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…
This has been discussed between the renal division and the cardiac surgery division in my institution. We know that AKI post cardiac surgery is an independent prognostic factor for mortality (Am J Nephrology 2010 31 408). It’s a…
We were evaluating a kidney transplant recipient three weeks after surgery who presented with a rise in creatinine. We obtained an ultrasound which showed a large fluid collection and mild hydronephrosis. Prograf level was at goal. Peritransplant fluid…
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….
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…
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…
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…
As nephrology fellows we see a lot of Acute Kidney Injury (AKI) on the inpatient consultative service. When AKI in the hospital requires dialysis people and their families naturally want to know whether this means long term dialysis…
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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