Calciphylaxis
An ESRD patient on CAPD was recently admitted to our hospital with possible pneumonia. It was noticed that he had painful plaque-like necrosis, with areas of ulceration. Even in the absence of a skin biopsy, the consensus was…
Hypercalcaemia induced polyuria
So Leo’s post got me thinking about the pathophysiology of hypercalcaemia-induced polyuria. I wanted to share what I have learned in relation to the mechanisms of this phenomenon. Calcium-sensing receptors (CaSR) are found on the basolateral membrane of…
NKF Spring Clinical Meeting – Calcium reabsorption
Here are some points from one of the cases presented at the electrolyte workshop this afternoon: The major teaching point was that the reabsorption of calcium closely follows that of sodium. Therefore, in sodium avid states, calcium tends…
Windows to the Soul…and the Vasculature
Continuing the theme of useful Nephrology bedside clinical signs, today we’ll focus on band keratopathy (BK). Often overlooked, this is a band of calcium deposition across the central cornea commonly seen in patients with advanced CKD. It reflects…
Revealed: my “covert” project with Nate a.k.a TRP channels in the kidney
Nate Hellman’s bench was three benches down from my lab. Nate and I trained together as clinical fellows. He and I had also brainstormed on research projects involving TRP channels and kidney disease. TRP channels are my research…
Warfarin and Vascular Calcification
Warfarin has recently been associated with an increased risk of stroke in ESRD patients with atrial fibrillation. This makes the decision whether to initiate warfarin therapy in dialysis patients with atrial fibrilltion anything but clear cut. Add to…
Hypercalcemia of Malignancy
Cancer-associated hypercalcemia is the #1 cause for hypercalcemia in the inpatient setting (in the outpatient setting, the main cause is primary hyperparathyroidism). In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by…
On the mechanism of thiazide-induced hypocalciuria
Back from the 2009 ASN Meeting in San Diego! I’ll admit to a few lapses in blogging, but the meeting kept me pretty busy. Thanks to everybody who stopped by the Renal Fellow Network poster and their encouraging…
The Electrolyte Composition of the Dead Sea
The Dead Sea, located between Israel and Jordan, is considered one the saltiest bodies of water on earth, giving swimmers a peculiar buoyancy when immersed. Interestingly, the electrolyte composition of the Dead Sea is quite different from that…
Bone Scan for Diagnosis of Calciphylaxis?
Calciphylaxis (also called calcific uremic arteriolopathy) is a syndrome of vascular calcification, thrombosis, and necrosis, occurring almost exclusively in ESRD patients. The diagnosis is typically achieved by clinical exam–demonstrating painful, necrotic, and sometimes ulcerating lesions usually on the…