SLE and Dialysis
It is well known that patients who are referred to see a nephrologist earlier in the course of their disease are more likely to start dialysis with a functioning fistula and have better overall survival relative to those…
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Gearoid McMahon
Diarrhea and Tacrolimus
Recently, a patient presented to the transplant service with diarrhea and dehydration. He had been trying unsuccessfully to manage his diarrhea at home and was admitted for intravenous fluids. During his work-up, his tacrolimus levels were noted to…
How bad is the long break for dialysis patients?
In this week’s NEJM, Foley and colleagues published a retrospective analysis of the End-Stage Renal Disease Clinical Performance Measures Project (CPM) cohort examining the association of the long interdialytic break (i.e. Friday to Monday for MWF patients and…
From the RFN Archives: Glucocorticoid-Remediable Aldosteronism
Glucocorticoid-Remediable Aldosteronism (GRA) is an inherited autosomal dominant disorder which causes early-onset (often childhood) high blood pressure, often occuring in individuals with Celtic ancestry. It typically presents with standard symptoms of aldosteronism (hypertension, hypokalemia, and metabolic alkalosis) with…
Don’t forget the vitamins
In the absence of glucose, the brain requires a water-soluble, fat-derived fuel for metabolism and ketoacids serve this function. Unsurprisingly, as a result of this, the main factor controlling the production of ketoacids is the relative lack of…
Subclavian subterfuge and “Catheter Last”
While performing an electronic chart biopsy prior to examining a consult patient, I noticed a “nephrologic no-no,” which can be seen on the patient’s chest x-ray coursing under the right clavicle (see image). This finding was confirmed on…
Fractional Excretion
The fractional excretion of sodium (FeNa) is a test that is often used in the setting of acute renal failure to help distinguish between pre-renal and intra-renal causes that has been mentioned in previous blog posts. In general,…
A spoonful of sugar…
Cholera epidemics have been a major public health issue throughout recorded history and much energy was devoted towards preventing them and treating affected patients once they occurred. However, it was not until 1831 that it was recognized that…
Methylene blue and refractory hypotension
My name is Will Pendergraft, and I just completed the clinical portion of the joint nephrology fellowship between Brigham and Women’s Hospital and Massachusetts General Hospital. I was inspired for the first time by Nate Hellman during my…
Mind the Gap
As Nate mentioned in a previous post, the urinary anion gap is helpful in differentiating whether a non-gap acidosis is of renal or extra-renal origin. Urinary Anion Gap = Na + K – Cl Because the major cation…