Renal

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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From The Archives: How to interpret troponins in renal disease?

March 15, 2012
From The Archives: How to interpret troponins in renal disease?

Please enjoy this post from the archives first posted on October 21, 2009.

By Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities.…

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Forgoing the Fear: Contrast Nephropathy

June 15, 2011
Forgoing the Fear: Contrast Nephropathy

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…

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Warning: Drinking Cola May Be Dangerous To Your Health

May 11, 2011
Warning: Drinking Cola May Be Dangerous To Your Health

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,…

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Kayexalate: What is it and does it work?

December 1, 2010
Kayexalate: What is it and does it work?

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 mEq/L. His EKG is

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Creatine Kinase: How Much is Too Much?

November 3, 2010
Creatine Kinase: How Much is Too Much?

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…

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Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

October 27, 2010
Nephrogenic Systemic Fibrosis-An Evolving Disease Entity

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…

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Why Does Multiple Myeloma Treat The Kidneys So Poorly?

September 22, 2010
Why Does Multiple Myeloma Treat The Kidneys So Poorly?

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 number of clinicopathologic…

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How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours…

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

September 30, 2009
When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

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…

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Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

August 26, 2009
Diseases 2.0: Calcific Uremic Arteriolopathy (CUA)

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…

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Grand Rounds: Primary Aldosteronism, Beyond Conn’s Syndrome

June 4, 2009
Grand Rounds: Primary Aldosteronism, Beyond Conn’s Syndrome

Michael Chu MD

Please also see the clinical vignette presented before Grand Rounds on the 21st of May.

The Medical Grand Rounds presentation on May 21, 2009 titled “Primary Aldosteronism, Beyond Conn’s Syndrome” was delivered by Dr. William F. Young M.D., Professor of Medicine at the Mayo Clinic College of Medicine. Dr. Young’s talk began with the index case of hyperaldosteronism that was described by Dr. Jerome Conn in the 1950’s, through the advances in the diagnosis of…

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