Episode 340: Rafael Medina Subspecialty Series – Headache & Blurry vision
Jun 18, 2024
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Rafael Medina, a nephrology specialist, and Dr. Jai Radhakrishnan discuss a case of a 28-year-old woman with headache and blurry vision. They explore the differential diagnosis, management of malignant hypertension, thrombotic microangiopathy, and the importance of urine analysis for early diagnosis.
Consider multiple differential diagnoses for headache and blurry vision based on patient history and symptoms.
Recommendations include blood pressure management, workup for secondary hypertension, and close monitoring for nephrology cases.
Utilize advanced diagnostic tests like urine analysis and renal biopsy to guide treatment decisions and differentiate between primary and secondary causes of glomerular diseases.
Reflect on the impact of chronic conditions on renal health, therapeutic decisions, and the complex diagnostic journey for patients with nephrological issues.
Deep dives
Introduction and Guest Introductions
The podcast episode begins by setting the context for an educational discussion, emphasizing medical advice disclaimer and the focus on nephrology. The two guests, Dr. O 'Jay and Maddie Abraham, introduce themselves, sharing their backgrounds, interests in internal medicine and nephrology, and personal hobbies like sports and martial arts.
Case Presentation: Chief Complaint Analysis
The case study features a 28-year-old female presenting with a chief complaint of headache and blurry vision. Delving into the differential diagnosis, the discussion navigates through possibilities like intracranial processes, malignant hypertension, and age-related vasculitis, highlighting the importance of considering the patient's history, symptoms, and risk factors.
Patient Medical History and Multiple Presentations
Further exploration reveals the patient's history of hypertension, PCOS, and recurrent UTIs. The symptoms of severe headache upon waking, associated with blurry vision and other manifestations, prompt considerations of past medical treatments, recurrent health issues, and their implications on the current presentation.
Initial Differential Diagnosis and Treatment Plan
The medical team contemplates differential diagnoses like malignant hypertension, secondary hypertension causes, and potential underlying conditions leading to the patient's symptoms and test results. Recommendations for blood pressure management, workup for secondary hypertension, and close monitoring are advised.
Advanced Diagnostics and Nephrology Workup
Advanced diagnostic tests, such as urine analysis, ultrasound, and laboratory investigations, including white blood cells, hemoglobin, platelets, and chemistry panel results, contribute to a comprehensive nephrology workup. Findings of proteinuria, RBCs, and key lab values guide discussions on primary glomerular diseases vs. secondary causes.
Final Diagnosis and Treatment Decisions
The renal biopsy confirms diffuse sclerosing glomerulonephritis with intense mesangial IgA staining, tubular atrophy, fibrosis, and arteriosclerosis. The distinct pathology pattern indicates a complex interplay of malignant hypertension, IgA nephropathy, chronic kidney disease progression, and adverse renal effects, leading to dialysis initiation and awaiting kidney transplant considerations.
Patient Outcome and Lessons Learned
The case concludes with reflections on the patient's ICU management, blood pressure control impact on hematologic parameters, indications for dialysis initiation, and the complex interplay of chronic conditions. Detailed insights shed light on the challenging diagnostic journey, therapeutic decisions, and long-term implications for the patient's renal health.
In this Nephrology Rafael Medina Subspecialty episode, Dr. Maddie Abrams presents a case to Dr. Jai Radhakrishnan of a 28 year old woman presenting with headache and blurry vision.
The goal of this session is to expand access to subspecialty, primary care, and internal medicine-adjacent specialty education to learners around the world. If you would like to get involved as a case presenter or discussant (or nominate an attending/educator), fill out the form HERE.
Case discussant: Dr. Jai Radhakrishnan is Professor of Medicine at Columbia University Medical Center in New York. He is the Director of Clinical Services of the Nephrology Division and co-director of the hypertension center of Columbia University. @jradnephro
Case presenter: Dr. Maddie Abrams is an Internal Medicine PGY-2 & an aspiring cardiologist at ColumbiaMedat NewYork-Presbyterian Hospital. She graduated from Zucker School of Medicine in 2022. @Maddie_Abrams
