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…
The Uncertainty of Monoclonal Gammopathies
I spend a lot of time discussing patients with renal disease and monoclonal gammopathies with my haematology colleagues, trying to figure out what is of ‘renal significance’ and ‘undetermined significance’. One of those discussions recently was around a…
The ELITE & the Rest in Kidney Transplantation
The ELITE-Symphony study enshrined standard triple therapy immunosuppression of tacrolimus, mycophenolic acid and prednisolone, for renal transplant recipients. We get familiar with these agents relatively quickly in our renal training, but what about the other less common agents…
An Under Recognised Cause of Metabolic Acidosis
The MUDPALES mnemonic for raised anion gap acidosis was drilled into me from medical school. However recently after working through each category I became stumped when nothing ticked the box to identify the cause. The lady I had…
Jaundice and Renal Failure
In patients with combined renal and liver dysfunction it is important to differentiate between renal impairment that is secondary to liver disease i.e. hepatorenal syndrome, and conditions where an insult directly affects both the liver and kidney. …
Spontaneous Tumor Lysis Syndrome
A 70 year old Ghanaian man was recently admitted under our care. He had been diagnosed with aggressive myelodysplasia 2 months previously after presenting with fatigue and abnormal blood results (WBC 50.3, platelets 130 and LDH 928 at…
Emphysematous Pyelonephritis
I was asked to see 74 year old man with an acute on chronic kidney injury. He had 2 days of generalised lower abdominal pain and vomiting but no urinary symptoms or fever. His past history included advanced…