Renal

Class Act: The Role of Angiotensin II in Renal Fibrosis and Diabetic Kidney Disease

December 9, 2008

Commentary by Daniel Fine MD

Faculty Peer Reviewed

Diabetic nephropathy is the most frequent cause of end-stage kidney disease in the United States, Europe and Japan. Large scale randomized controlled trials have shown that both ACE inhibitors and angiotensin II receptor antagonists reduce microalbuminuria, slow rate of decline of GFR and delay end stage kidney disease.

The renin-angiotensin system plays a significant role in the human inflammatory process in addition to its well known effects on blood pressure and sodium homeostasis.…

Diseases 2.0: Uric acid stones linked to diabetes

July 3, 2008

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

Commentary By David Goldfarb, M.D. Professor of Medicine, NYU Medical Center, Chief Nephrology Section VA New York Harbor

At the recent meeting of the National Kidney Foundation in Dallas, Dr. Orson Moe reviewed the links between diabetes and uric acid stones . Uric acid stones are most often caused by low urine pH. With a low urine pH, even relatively little uric acid can precipate, as it forms the…

Grand Rounds: “Nephrogenic systemic fibrosis”

June 5, 2008

Commentary by Jatin Roper MD, PGY-3

Medical Grand Rounds today was presented last week by Dr. Shawn Cowper, Assistant Professor of Dermatology and Pathology at Yale University School of Medicine. Grand Rounds began with the presentation of a case from Tisch Hospital:

A 46 year old female with a history of end-stage renal disease secondary to diffuse-proliferative glomerulonephritis on hemodialysis, systemic lupus erythematosis, antiphospholipid antibody syndrome, and IVC thrombosis presents to a dermatology consultant for progressive hardness, tightness, and tenderness…

Tumor Lysis Syndrome and the Role of Urinary Alkalinization

September 13, 2007

Commentary by Bani Chander MD, PGY-2, and Sergio Obligado MD, Attending Physician, Nephrology

Tumor lysis syndrome (TLS) is characterized by a group of metabolic abnormalities including hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia, following the initiation of cytotoxic therapy. Although there is no well established definition for this syndrome, the Cairo-Bishop definition is a commonly used classification system that stratifies the degree of severity by utilizing specific laboratory data and clinical features. The constellation of abnormalities that occurs in TLS is due…

X-Ray Visions: Update on Nephrogenic Systemic Fibrosis and Gadolinium Contrast MRI

July 24, 2007

Commentary by Andrew Hardie MD, Body MRI Fellow, NYU Dept of Radiology

The recent discovery of a link between Nephrogenic Systemic Fibrosis (NSF) and the administration of gadolinium contrast for MRI examinations has sent the imaging world scrambling. NSF is a debilitating fibrosing reaction primarily involving the skin and, to a variable degree, internal organs. While longitudinal studies currently do not exist to help determine which patients can be safely administered gadolinium, it is clear that severe renal dysfunction, including those patients on…

Hyperparathyroidism in Chronic Kidney Disease

June 13, 2007

Commentary by Sarah Berry MD, PGY-3 and Joseph Weisstuch, MD Clinical Assistant Professor of Medicine, Divsion of Nephrology

Case: Mr. K is a 59 year old gentleman with a past medical history of hypertension, non-insulin dependent diabetes mellitus, dyslipidemia and worsening chronic kidney disease (CKD) over the last six years, despite compliance with his medications and optimized glucose and blood pressure control. His current medication regimen includes metoprolol, hydrochlorothiazide, aspirin, simvastatin, glyburide, and monopril. Mr. K’s most recent lab work indicates that…

Recent Developments in the Treatment of Renal Cell Carcinoma

May 31, 2007

Commentary by Michael Seidman MD, Chief Oncology Fellow

New treatment options for both early and advanced Renal Cell Cancer have recently been published. Traditionally, treatment for early stage disease was partial or radical nephrectomy. In the metastatic setting, treatment options were limited to toxic cytokine therapy with IFN or IL-2.

Some recent literature has suggested that small, incidentally found renal tumors can safely be watched without the need for invasive surgery. Remzi et al retrospectively reviewed 287 tumor bearing kidneys 4cm or…

How should you approach a pregnant patient with chronic kidney disease?

May 25, 2007

A 31 year old female with hypertension and proteinuria secondary to IgA nephropathy, currently treated with an ARB, presents to clinic stating that she would like to become pregnant.

What is the risk of fetal morbidity in the setting of ARBs/ACE-inhibitors? What antihypertensive medications are used during pregnancy? At what point would you switch a patient’s medications if she is trying to become pregnant? What is the natural course of IgA nephropathy during pregnancy?

-Minisha Sood MD, PGY-3

Pregnancy and Chronic Kidney…

FDA Black Box Warning on Gadolinium

May 24, 2007

Back in December we reported on the FDA cautioning practioners about the use of gadolinium (an mri contrast agent) in patients with chronic kidney disease. The FDA is now requesting a black box warning stating “that patients with severe kidney insufficiency who receive gadolinium-based agents are at risk for developing a debilitating, and a potentially fatal disease known as nephrogenic systemic fibrosis (NSF). In addition, it would state that patients just before or just after liver transplantation, or those with chronic liver disease, are also at risk…

First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

Breaking News: FDA Advises Caution with Gadolinium Based Contrast

December 27, 2006

Commentary By: Minisha Sood PGY-3

The FDA has received reports of 90 patients with moderate to end-stage kidney disease who have undergone MRI or MRA with a gadolinium-based contrast agent and subsequently developed a new disease known as Nephrogenic Systemic Fibrosis (NSF).

Scientists first identified NSF, also known as Nephrogenic Fibrosing Dermopathy (NFD), in 1997 and its cause has not yet been identified. There have been approximately 200 reports of NSF/NFD only in people with kidney disease. Neither the duration of…

Epogen and Anemia-Less is More (Part 2)

December 14, 2006

Commentary By David Goldfarb, M.D. Professor of Medicine, NYU Medical Center, Chief Nephrology Section VA New York Harbor

2 weeks ago we reported on 2 lead articles in the New England journal that suggested that our targets for hemoglobin values when treating with erythropoietin were too high.

Last week, the New York Times reported that based on those NEJM articles (CHOIR and CREATE), the National…

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Clinical Correlations