A better way for CKD staging?

Presently the KDOQI Staging system for CKD (see figure) is what is used most commonly to classify the severity of reduced renal function. This is based purely on an estimation of the GFR, using equations such as the…

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The Erythropoietin Receptor

As we all know, erythropoietin is secreted predominantly by the kidney (85% from the kidney, 15% from the liver) in response to hypoxia and its function is to stimulate erythropoiesis in the bone marrow.  What  is the receptor…

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Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) accounts for a significant fraction of renal artery stenosis. The distinction between fibromuscular dysplasia and atherosclerotic renal artery stenosis is important as the former tends to respond much more readily to interventional therapy than the…

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Combined Kidney/Bone Marrow Transplants

One of the interesting ongoing protocols at the Massachusetts General Hospital Kidney Transplant Program is the combined kidney/bone marrow transplant protocol. The idea here is to transplant both kidney & hematopoeitic stem cells from the same donor, which…

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Lithium-Induced Hyperparathyroidism

Lithium, a very effective medication in the treatment of bipolar disorder, has a variety of well-documented renal side effects, including interstitial nephritis and nephrogenic diabetes insipidus.  A less well-recognized complication is an increased prevalence of hyperparathyroidism in chronic…

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How to Do the Water Deprivation Test

The water deprivation test is useful in the workup of patients with polyuria under certain situations. The differential diagnosis of polyuria often comes down to the following: does the patient have diabetes insipidus (either central or nephrogenic), psychogenic…

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Quality Electrolyte Articles

I was recently alerted to a great lecture series on acid-base & electrolytes by Mitch Halperin and colleagues which are published in the Quartery Journal of Medicine (QJM). They are generally case-based articles which use an imaginary physician…

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Prostaglandin Basics

A few basics about the prostaglandins, a major player in renal hemodynamics. Prostaglandins are fatty acid-based compounds which carry out a variety of cellular effects. The pathway begins with phospholipid within the plasma membrane, which is converted to…

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