Renal

Is Potassium Supplementation Beneficial in Hospitalized Patients?

October 25, 2017
Is Potassium Supplementation Beneficial in Hospitalized Patients?

By Sara Stream, MD

Peer Reviewed

As resident physicians, we are taught to supplement serum potassium to a goal level of 4.0 mEq/L in all hospitalized patients. While the dangers of severe potassium abnormalities are well established, the benefit of routine potassium supplementation of normal serum levels in the general hospitalized population is unclear.

Potassium is predominantly an intracellular ion with 98% of total body potassium located in the intracellular space. The accepted reference range for serum potassium levels is 3.5 to 5.0 mEq/L. The …

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Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

December 11, 2014
Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

By Miguel A. Saldivar, MD

Peer Reviewed 

When a patient with diabetes comes into a clinic or hospital, it is not uncommon to hear the question, “Is he/she on an angiotensin-converting-enzyme (ACE) inhibitor (ACEI) or an angiotensin-receptor blocker (ARB)?” Most clinicians know the mantra: ACEIs are renoprotective in diabetes. Most are aware that clinical studies dating back to the 1990s have indeed shown the protective effects of ACEIs, such as captopril, against renal function deterioration in diabetes . Most are even aware that there are …

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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 medical …

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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 5.9

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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 …

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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 a …

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