Tuesday, February 26, 2013

Thursday, February 21, 2013

AKI from valacyclovir?

Today in fellows clinic we saw an octogenarian with acute renal failure of unclear etiology.  She has CLL (in remission) and is on valacyclovir for chronic, recurrent HSV.  The question arose of whether valacyclovir is associated with acute kidney injury.

I happened upon this study which came out in AJKD last month.  Contrary to conventional wisdom, acyclovir and valacyclovir do not appear to be associated with AKI hospitalizations, at least within 30 days of new Rx, and as compared with famciclovir.

Sunday, February 17, 2013

Elevated Total Serum Calcium with normal Ionized Calcium.

Happens in multiple myeloma. Treatment not indicated.


Friday, February 15, 2013

Case 4-2013 — NEJM

Case 4-2013 — NEJM

Answer and full case discussion of renal infarct case published in NEJM few weeks back.

Thursday, February 14, 2013

Tuesday, February 12, 2013

Dialysis Modality and Correction of Uremic Metabolic Acidosis: Relationship with All-Cause and Cause-Specific Mortality


Monday, February 11, 2013


1) Can Ocular NSAIDS (e.g ketorolac eye drops) cause AKI?

2) Can Topical NSAIDS (e.g diclofenac skin cream) cause AKI ?  

Thursday, February 7, 2013

Wednesday, February 6, 2013

In Renal Rounds today Dr. Ali presented a case of 78 year old white female with ARF and Nephrotic syndrome with negative serologies and Biopsy showed Minimal change disease. She had history of intermittent NSAIDs use. Dr. S. Verma mentioned that in most of adult MCD with ARF, biopsies also show ATN, which is supported by the following paper.

Attached is retrospective study (cJASN) from columbia and NIH group.  Other important points from this article:

1.MCD with ARF, patients tend to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF.
2.At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. 3.These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy

Tuesday, February 5, 2013

In today's board review with Dr. Reichart, we had a question on Fabry Disease. Attached are two articles.

Imp points: 

X-linked recessive lysosomal storage disease caused by deficient activity of the lysosomal enzyme alpha galactosidase A.

Biopsy of involved or uninvolved skin is relatively non invasive way of making diagnosis.
Presence of Oval fat bodies and lipid droplets with a lamellar pattern and Maltese cross pattern under polarized microscopy of urinary sediment.

Urinary excretion of globotriaosylceramide (Gb3), also known as ceramide trihexoside (CTH), is another
useful approach to diagnosing.

On EM- Enlarged secondary lysosomes (myeloid or Zebra bodies) packed with lamellated membrane structures . These inclusions can vary in appearance, from granular to lamellated, the latter being more diagnostic.

25-50% patients progress to ESRD. Progression from CKD to ESRD  not affected by patient age at onset of CKD or magnitude of proteinuria.

Therapy with alpha-Gal A is associated with improved glomerular architecture and/or reduced glycolipid
deposits in the kidney, possible improvement in renal function.