A question which comes up not infrequently during nephrology fellowship is whether or not to perform pheresis on patients with multiple myeloma. Once very much in vogue, the results of a fairly recent (Annals of Internal Medicine, 2005)…
A quick one before the July 4th Weekend… Peritoneal dialysis solutions are often color-coded based on the dextrose concentration. Dextrose is used as the osmotically-active agent. As it is partially absorbed, patients with diabetes have to watch out…
Not all peritoneal membranes are created equally. The peritoneal equilibration test (PET) is a standardized method for assessing peritoneal membrane function, and is used for tailoring an appropriate, individualized PD prescription. The test is based on the fact…
We are all familiar with “uremic pericarditis” as one of the standard indications for initiating dialysis, and the number of physical exams with a negative cardiac rub I have documented this year is truly impressive. Which is why,…
What are the cells that make up crescents, the histopathologic hallmark of rapidly progressive glomerulonephritis (RPGN)? Classically these have been thought to be the parietal epithelial cells which make up Bowman’s capsule. However there is now some thought…
Are renin inhibitors the next big weapon in the fight against hypertension? As we all know, ACE-I’s & ARB’s have so many renoprotective effects that there is substantial evidence towards using these medications as first-line agents for blood…
There are a variety of interesting genetic diseases that can cause hereditary Magnesium wasting. Renal magnesium handling is a little different than other ions in that the primary site of reabsorption is not the proximal convoluted tubule. Rather,…
For many years, the existence of “phosphatonins”–substances secreted by certain tumors which result in profound renal phosphorus wasting and resultant osteomalacia–has been postulated. Evidence has recently been accumulating that fibroblast growth factor 23 (FGF-23) is the phosphatonin we…
I was consulted yesterday on a patient with liver and renal failure–obviously, not an uncommon occurrence, as the two often go hand in hand. The patient had presented with altered mental status, and the question came up: hepatic…
A quick fact about foscarnet, one of the many drugs which can cause drug-induced hypocalcemia. Foscarnet is an antiviral medication, commonly used in the treatment of herpesviruses and CMV infections (e.g., CMV retinitis). The mechanism of its hypocalcemic…