Renal

Preserving Residual Renal Function

May 1, 2013

By Jerome Lowenstein, MD

Faculty Peer Reviewed

Two questions that often arise concerning the administration of radio-contrast in patients with advanced renal disease, receiving hemodialysis or peritoneal dialysis, reveal what appear to be widespread and important misconceptions.

The first misconception is that in end-stage renal disease, glomerular filtration is absent or minimal and the removal of wastes (“uremic toxins”) is accomplished only by peritoneal or hemodialysis Most patients who reach the advanced stages of renal disease requiring hemodialysis or peritoneal dialysis are not oliguric and…

White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

March 20, 2013

By Lauren Foster

Faculty Peer Reviewed

Hypertension is a pervasive chronic disease affecting approximately 65 million adults in the United States, and a significant cause of morbidity and mortality . Antihypertensives are widely prescribed due to their effectiveness in lowering blood pressure, thereby reducing the risk of cardiovascular events. However, the phenomenon of the “white coat effect” may be a complicating factor in the diagnosis and management of hypertensive patients. It is well established that a considerable number of people experience an elevation of their…

Kidney Stones and Climate Change

October 10, 2012

By Jeffrey Shyu, MD

Faculty Peer Reviewed

Climate change has been linked to a variety of adverse effects on human health, effects that are expected to worsen in the coming decades . For example, a heat wave in August 2003 resulted in nearly 15000 deaths in France, and the anticipated increase in average world temperatures is expected to lead to longer and more frequent heat waves that will disproportionately affect our more vulnerable populations. Infectious disease outbreaks, particularly vector-borne ones such as malaria, are expected…

Should Patients With Nephrotic Syndrome Receive Anticoagulation?

May 9, 2012

By Jennifer Mulliken

Faculty Peer Reviewed

Case 1:

A 30-year-old African-American male with a history of bilateral pulmonary emboli presents with a 1-week history of bilateral lower extremity edema. Blood pressure is 138/83, cholesterol 385, LDL 250, albumin 2.9. Urinalysis shows 3+ protein. Twenty-four hour urinary protein is 7.2 grams.

Case 2:

A 47-year-old Hispanic male with a history of mild hypertension and venous insufficiency presents with a 3-month history of bilateral lower extremity edema. BP is 146/95, cholesterol 241, LDL 165, albumin 1.9.…

Forgoing the Fear: Contrast Nephropathy

June 15, 2011

By Mario V Fusaro, MD

Faculty Peer Reviewed

There are certain laws in the universe that are just not meant to be broken. One is gravity. Another one is relativity. The third, don’t give contrast to people with bad kidneys. Perhaps the last one is not so much a law as something we seem to be terrified of doing. While recently on service, I had a patient with unexplained right lower quadrant pain. The obvious first or second or fifth step would be a contrast…

Warning: Drinking Cola May Be Dangerous To Your Health

May 11, 2011

By Jessica Leifer

Faculty Peer Reviewed

As a new third year medical student excited to finally be seeing my own patients and still looking for my style as an interviewer, I approach the social history in the systematic way we have learned in the first 2 years of medical school. God forbid I leave something out. Over the past month of my first clerkship, I’ve grown comfortable with asking the uncomfortable questions: Are you currently sexually active? With men,…

Creatine Kinase: How Much is Too Much?

November 3, 2010

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from an asymptomatic…

Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

October 27, 2010

By Kevin Hsueh, MD

Faculty Peer Reviewed

In 2006 and 2007, Clinical Correlations reported on the FDA’s announcement of a link between Nephrogenic Systemic Fibrosis (NSF), a rare progressive condition identified in some patients with kidney disease, and exposure to gadolinium-based contrast agents (GBCAs). The initial lesion of NSF is classically a large “brawny” hyperpigmented nodular plaque that appears fixed to the underlying tissues when palpated. It most often develops on the lower extremities, often mimicking chronic venous stasis…

When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

September 30, 2009

Frederick Gandolfo MD

Faculty peer reviewed

At a recent conference on renal transplantation, the importance of early renal biopsy for the diagnosis of acute rejection was emphasized. As busy practitioners of general internal medicine, we rarely have the opportunity to learn the details of a subspecialty procedure such as renal biopsy. However, knowing the details of these procedures is important in providing care for these specific patients. What are the indications, risks, and follow-up care required for the renal…

Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

August 26, 2009

Rebecca Hall MD

Faculty Peer Reviewed

Diseases 2.0 – Bringing you the latest updates on disease pathophysiology and treatment

Patient S.J. is a 36 year old female with a 20 year history of lupus and lupus nephritis now with end stage renal disease (ESRD) on hemodialysis. She presented with indurated, violaceous skin lesions with ulceration on both thighs. The lesions worsened and became increasingly painful over the last 6 months. Her extensive four month hospital course has…

Morning Report: Hepatorenal Syndrome

February 19, 2009

Commentary by Catherine Lucero MD, PGY-3

Faculty Peer Reviewed

The patient is a 69-year old woman from El Salvador with a chief complaint of worsening abdominal distension for nine months. Three months earlier, the patient was told she had liver problems and was started on diuretics. Prior to presentation, the patient states that she stopped taking her medication and noticed increasing lower extremity edema and abdominal girth, as well as an unintentional 15-pound weight loss. The patient denied any other medical problems, including fever, chills,…

Grand Rounds: “VEGF and Renal Thrombotic Microangiopathy”

January 21, 2009

Commentary by Ilana Bragin, MD, PGY-3

Please also see the clinical vignette presented before last week’s grand rounds.

Last week’s Medical Grand Rounds was given by guest speaker Dr. Sue Quaggin, Associate Professor of Medicine at the University of Toronto, who shared with the audience her knowledge and passion of the role of Vascular Endothelial Growth Factor (VEGF) in kidney function. VEGF is a critical family of signaling proteins that is involved in vasculogenesis and angiogenesis. While the discovery of VEGF could be applied to…

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Clinical Correlations

Renal

Preserving Residual Renal Function

White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

Kidney Stones and Climate Change

Should Patients With Nephrotic Syndrome Receive Anticoagulation?

Forgoing the Fear: Contrast Nephropathy

Warning: Drinking Cola May Be Dangerous To Your Health

Creatine Kinase: How Much is Too Much?

Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

Morning Report: Hepatorenal Syndrome

Grand Rounds: “VEGF and Renal Thrombotic Microangiopathy”

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