UTHSC PA Program Podcast

In this episode, we review intrinsic acute kidney injury (AKI), an abrupt decline in renal function caused by direct injury to the kidney parenchyma. We break down the major causes—including acute tubular necrosis (ATN), acute interstitial nephritis, glomerular disease, and vascular injury—and discuss the clinical and diagnostic clues that help distinguish them. The segment also covers urinalysis findings such as the classic "muddy brown casts" of ATN, volume assessment, treatment of the underlying cause, and the AEIOU indications for dialysis.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Acute Kidney Injury: Medical Causes and Pathogenesis. Turgut F, Awad AS, Abdel-Rahman EM. Journal of Clinical Medicine. 2023;12(1):375. doi:10.3390/jcm12010375.
3. Acute Kidney Injury. Ronco C, Bellomo R, Kellum JA. Lancet (London, England). 2019;394(10212):1949-1964. doi:10.1016/S0140-6736(19)32563-2.
4. The Spectrum of Biopsy-Proven Kidney Diseases, Causes, and Renal Outcomes in Acute Kidney Injury Patients. Abuduwupuer Z, Lei Q, Liang S, et al. Nephron. 2023;147(9):541-549. doi:10.1159/000530615.

In this episode, we review autosomal dominant polycystic kidney disease (ADPKD), the most common inherited kidney disorder, characterized by progressive development of bilateral renal cysts and commonly associated with PKD1 and PKD2 variants. We discuss the clinical presentation, diagnostic role of renal imaging, and important renal and systemic complications, including hypertension, progressive chronic kidney disease, liver cysts, and intracranial aneurysms. The segment also highlights management strategies aimed at preserving renal function, controlling blood pressure, treating complications, and considering tolvaptan in selected patients at risk for rapid disease progression.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Chebib FT, Hanna C, Harris PC, Torres VE, Dahl NK. Autosomal dominant polycystic kidney disease: a review. JAMA. 2025;333(19):1708-1719. doi:10.1001/jama.2025.0310.
3. Ong ACM, Carriazo S, Ma BM, Torra R, Pei Y. Autosomal dominant polycystic kidney disease. Lancet. 2026;407(10535):1289-1302. doi:10.1016/S0140-6736(26)00046-2.
4. Caserta MP, Purysko AS, Catanzano TM, et al. ACR Appropriateness Criteria® autosomal dominant polycystic kidney disease. J Am Coll Radiol. 2026;23(7):1368-1383. doi:10.1016/j.jacr.2026.02.009.

In this episode, we review horseshoe kidney, the most common congenital renal fusion anomaly, in which the kidneys are typically fused at their lower poles and remain abnormally low and rotated. We discuss how this altered anatomy can impair urinary drainage and increase the risk of ureteropelvic junction (UPJ) obstruction, hydronephrosis, nephrolithiasis, and recurrent urinary tract infections. Learn how horseshoe kidney is identified with imaging, why many patients remain asymptomatic, and how management focuses primarily on recognizing, monitoring, and treating associated complications rather than the renal fusion itself.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Kang M, Kim YC, Lee H, et al. Renal outcomes in adult patients with horseshoe kidney. Nephrol Dial Transplant. 2021;36(3):498-503. doi:10.1093/ndt/gfz217.
3. Neville H, Ritchey ML, Shamberger RC, Haase G, Perlman S, Yoshioka T. The occurrence of Wilms tumor in horseshoe kidneys: a report from the National Wilms Tumor Study Group (NWTSG). J Pediatr Surg. 2002;37(8):1134-1137. doi:10.1053/jpsu.2002.34458.
4. Kumar G, Stern JM, Leslie SW. Horseshoe Kidney. [Updated 2025 Sep 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK431105/

In this episode, we review hypothyroidism, focusing on the causes, clinical presentation, diagnosis, and management of decreased thyroid hormone production. We discuss Hashimoto thyroiditis, the most common cause in iodine-sufficient regions, along with central and iatrogenic causes of hypothyroidism. Learn to recognize classic findings such as fatigue, weight gain, cold intolerance, constipation, bradycardia, and delayed reflexes, and understand how TSH, free T4, and thyroid antibodies guide the diagnostic workup. We also cover levothyroxine therapy, appropriate monitoring, and important complications, including severe hypothyroidism and its systemic effects.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Chaker L, Papaleontiou M. Hypothyroidism: a review. JAMA. 2025;334(19):1750-1760. doi:10.1001/jama.2025.13559
3. Razvi S, Weaver JU, Butler TJ, Pearce SHS. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med. 2012;172(10):811-817. doi:10.1001/archinternmed.2012.1159
4. Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: diagnosis and treatment. Am Fam Physician. 2021;103(10):605-613.

In this episode, we review hyperthyroidism, including the major etiologies of Graves disease, toxic nodular disease, and thyroiditis. We discuss classic clinical findings such as weight loss despite increased appetite, heat intolerance, palpitations, tremor, and tachycardia, along with the distinctive features of Graves disease. The episode also breaks down the diagnostic approach using TSH, T3/T4, thyroid antibodies, and radioactive iodine uptake, and reviews treatment with beta-blockers, antithyroid medications, radioactive iodine, and thyroidectomy. We finish with high-yield clinical pearls for distinguishing the major causes of hyperthyroidism and recognizing serious complications such as thyroid storm and atrial fibrillation.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Lee SY, Pearce EN. Hyperthyroidism: a review. JAMA. 2023;330(15):1472-1483. doi:10.1001/jama.2023.19052
3. Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016;375(16):1552-1565. doi:10.1056/NEJMra1510030
4. Burch HB, Cooper DS. Management of Graves disease: a review. JAMA. 2015;314(23):2544-2554. doi:10.1001/jama.2015.16535

In this episode, we review Lyme disease, the most common vector-borne disease in the United States, caused by Borrelia burgdorferi and transmitted by Ixodes ticks. We break down the progression from early localized disease with erythema migrans to disseminated manifestations such as facial nerve palsy, meningitis, cardiac conduction abnormalities, and late Lyme arthritis. We also discuss when Lyme disease is a clinical diagnosis, appropriate diagnostic testing, treatment strategies, and prevention—including the importance of prolonged tick attachment and criteria for post-exposure prophylaxis.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021;72(1):e1-e48. doi:10.1093/cid/ciaa1215
3. Centers for Disease Control and Prevention. Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. 6th ed. Published 2022. Accessed September 29, 2026.
4. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. Published online March 5, 2024. doi:10.1093/cid/ciae104

In this episode, we review Rocky Mountain spotted fever (RMSF), a potentially life-threatening tick-borne infection caused by Rickettsia rickettsii that produces systemic vasculitis and can rapidly progress to severe multisystem disease. We discuss key risk factors, the classic rash progression from the wrists and ankles to the palms, soles, and trunk, and important laboratory clues including thrombocytopenia, hyponatremia, and elevated liver enzymes. Most importantly, we emphasize why clinicians should treat first and confirm later, using doxycycline empirically when RMSF is suspected rather than delaying treatment for the rash or confirmatory testing.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States. MMWR Recomm Rep. 2016;65(2):1-44. doi:10.15585/mmwr.rr6502a1
3. Centers for Disease Control and Prevention. Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. 6th ed. Published 2022. Accessed September 29, 2026. https://www.cdc.gov/ticks/media/pdfs/2025/03/tickborne-diseases-manual-508.pdf
4. Bellman S, McCoy KD, Enriquez D, et al. Predictors of fatal outcomes among pediatric patients hospitalized for Rocky Mountain spotted fever, Sonora, Mexico, 2004–2024. Emerg Infect Dis. 2026;32(2):180-190. doi:10.3201/eid3202.251223

In this episode, we break down hypoglycemia, from the body's normal counterregulatory response to the mechanisms that place patients with diabetes at increased risk for severe episodes. We review key risk factors and the differences between fasting, postprandial, and medication-induced hypoglycemia, along with the progression from early neurogenic symptoms such as tremor, sweating, palpitations, and hunger to potentially life-threatening neuroglycopenic symptoms including confusion, seizures, and coma. We also discuss Whipple's triad, acute treatment with oral glucose, IV dextrose, or glucagon, and the importance of recognizing hypoglycemia-associated autonomic failure (HAAF) and hypoglycemic unawareness in patients with recurrent episodes.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013;369(4):362-372. doi:10.1056/NEJMra1215228
3. Service FJ. Hypoglycemic disorders. N Engl J Med. 1995;332(17):1144-1152. doi:10.1056/NEJM199504273321707
4. Morales J, Schneider D. Hypoglycemia. Am J Med. 2014;127(10 suppl):S17-S24. doi:10.1016/j.amjmed.2014.07.004

In this episode, we review varicose veins, a common manifestation of chronic venous disease caused by dysfunctional venous valves, reflux, and impaired return of blood from the lower extremities. We discuss important risk factors including older age, family history, pregnancy, obesity, prolonged standing, sedentary lifestyle, and previous DVT, along with typical symptoms such as aching, heaviness, swelling, itching, and visible dilated or tortuous veins. The episode also covers clinical evaluation and the role of duplex ultrasound in identifying venous reflux or obstruction, as well as treatment options ranging from compression therapy, exercise, leg elevation, and weight loss to procedural interventions such as ablation, phlebectomy, sclerotherapy, and venous stenting.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Attaran RR, Edwards ML, Arena FJ, et al. 2025 SCAI Clinical Practice Guidelines for the Management of Chronic Venous Disease: This statement was endorsed by the Society for Vascular Medicine (SVM). J Soc Cardiovasc Angiogr Interv. 2025;4(8):103729. Published 2025 Jun 30. doi:10.1016/j.jscai.2025.103729
3. O'Malley PG, Fukaya E, Kolluri R. Nonsurgical Management of Chronic Venous Insufficiency. N Engl J Med. 2024;390:727-735. DOI: 10.1056/NEJMcP2310224
4. The 2020 update of the CEAP classification system and reporting standards. Lurie, Fedor et al. Journal of Vascular Surgery: Venous and Lymphatic Disorders, Volume 8, Issue 3, 342 - 352

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In this episode, we review hypotension, a clinical state of abnormally low blood pressure that can lead to inadequate tissue perfusion and organ dysfunction. We discuss the major underlying mechanisms, including hypovolemia, distributive shock, cardiogenic causes, and obstructive physiology, along with common risk factors such as dehydration, hemorrhage, sepsis, medications, endocrine disorders, and cardiac disease. The episode highlights classic signs and symptoms including dizziness, syncope, weakness, altered mental status, tachycardia, and signs of shock, emphasizing the importance of identifying the underlying cause rather than treating the blood pressure value alone. We also review key components of the diagnostic evaluation, including orthostatic vitals, laboratory studies, EKG, and bedside assessment of perfusion, as well as initial management with fluid resuscitation, vasopressors when indicated, and rapid treatment of the underlying etiology.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817
2. Wieling W, Kaufmann H, Claydon V et al. Diagnosis and treatment of orthostatic hypotension. The Lancet Neurology, 21, 735-746
3. Goldberger, Z, Petek, B, Brignole, M. et al. ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison. JACC. 2019 Nov, 74 (19) 2410–2423. https://doi.org/10.1016/j.jacc.2019.09.012
4. VanWijnen VK, Finucane C, Harms MPM, Nolan H, Freeman RL, Westerhof BE, Kenny RA, terMaaten JC, Wieling W (University Medical Center Groningen, University of Groningen, The Netherlands; St James's Hospital; Lincoln Gate, Trinity College, Dublin, Ireland; Harvard Medical School, Boston, MA, USA; VU University Medical Center; Academic Medical Center, Amsterdam, The Netherlands). Noninvasive beat-to-beat finger arterial pressure monitoring during orthostasis: a comprehensive review of normal and abnormal responses at different ages (Review). J Intern Med2017; 282: 468–483
5. Kim, M. J., & Farrell, J. (2022). Orthostatic Hypotension: A Practical Approach. American family physician, 105(1), 39–49.