Kidney - hypertension

- stones
Normal function
Congenital abnormalities
- clean waste material form the
blood - malformed or absent kidneys
- retain and excrete water and
Hereditary abnormalities
salt
- regulate blood pressure - polycystic kidney
- stimulate bone marrow for - alports disease
blood
- control calcium and
phosphorus absorption and
excretion

Signs and symptoms or RD

- proteinuria/ hematonuria
- low back pain
- fluid retention
- fatigue
- hypertension
- bone disease

Types and causes

- congenital deformities
- systemic diseases
- hereditary impairments
- toxin
- infection
- nephritis
Rheumatology - Extra-articular manifestations

History Important in physical exams

- determine location of pain - Signs of inflammatory

and pathophysio o Synovial hypertrophy
- risk factors o Joint effusions
o genetics o Joint tenderness
o obesity o Erythema and warmth
o occupation o Limited rom
o age and gender o Pain with motion
- differentiate inflammatory vs - Signs of degenerative
non-inflammatory vs o Boney overgrowth
arthralgia o Crepitus in active and
passive motion
Look for the following (PSSLoMWF)
o Joint deformity
- pain o Limited range of motion
- swelling
Rheumatoid arthritis
- stiffness
- loss of motion - Chronic systemic
- weakness inflammation
- fatigue - Unknown cause
- Hla-dr4 (60%)
Observe the following (ONSDDE)
- Autoimmune reaction
- Onset, duration, temporal triggered by
pattern o Extra-articular chenes
- Number of involvement o Synovial hypertrophy
- Symmetry of involvement o Chronic joint
- Distribution of affectation inflammation
- Distinct muscle involvement - Common triggers (SIT)
 o Smoking
o Infection
o Trauma
- 35-50 yo; F>M
2010 eular diagnostic criteria
- joint involvement
- serology test result
- acute phase reactant
- self-report duration
- Definitive RA >6points
Joint involvement
- 1 L joint: 0 pt
- 2-10 l joint: 1 pts
- 1-3 s joints: 2 points
- 4-10 s joints: 3 pts
- >10 joints: 5 pts
Serology test
- Negative rheumatoid factor
and anti-citullinated protein
antibody 0 point
- Low RF and ACPA 2 points
- High RF or ACPA 3 points
Acute phase reactants
- Normal CRP and ESR 0
point
- Abnormal CRP and ESR 1
point
Patients self-report
- <6 weeks 0 point
- >6 weeks 1 point
Stages of RA
- Stage 1: no destructive
change on xray; osteoporosis
is possible
- Stage 2: slight arti damage;
periarticular osteo; no joint
deformities
- Stage 3: joint deformities;
bone and cartilage damage
- Stage 4: ankylosis
Functional status of RA
- Class 1: usual adls
- Class 2: self-care and
vocationals activities
- Class 3: self care but limited
to vocational and avocational
- Class 4: limited to all
RA assessment
- pain
- swelling
 - stiffness
- deformity
- limited rom
- rheuma nodules
- extra-articular

Extra-articular manifestations

- MI; pericardial effusion

- Pleural effusion
- Vasculitis
- Anemia
- Nerve enlargement
- Keratoconjunctivitis sclera

Comlications (IGOSFE)

- Infections
- GI problems
- Osteop
- Sjorgen syndrome
- Felty syndrome

Has medications

-nsaids, dmards, corticosteroids,

immune suppressants