PPI-Associated Hypomagnesemia
At renal grand rounds today, we heard about a case of severe hypomagnesemia in a patient who was on chronic omeprazole therapy. While the etiology of the low Mg2+ was likely multifactorial, I was surprised to find out…
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Measures of dialysis dose
As previously discussed on RFN, the urea Kt/V is a measure of dialysis dose that is related to patient outcome. There are several different Kt/Vs encountered in the dialysis literature. spKt/V = single pool eKt/V = equilibratedstdKt/V =…
Primer on Posterior Urethral Valves
As usually happens when the renal fellows help with the medical student nephrology block, I found myself confronted last week with questions I couldn’t answer. One involved the pathophysiology of posterior urethral valves (PUV), which came up in…
Try this in clinic…
It was the usual sort of day in clinic and the team was seeing a middle aged woman with stable diabetic nephropathy and subnephrotic proteinuria. Her blood pressure and blood sugars had been well controlled since the last…
Alimentary Azotemia Redux: A Quantitative Approach
The issue of whether a marked elevation in the BUN when compared with the creatinine might represent gastrointestinal bleeding was nicely covered previously on RFN. One of our attendings recently had our group of first year fellows review…
TRAPS
It’s been a long time since my last blog post, so I have decided to catch up by writing about two cases I saw in my transplant clinic. However, they have the same disease, a brother and sister…
Intradialytic hypertension
I’ve recently had a few calls from our outpatient dialysis unit about patient’s with rises in their blood pressure during and after dialysis. Intradialytic hypotension is a very common phenomenon and it’s been interesting to learn that intradialytic…
PD: Catheter outflow failure
I recently saw a patient in our peritoneal dialysis clinic who had been ultrafiltering about a liter a day but who was now consistently draining 100ml less than his instilled PD solution volumes despite extended drain times and…
Clearance and Kt/V
The complete removal of a substance expressed as volume per unit time is known as clearance. The hemodialysis machine is built to be a urea clearance machine and typical urea clearance rates range from 200-260 ml/min, far more…
Tacrolimus in refractory lupus nephritis?
One of my patients has recently presented a treatment conundrum. She is a young woman with lupus that has required chronic low-dose steroids and mycofenolate mofetil at maximum dose to prevent relapse, a regimen she has been taking…