Spare a thought today for Ronald Lee Herrick who died on Monday at age 79. In 1954, his identical twin brother, Richard, had end-stage kidney disease with little prospect of long-term survival. Dr Joseph Murray, a pioneering surgeon…
Peritoneal dialysis solutions containing glucose polymers are becoming more popular, particularly in patients on APD who tend to retain fluid during their daytime fills. The rationale for their use is that they lead to a reduced absorption of…
When reviewing a consult patient with hyponatremia, the first thing I look at is the medication list to see if the culprit is to be found there. Along with the usual suspects – diuretics, NSAIDs, SSRIs and anti-convulsants,…
In our dialysis unit, the standard HCO3 bath is 35 mmol/L. While it is adjustable, it is rarely changed but recently we had a patient with a pre-dialysis HCO3 of 12 which got me thinking about what constitutes…
One of the commonest calls that one gets as a renal fellow in the dialysis unit concerns poor flows from catheters. This is often related to catheter-related thrombus formation and there are a number of different strategies employed…
The Renin-Angiotensin system is a major mediator of progressive renal injury In CKD and drugs that target the RAS have been shown to slow the progression of glomerulosclerosis, tubulointerstitial fibrosis and proteinuria. However, the effects of even maximal…
Recently we had a patient who, despite good adherence to dietary restrictions and 4 hour dialysis runs, had a high pre-dialysis potassium and an inadequate URR. She had an AVF with a history of multiple central stenoses and…
About 40% of patients treated with mycophenolate after transplantation develop GI side-effects, the commonest of which is diarrhea. A number of strategies can be employed to reduce the severity of these complaints. First, the dose can be taken…
When seeing consults on the maternity floor, figuring out the normal values at the various stages of pregnancy can be a frustrating experience. There are well recognized hemodynamic and biochemical changes which occur from the earliest stages of…
In a previous post I discussed the relative rates of infection and graft failure of femoral and jugular dialysis catheters. As a follow-on I wanted to talk about another potential complication of catheters. Recently one of our patients…
