Tuesday, February 26, 2013
The Kidney Doctor: Will Peginesatide (Omontys) ever see the light of ...
The Kidney Doctor: Will Peginesatide (Omontys) ever see the light of ...: In the New York Times story by Andrew Pollack on February 24 , both Dan Coyne and I are interviewed about the peginesatide (Omontys) recall...
Renal Fellow Network: Πάντα ρεί - once more on the (right) fluids
Renal Fellow Network: Πάντα ρεί - once more on the (right) fluids: Yet another manuscript evaluating fluids for IV replacement was published in JAMA this week underscoring the importance and controvers...
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.
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.
Happens in multiple myeloma. Treatment not indicated.
http://www.ncbi.nlm.nih.gov/pubmed?term=1872567
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.
Answer and full case discussion of renal infarct case published in NEJM few weeks back.
Thursday, February 14, 2013
The Kidney Doctor: Guidelines on How To Manage Alport's and Thin Base...
The Kidney Doctor: Guidelines on How To Manage Alport's and Thin Base...: I would recommend that you read the recently published commentary in JASN on Alport's and thin basement membrane nephropathy. It provides ...
The Kidney Doctor: Image Quiz
The Kidney Doctor: Image Quiz: This is a high powered EM of a glomerular capillary loop. What does it show?
Tuesday, February 12, 2013
Dialysis Modality and Correction of Uremic Metabolic Acidosis: Relationship with All-Cause and Cause-Specific Mortality
http://cjasn.asnjournals.org/content/8/2/254.full.pdf
Monday, February 11, 2013
Thursday, February 7, 2013
Renal Fellow Network: From the RFN Archives: Fabry's disease and the kid...
Renal Fellow Network: From the RFN Archives: Fabry's disease and the kid...: I read a nice review of Fabry’s disease recently, and was surprised to read that its prevalence in ESRD may be as high as 1-2%. That fig...
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
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.
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.
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