Chronic kidney disease: proteinuria Proteinuria is an important marker of chronic kidney disease, especially for diabetic nephropathy. NICE recommend using the albumin:creatinine ratio (ACR) in preference to the protein:creatinine ratio (PCR) when identifying patients with proteinuria as it has greater …
Acute renal failure: acute tubular necrosis vs. Prerenal uraemia Prerenal uraemia – kidneys hold on to sodium to preserve volume Pre-renal uraemia Acute tubular necrosis Urine sodium < 20 mmol/L > 30 mmol/L Fractional sodium excretion* < 1% > 1% …
Glycosylated haemoglobin Glycosylated haemoglobin (HbA1c) is the most widely used measure of long-term glycaemic control in diabetes mellitus. HbA1c is produced by the glycosylation of haemoglobin at a rate proportional to the glucose concentration. The level of HbA1c therefore is …
The high incidence of parathyroid tumours and hypercalcaemia make serum calcium a useful indicator of MEN type 1 in suspected individuals Multiple endocrine neoplasia The table below summarises the three main types of multiple endocrine neoplasia (MEN) MEN type I …
Haemochromatosis: features Haemochromatosis is an autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. It is caused by inheritance of mutations in the HFE gene on both copies of chromosome 6*. It is often asymptomatic in early …
Thyroid function tests The interpretation of thyroid function tests is usually straightforward: TSH Free T4 Thyrotoxicosis (e.g. Graves’ disease) Low High In T3 thyrotoxicosis the free T4 will be normal Primary hypothyroidism (primary atrophic hypothyroidism) High Low Secondary hypothyroidism Low …
Multiple endocrine neoplasia The table below summarises the three main types of multiple endocrine neoplasia (MEN) MEN type I MEN type IIa MEN type IIb Mnemonic ‘three P’s’: parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia pituitary (70%) pancreas (50%, e.g. …
This patient has proliferative diabetic retinopathy and urgent referral to an ophthalmologist for panretinal photocoagulation is indicated Diabetic retinopathy Diabetic retinopathy is the most common cause of blindness in adults aged 35-65 years-old. Hyperglycaemia is thought to cause increased retinal …
Haemochromatosis: features Haemochromatosis is an autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. It is caused by inheritance of mutations in the HFE gene on both copies of chromosome 6*. It is often asymptomatic in early …
Long-term corticosteroid use is linked to osteopaenia and osteoporosis, rather than osteomalacia. Corticosteroids Corticosteroids are amongst the most commonly prescribed therapies in clinical practice. They are used both systemically (oral or intravenous) or locally (skin creams, inhalers, eye drops, intra- …