I recently wrote a short post detailing safety concerns surrounding warfarin use for atrial fibrillation (AF) in dialysis patients. I focussed mostly on the emerging evidence that it may promote vascular and valvular calcification by the inhibition of…
What is your approach to the patient with occasional high, or variable, blood pressure readings, or measurements that bounce around above and below the target range? In such situations, the American Heart Association guidelines on measurement of blood…
Since the retraction of the COOPERATE trial by the Lancet late last year (following Regina Kunz’s famous ‘letter of concern’), combination RAAS blockade has suffered something of a fall from grace. This was dealt a second blow by…
I had a patient come to see me last week with the rare disorder, Birt Hogg Dube Syndrome (BHD). She was referred with a mildly elevated serum creatinine and microalbuminuria against a background of a single kidney following…
According to the most recent NHANEs data, 15.5 million Americans have CKD III, a figure that has increased by over 40% in less than a decade. CKD III is primarily a marker of global health outcomes, and affected…
Nate Hellman MD PhD, the founder of the Renal Fellow Network, died tragically just over two months ago. He was a wonderful person, who possessed a strong sense of humanity, humor and compassion. Nate touched the lives of…
Almost one year ago, Nate posted here about the results of a large GWA study of chronic kidney disease by Kottgen et al. This project was the result of a collaboration between 4 groups, and produced many exciting…
I saw a patient in clinic in follow up this week who was interesting. A 90 year old thoroughly delightful woman who presented last July with acute renal failure, creatinine rising from normal to 4.4 within a period…
Spironolactone has long been favored in the setting of decompensated liver disease; the effective control of “secondary aldosteronism” is usually given as the reason for this in textbooks. However, this is like saying you should open a new…
I recently saw a patient in clinic who has type I diabetes and received a kidney transplant from a sibling ~15 yrs ago. His allograft function remains excellent, but recently his diabetic control has been more difficult, despite…
