{"version":"1.0.0","segments":[{"startTime":1.543,"endTime":3.346,"body":"♪ (music) ♪"},{"startTime":3.346,"endTime":5.758,"body":"(Cathy) Hi, welcome"},{"startTime":3.346,"endTime":5.758,"body":"to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e"},{"startTime":5.758,"endTime":8.641,"body":"where we discuss important concepts"},{"startTime":5.758,"endTime":8.641,"body":"in internal medicine."},{"startTime":8.641,"endTime":11.058,"body":"- I'm Cathy Handy."},{"startTime":8.641,"endTime":11.058,"body":"- (Charlie) And I'm Charlie Wiener,"},{"startTime":11.058,"endTime":13.973,"body":"and we're coming to you"},{"startTime":11.058,"endTime":13.973,"body":"from the Johns Hopkins School of Medicine."},{"startTime":13.973,"endTime":15.233,"body":"♪ (music) ♪"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":17.542,"endTime":21.005,"body":"A 75-Year-Old"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":17.542,"endTime":21.005,"body":"with Abdominal Pain and Nausea."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":21.005,"endTime":22.518,"body":"(Charlie) Okay, here's the question."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":22.518,"endTime":26.31,"body":"A 75-year-old man underwent"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":22.518,"endTime":26.31,"body":"diagnostic coronary angiography"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":26.31,"endTime":28.256,"body":"after an abnormal stress test."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":28.256,"endTime":31.633,"body":"Arterial access was obtained easily"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":28.256,"endTime":31.633,"body":"in the right femoral artery,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":31.633,"endTime":36.11,"body":"and the angiography was completed"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":31.633,"endTime":36.11,"body":"with 35 mL of contrast dye."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":36.11,"endTime":40.203,"body":"Fortunately, while he did have"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":36.11,"endTime":40.203,"body":"diffuse mild atherosclerosis,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":40.203,"endTime":43.162,"body":"there were no significant"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":40.203,"endTime":43.162,"body":"coronary stenoses identified"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":43.162,"endTime":45.996,"body":"and none that required intervention."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":45.996,"endTime":47.6,"body":"Now, seven days later,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":47.6,"endTime":49.327,"body":"the man presents"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":47.6,"endTime":49.327,"body":"to the emergency department"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":49.327,"endTime":52.842,"body":"with abdominal pain and nausea"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":49.327,"endTime":52.842,"body":"over the past couple of days."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":52.842,"endTime":56.86,"body":"He's reported also that his urine output"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":52.842,"endTime":56.86,"body":"has been dropping off."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":56.86,"endTime":61.798,"body":"Physical examination reveals"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":56.86,"endTime":61.798,"body":"a slight fever of 38.3°C"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":61.798,"endTime":64.089,"body":"and otherwise normal vital signs."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":64.089,"endTime":66.095,"body":"His lungs and his heart are normal,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":66.095,"endTime":70.933,"body":"but his skin exam shows livedo reticularis"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":66.095,"endTime":70.933,"body":"on his lower extremities."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":70.933,"endTime":75.633,"body":"His laboratories are notable"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":70.933,"endTime":75.633,"body":"for a creatinine of 2.7 mg/dL,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":75.633,"endTime":80.03,"body":"and notably, it was previously 1.1"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":75.633,"endTime":80.03,"body":"prior to the procedure."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":80.03,"endTime":84.977,"body":"His white blood cell count is 10,500,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":80.03,"endTime":84.977,"body":"with 21% eosinophils"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":84.977,"endTime":89.185,"body":"and an erythrocyte"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":84.977,"endTime":89.185,"body":"sedimentation rate is 92 mm/h."},{"speaker":"(Cathy) Welcome to Episode 45","startTime":89.185,"endTime":92.683,"body":"The question's going to ask,"},{"speaker":"(Cathy) Welcome to Episode 45","startTime":89.185,"endTime":92.683,"body":"\"What is the most likely diagnosis?\""},{"speaker":"And the options are","startTime":94.476,"endTime":97.27,"body":"A. acute interstitial nephritis;"},{"speaker":"And the options are","startTime":97.27,"endTime":100.409,"body":"B. atheroembolic renal disease;"},{"speaker":"And the options are","startTime":100.409,"endTime":103.092,"body":"C. Churg-Strauss syndrome;"},{"speaker":"And the options are","startTime":103.092,"endTime":106.027,"body":"D. contrast-induced nephropathy;"},{"speaker":"And the options are","startTime":106.027,"endTime":108.814,"body":"or E. hypereosinophilic syndrome."},{"speaker":"And the options are","startTime":108.814,"endTime":111.335,"body":"(Cathy) Okay, this is a good one,"},{"speaker":"And the options are","startTime":108.814,"endTime":111.335,"body":"because he has a lot going on."},{"speaker":"And the options are","startTime":111.335,"endTime":114.947,"body":"So, let's go through the case"},{"speaker":"And the options are","startTime":111.335,"endTime":114.947,"body":"and talk about the relevant findings."},{"speaker":"And the options are","startTime":114.947,"endTime":116.419,"body":"(Charlie) Okay,"},{"speaker":"And the options are","startTime":114.947,"endTime":116.419,"body":"where do you want to start?"},{"speaker":"And the options are","startTime":116.419,"endTime":119.096,"body":"(Cathy) Well, so let's start"},{"speaker":"And the options are","startTime":116.419,"endTime":119.096,"body":"with a summary of what we heard so far."},{"speaker":"And the options are","startTime":119.096,"endTime":122.617,"body":"So, we have a 75-year-old man"},{"speaker":"And the options are","startTime":119.096,"endTime":122.617,"body":"who had an abnormal stress test"},{"speaker":"And the options are","startTime":122.617,"endTime":124.605,"body":"which prompted coronary angiogram,"},{"speaker":"And the options are","startTime":124.605,"endTime":128.297,"body":"and then a week later he presents"},{"speaker":"And the options are","startTime":124.605,"endTime":128.297,"body":"with acute kidney injury, fever,"},{"speaker":"And the options are","startTime":128.297,"endTime":131.396,"body":"eosinophilia, and an elevated ESR."},{"speaker":"And the options are","startTime":131.396,"endTime":133.093,"body":"The angiography was negative,"},{"speaker":"And the options are","startTime":133.093,"endTime":136.913,"body":"and during the procedure"},{"speaker":"And the options are","startTime":133.093,"endTime":136.913,"body":"he received 35 mL of contrast."},{"speaker":"And the options are","startTime":136.913,"endTime":139.205,"body":"Now, any time"},{"speaker":"And the options are","startTime":136.913,"endTime":139.205,"body":"an elderly patient gets contrast,"},{"speaker":"And the options are","startTime":139.205,"endTime":141.827,"body":"it makes you think"},{"speaker":"And the options are","startTime":139.205,"endTime":141.827,"body":"of contrast-induced nephropathy"},{"speaker":"And the options are","startTime":141.827,"endTime":143.634,"body":"as the cause of his renal failure,"},{"speaker":"And the options are","startTime":143.634,"endTime":145.55,"body":"but his baseline renal function was normal"},{"speaker":"And the options are","startTime":145.55,"endTime":147.467,"body":"and the risk"},{"speaker":"And the options are","startTime":145.55,"endTime":147.467,"body":"of contrast-induced nephropathy"},{"speaker":"And the options are","startTime":147.467,"endTime":149.702,"body":"in that setting is really quite low."},{"speaker":"And the options are","startTime":149.702,"endTime":152.708,"body":"Add to that that he only got"},{"speaker":"And the options are","startTime":149.702,"endTime":152.708,"body":"35 mL of contrast,"},{"speaker":"And the options are","startTime":152.708,"endTime":154.375,"body":"which really isn't that much."},{"speaker":"And the options are","startTime":154.375,"endTime":155.72,"body":"The other factors in this case"},{"speaker":"And the options are","startTime":155.72,"endTime":158.341,"body":"that go against this being"},{"speaker":"And the options are","startTime":155.72,"endTime":158.341,"body":"contrast-induced nephropathy"},{"speaker":"And the options are","startTime":158.341,"endTime":159.746,"body":"are the systemic symptoms,"},{"speaker":"And the options are","startTime":159.746,"endTime":162.138,"body":"because in CIN"},{"speaker":"And the options are","startTime":159.746,"endTime":162.138,"body":"you wouldn't have any of those,"},{"speaker":"And the options are","startTime":162.138,"endTime":164.516,"body":"and also the time course doesn't fit."},{"speaker":"And the options are","startTime":164.516,"endTime":167.227,"body":"Usually, in someone who does have"},{"speaker":"And the options are","startTime":164.516,"endTime":167.227,"body":"contrast-induced nephropathy,"},{"speaker":"And the options are","startTime":167.227,"endTime":170.675,"body":"you'll see a rise in the creatinine"},{"speaker":"And the options are","startTime":167.227,"endTime":170.675,"body":"in the first couple of days."},{"speaker":"And the options are","startTime":170.675,"endTime":174.112,"body":"Seven days after contrast exposure,"},{"speaker":"And the options are","startTime":170.675,"endTime":174.112,"body":"which we hear about in this case,"},{"speaker":"And the options are","startTime":174.112,"endTime":176.292,"body":"the creatinine really should be"},{"speaker":"And the options are","startTime":174.112,"endTime":176.292,"body":"back to normal."},{"speaker":"And the options are","startTime":176.292,"endTime":179.209,"body":"(Charlie) Okay, so it sounds like"},{"speaker":"And the options are","startTime":176.292,"endTime":179.209,"body":"you've ruled out Option D,"},{"speaker":"And the options are","startTime":179.209,"endTime":180.982,"body":"contrast-induced nephropathy."},{"speaker":"And the options are","startTime":180.982,"endTime":182.743,"body":"What do you think"},{"speaker":"And the options are","startTime":180.982,"endTime":182.743,"body":"about the rest of the case?"},{"speaker":"And the options are","startTime":182.743,"endTime":184.962,"body":"And, in particular, what about"},{"speaker":"And the options are","startTime":182.743,"endTime":184.962,"body":"these systemic symptoms"},{"speaker":"And the options are","startTime":184.962,"endTime":186.416,"body":"and the skin findings?--"},{"speaker":"And the options are","startTime":186.416,"endTime":189.192,"body":"because that's not common"},{"speaker":"And the options are","startTime":186.416,"endTime":189.192,"body":"after cardiac catheterization either."},{"speaker":"And the options are","startTime":189.192,"endTime":190.187,"body":"(Cathy) No, it's not,"},{"speaker":"And the options are","startTime":190.187,"endTime":193.538,"body":"and the presence of those symptoms"},{"speaker":"And the options are","startTime":190.187,"endTime":193.538,"body":"helps you identify what's going on."},{"speaker":"And the options are","startTime":193.538,"endTime":196.543,"body":"So, acute interstitial nephritis,"},{"speaker":"And the options are","startTime":193.538,"endTime":196.543,"body":"which is Option A,"},{"speaker":"And the options are","startTime":196.543,"endTime":198.759,"body":"is generally caused by a drug reaction"},{"speaker":"And the options are","startTime":198.759,"endTime":201.708,"body":"and would also cause"},{"speaker":"And the options are","startTime":198.759,"endTime":201.708,"body":"eosinophilia and renal failure,"},{"speaker":"And the options are","startTime":201.708,"endTime":203.115,"body":"like we see in this case."},{"speaker":"And the options are","startTime":203.115,"endTime":204.922,"body":"But we didn't hear about"},{"speaker":"And the options are","startTime":203.115,"endTime":204.922,"body":"any new medications"},{"speaker":"And the options are","startTime":204.922,"endTime":206.328,"body":"that this patient was taking,"},{"speaker":"And the options are","startTime":206.328,"endTime":207.96,"body":"so I have no reason to really think"},{"speaker":"And the options are","startTime":207.96,"endTime":210.883,"body":"that this is the cause"},{"speaker":"And the options are","startTime":207.96,"endTime":210.883,"body":"of his renal failure now."},{"speaker":"And the options are","startTime":210.883,"endTime":213.775,"body":"(Charlie) Okay, so Option A,"},{"speaker":"And the options are","startTime":210.883,"endTime":213.775,"body":"acute interstitial nephritis,"},{"speaker":"And the options are","startTime":213.775,"endTime":215.319,"body":"is also incorrect."},{"speaker":"And the options are","startTime":215.319,"endTime":217.154,"body":"What do you think of the other options?"},{"speaker":"And the options are","startTime":217.154,"endTime":219.717,"body":"(Cathy) Option C talks about"},{"speaker":"And the options are","startTime":217.154,"endTime":219.717,"body":"Churg-Strauss syndrome,"},{"speaker":"And the options are","startTime":219.717,"endTime":221.031,"body":"which is now also called"},{"speaker":"And the options are","startTime":221.031,"endTime":224.466,"body":"eosinophilic granulomatosis"},{"speaker":"And the options are","startTime":221.031,"endTime":224.466,"body":"with polyangiitis."},{"speaker":"And the options are","startTime":224.466,"endTime":226.544,"body":"It's a small-to-medium vessel vasculitis"},{"speaker":"And the options are","startTime":226.544,"endTime":229.504,"body":"that does present"},{"speaker":"And the options are","startTime":226.544,"endTime":229.504,"body":"with renal dysfunction and eosinophilia."},{"speaker":"And the options are","startTime":229.504,"endTime":231.583,"body":"But lung involvement is the most common,"},{"speaker":"And the options are","startTime":231.583,"endTime":235.592,"body":"so you'll hear about patients with asthma"},{"speaker":"And the options are","startTime":231.583,"endTime":235.592,"body":"and allergic rhinitis most commonly."},{"speaker":"And the options are","startTime":235.592,"endTime":237.467,"body":"There are skin findings that can occur,"},{"speaker":"And the options are","startTime":237.467,"endTime":239.647,"body":"but typically, that's cutaneous purpura,"},{"speaker":"And the options are","startTime":239.647,"endTime":242.785,"body":"not the livedo reticularis"},{"speaker":"And the options are","startTime":239.647,"endTime":242.785,"body":"that you hear about in this case."},{"speaker":"And the options are","startTime":242.785,"endTime":244.965,"body":"Also, it usually happens"},{"speaker":"And the options are","startTime":242.785,"endTime":244.965,"body":"much earlier in life,"},{"speaker":"And the options are","startTime":244.965,"endTime":247.746,"body":"so it would be very atypical"},{"speaker":"And the options are","startTime":244.965,"endTime":247.746,"body":"for it to present for the first time"},{"speaker":"And the options are","startTime":247.746,"endTime":249.549,"body":"in a 75-year-old man."},{"speaker":"And the options are","startTime":249.549,"endTime":252.031,"body":"(Charlie) Okay, so now you've ruled out"},{"speaker":"And the options are","startTime":249.549,"endTime":252.031,"body":"Churg-Strauss syndrome,"},{"speaker":"And the options are","startTime":252.031,"endTime":256.694,"body":"and we're down to atheroembolic disease"},{"speaker":"And the options are","startTime":252.031,"endTime":256.694,"body":"and the hypereosinophilic syndrome."},{"speaker":"And the options are","startTime":256.694,"endTime":258.582,"body":"Which do you think is going on here?"},{"speaker":"And the options are","startTime":258.582,"endTime":261.002,"body":"The patient's clinical scenario"},{"speaker":"And the options are","startTime":258.582,"endTime":261.002,"body":"is most consistent"},{"speaker":"And the options are","startTime":261.002,"endTime":263.324,"body":"with atheroembolic renal disease."},{"speaker":"And the options are","startTime":263.324,"endTime":266.114,"body":"So, atheroemboli in the kidney"},{"speaker":"And the options are","startTime":263.324,"endTime":266.114,"body":"are strongly associated"},{"speaker":"And the options are","startTime":266.114,"endTime":269.621,"body":"with aortic aneurysmal disease"},{"speaker":"And the options are","startTime":266.114,"endTime":269.621,"body":"and renal artery stenosis."},{"speaker":"And the options are","startTime":269.621,"endTime":273.145,"body":"Now, most clinical cases"},{"speaker":"And the options are","startTime":269.621,"endTime":273.145,"body":"can be linked to precipitating events,"},{"speaker":"And the options are","startTime":273.145,"endTime":275.963,"body":"such as angiography,"},{"speaker":"And the options are","startTime":273.145,"endTime":275.963,"body":"like we heard about in this case,"},{"speaker":"And the options are","startTime":275.963,"endTime":279.228,"body":"but also vascular surgery,"},{"speaker":"And the options are","startTime":275.963,"endTime":279.228,"body":"anticoagulation with heparin,"},{"speaker":"And the options are","startTime":279.228,"endTime":281.761,"body":"thrombolytic therapy, or even trauma."},{"speaker":"And the options are","startTime":281.761,"endTime":284.529,"body":"Clinical manifestations"},{"speaker":"And the options are","startTime":281.761,"endTime":284.529,"body":"of this syndrome commonly develop"},{"speaker":"And the options are","startTime":284.529,"endTime":287.652,"body":"between right after"},{"speaker":"And the options are","startTime":284.529,"endTime":287.652,"body":"whatever the inciting event is,"},{"speaker":"And the options are","startTime":287.652,"endTime":289.895,"body":"or up to two weeks"},{"speaker":"And the options are","startTime":287.652,"endTime":289.895,"body":"after the inciting event,"},{"speaker":"And the options are","startTime":289.895,"endTime":292.296,"body":"so the time course would fit with that."},{"speaker":"And the options are","startTime":292.296,"endTime":294.543,"body":"(Charlie) So, the time course"},{"speaker":"And the options are","startTime":292.296,"endTime":294.543,"body":"in this case fits,"},{"speaker":"And the options are","startTime":294.543,"endTime":297.176,"body":"and we're also told"},{"speaker":"And the options are","startTime":294.543,"endTime":297.176,"body":"that he had diffuse atherosclerosis"},{"speaker":"And the options are","startTime":297.176,"endTime":298.815,"body":"found in his angiography,"},{"speaker":"And the options are","startTime":298.815,"endTime":301.614,"body":"although he had"},{"speaker":"And the options are","startTime":298.815,"endTime":301.614,"body":"no intervenable coronary lesions."},{"speaker":"And the options are","startTime":301.614,"endTime":303.738,"body":"(Cathy) Seven days"},{"speaker":"And the options are","startTime":301.614,"endTime":303.738,"body":"post-procedure is typical,"},{"speaker":"And the options are","startTime":303.738,"endTime":306.963,"body":"and it may continue to develop"},{"speaker":"And the options are","startTime":303.738,"endTime":306.963,"body":"for weeks thereafter."},{"speaker":"And the options are","startTime":306.963,"endTime":309.212,"body":"Systemic embolic disease manifestations,"},{"speaker":"And the options are","startTime":309.212,"endTime":313.216,"body":"such as fever, abdominal pain,"},{"speaker":"And the options are","startTime":309.212,"endTime":313.216,"body":"weight loss, are not that common"},{"speaker":"And the options are","startTime":313.216,"endTime":315.136,"body":"and are present"},{"speaker":"And the options are","startTime":313.216,"endTime":315.136,"body":"in less than half of patients,"},{"speaker":"And the options are","startTime":315.136,"endTime":316.79,"body":"although cutaneous manifestations,"},{"speaker":"And the options are","startTime":316.79,"endTime":320.675,"body":"like livedo reticularis"},{"speaker":"And the options are","startTime":316.79,"endTime":320.675,"body":"or even sometimes localized toe gangrene"},{"speaker":"And the options are","startTime":320.675,"endTime":322.252,"body":"may be more common."},{"speaker":"And the options are","startTime":322.252,"endTime":325.044,"body":"Worsening hypertension"},{"speaker":"And the options are","startTime":322.252,"endTime":325.044,"body":"and deteriorating kidney function"},{"speaker":"And the options are","startTime":325.044,"endTime":326.538,"body":"are also common."},{"speaker":"And the options are","startTime":326.538,"endTime":328.471,"body":"Now, the lab findings that we would expect"},{"speaker":"And the options are","startTime":328.471,"endTime":331.578,"body":"include a rising creatinine--"},{"speaker":"And the options are","startTime":328.471,"endTime":331.578,"body":"we see that here;"},{"speaker":"And the options are","startTime":331.578,"endTime":335.049,"body":"transient eosinophilia,"},{"speaker":"And the options are","startTime":331.578,"endTime":335.049,"body":"that happens in more than half of cases--"},{"speaker":"And the options are","startTime":335.049,"endTime":336.465,"body":"we also see that here;"},{"speaker":"And the options are","startTime":336.465,"endTime":341.147,"body":"and elevated ESR and hypocomplementemia"},{"speaker":"And the options are","startTime":336.465,"endTime":341.147,"body":"is a little less common."},{"speaker":"And the options are","startTime":341.147,"endTime":343.426,"body":"But we see most"},{"speaker":"And the options are","startTime":341.147,"endTime":343.426,"body":"of those findings in this case,"},{"speaker":"And the options are","startTime":343.426,"endTime":346.735,"body":"which leads me to believe that"},{"speaker":"And the options are","startTime":343.426,"endTime":346.735,"body":"that's the cause of what's going on here."},{"speaker":"And the options are","startTime":346.735,"endTime":348.746,"body":"(Charlie) Okay, so the answer"},{"speaker":"And the options are","startTime":346.735,"endTime":348.746,"body":"to this question"},{"speaker":"And the options are","startTime":348.746,"endTime":351.532,"body":"is C. atheroembolic disease."},{"speaker":"And the options are","startTime":351.532,"endTime":353.586,"body":"And interesting that the question noted"},{"speaker":"And the options are","startTime":353.586,"endTime":357.407,"body":"that the access point for this case"},{"speaker":"And the options are","startTime":353.586,"endTime":357.407,"body":"was the right femoral artery,"},{"speaker":"And the options are","startTime":357.407,"endTime":361.575,"body":"and interventional cardiologists,"},{"speaker":"And the options are","startTime":357.407,"endTime":361.575,"body":"utilizing technological advancements,"},{"speaker":"And the options are","startTime":361.575,"endTime":365.148,"body":"have allowed them to utilize"},{"speaker":"And the options are","startTime":361.575,"endTime":365.148,"body":"less dangerous arteries,"},{"speaker":"And the options are","startTime":365.148,"endTime":370.481,"body":"such as the brachial or radial arteries,"},{"speaker":"And the options are","startTime":365.148,"endTime":370.481,"body":"for diagnostic cardiac catheterization."},{"speaker":"And the options are","startTime":370.481,"endTime":373.321,"body":"(Cathy) Yes, the combination"},{"speaker":"And the options are","startTime":370.481,"endTime":373.321,"body":"of the host factors, recent procedure,"},{"speaker":"And the options are","startTime":373.321,"endTime":376.862,"body":"and exam and laboratory findings"},{"speaker":"And the options are","startTime":373.321,"endTime":376.862,"body":"make this the most likely cause."},{"speaker":"And the options are","startTime":376.862,"endTime":378.33,"body":"(Charlie) Okay, let's round it out,"},{"speaker":"And the options are","startTime":378.33,"endTime":382.129,"body":"and tell me why you don't think"},{"speaker":"And the options are","startTime":378.33,"endTime":382.129,"body":"this is the hypereosinophilic syndrome."},{"speaker":"And the options are","startTime":382.129,"endTime":385.113,"body":"(Cathy) So, that's a subcategory"},{"speaker":"And the options are","startTime":382.129,"endTime":385.113,"body":"of idiopathic eosinophilia"},{"speaker":"And the options are","startTime":385.113,"endTime":388.643,"body":"with a persistent increase"},{"speaker":"And the options are","startTime":385.113,"endTime":388.643,"body":"of the absolute eosinophilic count"},{"speaker":"And the options are","startTime":388.643,"endTime":392.417,"body":"to over 1500 eosinophils/mcL."},{"speaker":"And the options are","startTime":392.417,"endTime":396.336,"body":"But you also need to have the presence"},{"speaker":"And the options are","startTime":392.417,"endTime":396.336,"body":"of eosinophil-mediated organ damage."},{"speaker":"And the options are","startTime":396.336,"endTime":398.628,"body":"So, this could include cardiomyopathies,"},{"speaker":"And the options are","startTime":398.628,"endTime":401.04,"body":"gastroenteritis, cutaneous lesions,"},{"speaker":"And the options are","startTime":401.04,"endTime":405.505,"body":"sinusitis, pneumonitis, neuritis,"},{"speaker":"And the options are","startTime":401.04,"endTime":405.505,"body":"and even vasculitis."},{"speaker":"And the options are","startTime":405.505,"endTime":409.089,"body":"In addition, some patients will manifest"},{"speaker":"And the options are","startTime":405.505,"endTime":409.089,"body":"with thromboembolic complications"},{"speaker":"And the options are","startTime":409.089,"endTime":410.861,"body":"or even hepatosplenomegaly,"},{"speaker":"And the options are","startTime":410.861,"endTime":413.417,"body":"and then you either get"},{"speaker":"And the options are","startTime":410.861,"endTime":413.417,"body":"elevations or decreases"},{"speaker":"And the options are","startTime":413.417,"endTime":415.524,"body":"in the rest of the blood counts too."},{"speaker":"And the options are","startTime":415.524,"endTime":417.31,"body":"In this case, you'd have to decide first"},{"speaker":"And the options are","startTime":417.31,"endTime":419.965,"body":"if the eosinophilia is not due"},{"speaker":"And the options are","startTime":417.31,"endTime":419.965,"body":"to a different cause--"},{"speaker":"And the options are","startTime":419.965,"endTime":421.777,"body":"which, I said before, I think it is--"},{"speaker":"And the options are","startTime":421.777,"endTime":424.569,"body":"and, again, it'd be very uncommon"},{"speaker":"And the options are","startTime":421.777,"endTime":424.569,"body":"to present for the first time"},{"speaker":"And the options are","startTime":424.569,"endTime":425.849,"body":"in someone of this age"},{"speaker":"And the options are","startTime":425.849,"endTime":428.619,"body":"who has another more likely cause"},{"speaker":"And the options are","startTime":425.849,"endTime":428.619,"body":"of his eosinophilia."},{"speaker":"And the options are","startTime":428.619,"endTime":430.675,"body":"(Charlie) Great."},{"speaker":"And the options are","startTime":428.619,"endTime":430.675,"body":"So, the teaching point in this case"},{"speaker":"And the options are","startTime":430.675,"endTime":432.538,"body":"is that atheroembolic renal disease"},{"speaker":"And the options are","startTime":432.538,"endTime":435.48,"body":"commonly occurs"},{"speaker":"And the options are","startTime":432.538,"endTime":435.48,"body":"after some precipitating event,"},{"speaker":"And the options are","startTime":435.48,"endTime":437.855,"body":"and commonly presents with skin findings,"},{"speaker":"And the options are","startTime":437.855,"endTime":441.323,"body":"rising creatinine,"},{"speaker":"And the options are","startTime":437.855,"endTime":441.323,"body":"and a transient eosinophilia,"},{"speaker":"And the options are","startTime":441.323,"endTime":443.281,"body":"although there can be"},{"speaker":"And the options are","startTime":441.323,"endTime":443.281,"body":"worse systemic symptoms,"},{"speaker":"And the options are","startTime":443.281,"endTime":446.376,"body":"like fever, abdominal pain,"},{"speaker":"And the options are","startTime":443.281,"endTime":446.376,"body":"and weight loss."},{"speaker":"And the options are","startTime":446.376,"endTime":448.34,"body":"(Cathy) And if you'd like"},{"speaker":"And the options are","startTime":446.376,"endTime":448.34,"body":"to read more about this,"},{"speaker":"And the options are","startTime":448.34,"endTime":449.778,"body":"you can check out \u003ci\u003eHarrison's\u003c/i\u003e chapter"},{"speaker":"And the options are","startTime":449.778,"endTime":452.27,"body":"on Disorders"},{"speaker":"And the options are","startTime":449.778,"endTime":452.27,"body":"of the Cardiovascular System."},{"speaker":"And the options are","startTime":452.27,"endTime":454.053,"body":"♪ (music) ♪"}]}