Achilles heel of dialysis

Vascular access is the Achilles tendon of hemodialysis. Just yesterday, I saw a patient with one of those lumbar catheters… Examining his arm revealed that he had failed 4 attempts of access creation (2 fistulas and 2 grafts)….

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Typical HUS: beyond shiga

Hemolytic Uremic Syndrome is characterized by the triad of Microangiopathic hemolytic anemia Thrombocytopenia Renal failure. The disease is broken down into Typical, or diarrhea associated Atypical, or diarrhea negative cases. 90% of HUS cases in the United States…

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Vas-cath exposure variability

How many vas-caths did you (the renal fellow) place during your clinical year (1 year)? Poll results: 0-5 (IR does most of these) 4 (4%) 0-5 (Surgery does most of these) 2 (2%) 0-5 (IM residents do most…

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Therapeutic misadventures in rhabdo

There are three commonly promoted strategies used in the treatment and prevention of AKI in rhabdomyolysis: 1) Normal saline 2) Bicarbonate containing solutions 3) Mannitol. Volume resuscitation is clearly paramount when treating rhabdo, but whether bicarbonate or mannitol…

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World Cup fever

Congratulations to the USA and England on going through to the second round of the World Cup today. As an Irishman, I will confess to a modicum of schadenfreude at the humiliating exit of France yesterday, but we…

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Of snakes and men

As mentioned in a previous post, there is not much salt available in the Amazon and as a result, the inhabitants (human and otherwise) have developed very active renin/angiotensin systems in order to retain whatever salt they can…

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The bad habit of ACEI!!!!

Coming to the transplant clinic from 2 years of CKD clinic, prescribing ACEI/ARBs was a habit, a good one I guess. Does this hold truth in the transplant world, well… I am not sure anymore after I read…

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Board question: Transplant-1 answer

The vast majority of people answered correctly; the best answer is D. Approximately 3-5% of patients with Alport’s syndrome develop de novo anti-glomerular basement membrane (GBM) disease in the transplanted kidney. Alport’s syndrome is a genetic disorder that…

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No salt, no hypertension

Back in the early 1970s researchers traveled into the jungle in Northern Brazil to visit a group of Indians. The Yanamomo tribe had lived in isolation for thousands of years and had only been contacted in the 1950s….

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Ultrasound guided vas-cath placement

Much of the clinical year of the renal fellow is spent in the hospital rounding on patients admitted with access malfunction, catheter related infections or are in the ICU’s with acute kidney injury. Many of these patients will…

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