Renal

From The Archives: Forgoing the Fear: Contrast Nephropathy

January 30, 2014
From The Archives: Forgoing the Fear: Contrast Nephropathy

Please enjoy this post from the archives, dated 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…

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To Stent or not to Stent? A Review of the Evidence on the Utility of Stenting in Renal Artery Stenosis

November 22, 2013
To Stent or not to Stent? A Review of the Evidence on the Utility of Stenting in Renal Artery Stenosis

By Elizabeth Hammer, MD

Faculty Peer Reviewed

Renovascular hypertension, often caused by renal artery stenosis (RAS) due to atherosclerosis or fibromuscular dysplasia, is the most common potentially correctable cause of secondary hypertension. Although only approximately one percent of patients with hypertension have atherosclerotic renovascular disease (ARVD), the prevalence increases to 30-40% in patients with CAD, CHF, and PVD. Screening studies of asymptomatic populations in the United States demonstrate a disease prevalence of 7%, with an annual incidence of 0.5% per year in analyses of…

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FROM THE ARCHIVES – Kayexalate: What is it and does it work?

November 7, 2013
FROM THE ARCHIVES – Kayexalate: What is it and does it work?

Please enjoy this post from the archives dated December 1, 2010

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of

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From The Archives: Creatine Kinase: How Much is Too Much?

October 24, 2013
From The Archives: Creatine Kinase: How Much is Too Much?

Please enjoy this post from the archives dated 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…

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Decoding the APOL1 Kidney

September 25, 2013
Decoding the APOL1 Kidney

By Areeba Sadiq

Faculty Peer Reviewed

African American patients have a higher risk of developing end-stage renal disease (ESRD) than their Caucasian counterparts . If over the age of 70, that risk is 3 times higher. If between the ages of 60-69, the risk is 8 times higher. And, if between 30 and 39, African American patients are an astounding 11 times more likely to develop ESRD . Why are African Americans more likely to develop ESRD? What is different about the African American kidney?…

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From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

July 11, 2013
From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

Please enjoy this post from the Archives dated September 22, 2010

By Jon Emile Kenny, MD

Faculty Peer Reviewed

“You mean I’ve got cancer and my kidneys are failing, doc?” said my frail patient on the Bellevue oncology service shortly after a medical student had told him that his kidneys were damaged. Indeed, his new diagnosis of multiple myeloma was accompanied by an admission creatinine of 2.5 mg/dL.

About a quarter of patients with multiple myeloma have renal insufficiency at diagnosis . There are…

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Preserving Residual Renal Function

May 1, 2013
Preserving Residual Renal Function

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…

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

March 20, 2013
White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

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…

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Kidney Stones and Climate Change

October 10, 2012
Kidney Stones and Climate Change

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…

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How to Get Your Patient a Kidney

September 28, 2012
How to Get Your Patient a Kidney

By Ilina Datkhaeva

Faculty Peer Reviewed

We give hope to patients with advanced kidney disease that a transplant will save them from their Monday, Wednesday, Friday trips to the dialysis unit. But how certain are we that they even qualify to be a recipient? And if they do, are they going to live long enough to get their new lease on life?

Kidney donation has received its fair share of publicity recently, from the allocation of organs to illegal immigrants to Good Samaritans…

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Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

September 5, 2012
Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

By Jon-Emile S Kenny, MD

Faculty Peer Reviwed

A 62- year-old man with a history of hypertension, diastolic dysfunction and chronic kidney disease is admitted 4 days after beginning outpatient treatment of community acquired pneumonia with cefpodoxime and azithromycin; he had been intermittently vomiting for two days, but proudly states that he has been keeping all of his home medications down, including hydrochlorothiazide. The morning after his admission, he was noted to have a serum creatinine of 3.4 mg/dL (from a baseline of 1.7 mg/dL).…

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Should Patients With Nephrotic Syndrome Receive Anticoagulation?

May 9, 2012
Should Patients With Nephrotic Syndrome Receive Anticoagulation?

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.…

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