Saturday Night Acute Kidney Injury
We recently took over the care of a 20 year old man of Asian origin who was admitted under the surgical team. He presented with 4 days of bilateral, colicky loin pain. He had no past medical history…
Not Just Muscle Damage – The Many Ways Cocaine Causes Kidney Injury
As a nephrology trainee, everyone expects you to know all things nephron. I was having a corridor discussion with a rheumatology colleague about a recent case. He mentioned a young man who presented with acute kidney injury following…
When to Start Renal Replacement Therapy in the Critically Ill?
The vast majority of us have been confronted with these questions: When to start dialysis in a patient in the ICU ? What modality should I start with? What kind of vascular access should I place? How I…
Epstein Barr Virus & Acute Interstitial Nephritis
Acute interstitial nephritis (AIN) has resurfaced as an important cause of kidney injury in the hospitalized patient, particularly because of recent evidence implicating such common medications as proton pump inhibitors. Though most current cases of AIN have been…
False-positive AKI and the perfectly imperfect biomarker
A small absolute change in serum creatinine level, 0.3 mg/dl, is used by Acute Kidney Injury Network (AKIN) and Kidney Disease Improving Global Outcomes (KDIGO) guidelines to define the presence of Acute Kidney Injury (AKI). The base of…
Lazarus Kidney
For my inaugural RFN post, a special case I saw last year with Dr. David Mount and Young-Soo Song a fellow nephrologist in training at BMC. A 74-year-old man with history of HTN, peripheral artery disease, CKD (baseline…
Scleritis and Kidney Disease – More than meets the eye…
Scleritis is a severe inflammation involving the deep episclera and sclera. Symptoms include moderate to marked pain, hyperemia of the globe, lacrimation, and photophobia. Scleritis tends to recur and is frequently associated with an underlying systemic illness, such…
NephroCheck®—can we predict AKI in the ICU? And then what?
Nephrologists have been looking for sensitive biomarkers to predict AKI. Efforts have been made and the idea of “renal angina” was proposed by Goldstein and Chawla in 2010, but still there has been no reliable biomarker commercially available…
Hyperammonemia – When should we start dialysis?
I would like to discuss a case that I recently saw in renal consult. He was a man in his 60s with history of end stage liver disease who received a liver transplant. His hospital course was complicated…
Tick borne diseases for the nephrologist – Babesiosis
The following few posts are a summary of tick borne illnesses that can cause renal failure and/or electrolyte problems. Babesiosis First identified on Nantucket Island in 1969 and was initially know as Nantucket fever. Endemic areas. CDC map….