Nephrolithiasis (Kidney Stones): Evaluation and Management

Chronic Kidney Disease (CKD): Diagnosis and Management

Define CKD as reduced eGFR below 60 mL/min/1.73 m2 or markers of kidney damage such as albuminuria persisting beyond 3 months, and stage it by eGFR and albuminuria category. Control blood pressure, targeting roughly below 130/80 mmHg, using an ACE inhibitor or ARB when albuminuria is present. Add an SGLT2 inhibitor for diabetic CKD with albuminuria, prescribe a statin for cardiovascular risk, and adjust doses of renally cleared drugs. Avoid nephrotoxins including NSAIDs and unchecked contrast exposure. Refer to nephrology when eGFR falls below 30, declines rapidly, or when refractory hyperkalemia, acidosis, or anemia emerges, and vaccinate against hepatitis B, influenza, and pneumococcus.

Urosepsis: Diagnosis and Management

Urosepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection originating from the urinary tract. It represents a severe systemic inflammatory response syndrome (SIRS) triggered by a urinary tract infection (UTI). Treatment involves immediate initiation of broad-spectrum intravenous antibiotics, empirically selected to cover common uropathogens, and subsequently narrowed based on culture sensitivities. Aggressive supportive care, including intravenous fluid resuscitation to correct hypotension, and vasopressors if needed, is crucial to maintain organ perfusion. Source control, such as removal of an obstructed catheter or drainage of a collection, is also a critical component of management. Patients commonly present with signs of systemic infection, including high fever, chills, tachycardia, and hypotension. They may also exhibit symptoms related to the urinary source, such as dysuria, flank pain, urgency, or suprapubic tenderness. Signs of organ dysfunction like altered mental status, oliguria, tachypnea, or mottled skin may also be present, indicating severe sepsis or septic shock.

Systemic Lupus Erythematosus (SLE): Diagnosis and Management

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease characterized by widespread inflammation and tissue damage, as the immune system mistakenly attacks its own healthy tissues and organs. It can affect nearly any part of the body, including joints, skin, kidneys, brain, heart, and lungs. Treatment for SLE aims to control symptoms, reduce inflammation, prevent organ damage, and minimize flare-ups. This typically involves corticosteroids for acute flares, antimalarials (e.g., hydroxychloroquine) for long-term disease control, and immunosuppressants (e.g., methotrexate, azathioprine, mycophenolate mofetil) for moderate to severe disease. Biologic agents (e.g., belimumab, anifrolumab) are also used for targeted immunomodulation. SLE presents with a diverse range of symptoms due to multi-organ involvement. Common manifestations include joint pain and swelling (arthritis/arthralgia), a characteristic butterfly-shaped malar rash, photosensitivity, oral ulcers, and profound fatigue. More severe features can include lupus nephritis (kidney inflammation), neurological issues (seizures, psychosis), serositis (inflammation of lining of lungs or heart), and hematologic abnormalities (anemia, leukopenia, thrombocytopenia).