocytosis • Polycythemia Vera • Chronic Myelogenous Leukemia • Primary Myelofibrosis Infectious: • Acute or Chronic Inflammatory: • IBD • Rheumatic disorders • Celiac disease Tissue Damage: • Post-op surgery • Trauma • Burns Non malignant hematologic conditions: • Rebound effect following treatment of ITP • Rebound effect following EtOH induced thrombocytopenia Other: • Post-splenectomy or hyposplenic states • Non-hematologic malignancy • Iron deficiency anemia #Thrombocytosis #Differential #Diagnosis #Algorithm #Causes #Hematology

Causes of Ascites - Differential Diagnosis Algorithm Portal Hypertension - Prehepatic: • Portal vein thrombosis • Splenic vein thrombosis • Extrinsic compression • Splanchnic arteriovenous fistula Portal Hypertension - Hepatic: • Cirrhosis • Schistosomiasis • Infiltrative disease • Acute liver failure • Primary biliary cholangitis • Primary sclerosing cholangitis • Idiopathic portal hypertension • Sinusoidal obstruction syndrome Portal Hypertension - Post-Hepatic: • Heart failure • Constrictive pericarditis • Budd-Chiari syndrome • Inferior vena cava obstruction Non-portal Hypertension - Protein-poor: • Nephrotic syndrome • Malnutrition • Protein-losing enteropathy Non-portal Hypertension - Protein-rich: • Malignancy • Pancreatitis • Tuberculosis • Hemoperitoneum • Chylous ascites • Myxedema • Perforated viscus Dr. André Mansoor @AndreMansoor - Author of Frameworks for Internal Medicine https://amzn.to/2LmUODZ #Ascites #Differential #Diagnosis #Algorithm #Hepatology #causes

Ascites - Diagnosis and Management Summary Paracentesis studies: cell count + differential, albumin, protein, culture • Serum-ascites-albumin-gradient (SAAG): > 1.1 g/dL suggests portal hypertensive source • SBP: PMN count (WBC x PMN%) > 250 cells • Secondary Peritonitis: 2+ of following: protein > 1g/dL, glucose < 50mg/dL, LDH > ULN • Protein: level < 1-1.5g/dL suggests higher SBP risk. If > 2.5 g/dL, consider cardiac ascites 1) Sodium restriction <2g (88mmol) Na per day Not recommended to restrict Na intake more than above as this may lead to reduced overall caloric intake 2) Diuretic therapy Initial: spironolactone +/- furosemide Ratio: 100:40 (maintains K+ balance) Titrate: q3-5 days at start Diuretic resistance: inadequate diuresis at max doses Diuretic intolerance: limited by side effects ( severe AKI or ↓Na+) 3) Large-volume paracentesis Consider in: Large, tense ascites, Diuretic-resistance/intolerance Administer albumin to ↓ PPCD: • If LVP > 5L: 25% albumin, 6-8g/L removed • If AKI/CKD: give regardless of amount removed 4) TIPS - Consider in carefully selected patients with diuretic resistance/intolerance Compared to LVP: ↑ Control of ascites, ↑Risk of encephalopathy, ? Impact on survival depends on appropriate patient selection 5) Other • Midodrine: can increase response in diuretic-resistant • Medications to avoid: NSAIDs, ACE inhibitors, Angiotensin receptor blocker (ARBs), ? Beta-blockers (in ascites w/ ↓ BP) - Dr. Hersh Shroff @HershShroff #Ascites #Diagnosis #Management #Summary #Hepatology #SAAG #paracentesis