Ultrafiltration for Heart Failure
The concept of removing excess fluid via ultrafiltration (UF) is not a new one. The first described use of UF dates back to 1974. Back then, drip clamps were used to calibrate the amount of UF. For this…
DREAM-CARD. Diuresis Related Endpoints After Major CARDiac surgery
This is my contribution to the Dream RCT in Nephrology poll being coordinated by UKidney. As a nephrologist it seems one spends a lot of time trying to rationalize the use of diuretics in the Cardio-Thoracic ICU. Volume…
Diuretics in acute decompensated heart failure – evidence?
A randomized controlled trial of loop diuretics was published in NEJM two weeks ago. The trial involved 308 patients, from 26 clinical sites. The details are below: Type: Prospective double-blind randomized controlled trial (intention to treat analysis) Inclusion:…
Under Pressure!
Renal failure occurring in the setting of acute decompensated heart failure (ADHF) is traditionally believed to be due to renal hypoperfusion from poor “forward flow”. This mechanism has intuitive appeal, and appears to be borne out by our…
Are all thiazides created equal?
At the Brigham Renal Board Review course (review of board prep options) a few weeks ago, Dr Burton Rose argued that for all of us who use thiazide diuretics (review of thiazides) to treat mild hypertension, chlorthalidone should…
Endocrine and thiazide-induced hyponatremia
We have all been taught that before making the diagnosis of SIADH, we have to ensure that the patient has normal adrenal and thyroid axes. Why is this so important and how do thyroid and adrenal dysfunction cause…
Thiazide Diuretics
There is a good review article in this month’s NEJM entitled “Use of Diuretics in Patients with Hypertension” by Ernst and Moser which focuses predominantly on the thiazide class of diuretics. The thiazides are considered a FUNCTIONAL rather…
Kidney Clips
It’s the weekend, I need to decompress from the boards. Here’s some random kidney-related clips. The first is pretty bizarre. This next one is pretty basic, but the animation is good.
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…
Potassium-Sparing Diuretics
The potassium-sparing diuretics consist of the following 4 medications–only some of which (spironolactone & eplerenone in the list below) are structurally similar. Spironolactone is an antagonist of the aldosterone receptor, which like other steroid receptors is an…