Photo Quiz 7

What is this finding in a case of CKD? How will you manage this condition?

Answer:

1. This is an aneurysm in the AV Fistula which was made for hemodialysis. You can see the scar of the surgery in the typical site of a radiocephalic fistula. True aneurysms occur very commonly in native fistulas and generally cause no problems. Surgical intervention is required only if the aneurysms compromises the arterial anastomosis or shows rapid expansion raising a danger of dissection or rupture.
2. The reported incidence of this complication is around 5-6%.
3. Procedures which have been described in treating this condition are:

•  Surgical excision of the aneurysm with restoration of the continuity of the artery.
• Stapling across the aneurysm.
• Excising the excess wall and preserving the fistula.
• Excising the aneurysm and creating a new AVF

The last 2 procedures keeps the AVF intact.

Photo Quiz 6

What is this NCCT finding in a patient with recurrent UTI since childhood and CKD? What are the other associated renal anomalies that can be seen in this condition?

Answer:

1. NCCT KUB films showing a atrophic left kidney (A) with a calculi in the upper pole, and duplex right kidney with partial duplication of the right ureter till the upper third (D) with hydroureteronephrosis.
2. Associated anomalies seen are renal dysplasia, ureteral obstruction, VUR, ectopic ureter and ureterocele. Complete double ureters are commonly associated with vesicoureteral reflux due to their ectopic opening into the urinary bladder or the ureterocele

Weekly Photo quiz 5

This 23 year old male patient with a very strong family history of renal disease, What is this finding? What is the abnormality in this condition? Waht are the inheritance patterns?

Answer:
1. This is a finding seen in a case with keratoconus. Known as MUNSONs sign, it is observed as a indentation in the lower eyelid produced by the keratoconus when the patient looks downwards.
2. The basic diagnosis is Alport syndrome.
3. Most common inheritence pattern of Alport syndrome is X-linked. However, there are autosomal recessive and Autosomal dominant forms as well.

Photo Quiz 4

52 year old female patient with CKD on Dialysis for 3 years presented with this finding.

What is it?

What is the Pathogenesis of this condition?

Answer:

HALF AND HALF NAIL

          Half and half nail (Lindsay nail) is usually diagnosed in patients with chronic renal disease. This disorder was reported first by Bean in 1963. The typical picture of half and half nail includes red, pink, or brown transverse distal bands occupying 20-60% of the total nail length with the remaining proximal portion exhibiting a dull whitish ground glass appearance.

            The estimated frequency of this change varies from 20-50% in patients with chronic renal disease. There is no correlation between the severity of renal disease and the depth of the distal color band. This disorder usually remains unchanged even after undergoing hemodialysis, but it may disappear after successful kidney transplantation.

           The pathogenesis of this condition is unknown. Stimulation of nail melanocytes by high levels of melanotrophic  hormone has been postulated and high levels of this hormone have been documented in patients with CKD in dialysis.

Photo Quiz 3

35 year old male had sustained a leg injury followed by development of a large ulcer over the accident site with high grade fever and acute renal failure.
What is the skin condition in the picture?
What is the probable organism responsible for it?



Answer:
Ecthyma Gangrenosum
       Ecthyma gangrenosum (EG) is a well-recognized but uncommon cutaneous infection most often associated with a Pseudomonas aeruginosa bacteremia. EG usually occurs in patients who are critically ill and immunocompromised and is almost always a sign of pseudomonal sepsis. The characteristic lesions of EG are hemorrhagic pustules or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers surrounded by erythema.
      This patient had grown Pseudomonas from his blood cs and he expired after 2 days of admission due to reractory septic shock.

Photo Quiz 2

8 year old male patient with h/o recurrent UTI since childhood was investigated and the following findin was documented. What is the study? What are the findings? what is the probable diagnosis?

This is a MCUG. It shows gross VUR into the left kidney with non-visualization of the right kidney. The Urinary baldder shows trabeculations due to the chronic obstruction and the posterior urethra is dilated. The DTPA scan showed two kidney with grossly reduced GFR. Cystoscopy was done which showed PUV. The child has already developed severe growth retardation and CKD

Photo Quiz 1

50 year old female with h/o Raynaud's phenomenon, dysphagia and exertional dyspnea presented with this finding. What is the finding? and what is the diagnosis?

ANSWER: Case of systemic sclerosis with calcinosis cutis