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acute kidney injury

Cisplatin again

In a previous post, we discussed the way the cilastatin prevents imipenem nephrotoxicity by inhibiting dihydropeptidase, a proximal tubular brush border enzyme which facilitates the uptake of imipenem metabolites into proximal tubular cells. This allows imipenem to be…

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Antibiotics and encephalopathy

Recently I was involved in the care of a renal transplant recipient who was admitted with C. Difficile colitis that was complicated by a bowel perforation. He had a history of hepatitis C with relatively preserved hepatic function….

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Hold the potassium

It was not an unusual event during my clinical fellowship to get a call from the cardiac team asking for dialysis in a patient with hyperkalemia and acute renal failure. On a few occasions the hyperkalemia seemed disproportionate…

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ACT: Now more than thespians

As a kid growing up in the San Francisco ACT brought to mind guys in tights running around and projecting their voices at the American Conservatory Theater. Now I’ve got to adjust my association with the acronym with…

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AKI and Fluid Overload

Even in my limited experience as a first year fellow, it seems that the decision to institute RRT seems to hinge on an idiosyncratic blend of patient and center-specific parameters. I was not surprised to learn that there…

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Peak or Trough?

We were recently consulted on a patient with a history of repeated admissions with pneumonia who had developed AKI following treatment with Tobramycin. It got me thinking about the mechanisms of aminoglycoside toxicity. The traditional teaching is that…

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Sepsis & AKI – an insoluble problem?

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