Rapamycin and PCKD
A couple of years ago, it was noted that mTOR inhibitors slowed the growth of cysts in animal models of Polycystic Kidney Disease. Although the activity of mTOR is minimal in normal renal epithelial cells, in cyst epithelial…
Bardoxolone – Part 3
Last year, we had a post about Bardoxolone for the treatment of diabetic nephropathy. After one year of treatment, eGFR increased significantly in patients treated with Bardoxolone relative to controls. At the time, significant concerns were raised about…
Medication Nonadherence in Renal Transplantation: Barriers and Consequences
It is surprising how high the nonadherence rates for immunosuppressants is among renal transplant recipients, ranging from 15 to 40%, despite the potential impact of nonadherence and the degree of education provided to transplant recipients. Nonadherence to immunosuppressive…
Cisplatin again
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…
The ABCs of ADME in AKI
The pharmacokinetics of a drug refers to the study of the absorption, distribution, metabolism and elimination of that drug (often referred to as ADME). Each of these characteristics can be greatly altered in a patient presenting with acute…
Azathioprine in pregnancy
We recently discussed this issue in conference and I thought it might be worth sharing a few interesting points: Azathioprine is normally converted to the active metabolite 6-mercaptopurine. However, in pregnancy the placenta can metabolize azathioprine to thiouric…
Calcium blocker induced dependent oedema
Dihydropyridine (DHP) calcium channel blockers are notoriously associated with dependent oedema, but what mechanisms underlie the pathogenesis of this finding? Here are some explanations from a nice review I came across. Going back to Starling’s forces governing the…
Cisplatin nephrotoxicity
Cisplatin was discovered more than 40 years ago, and is still widely used in chemotherapy regimens for many different types of cancer. Its wider use has been limited by toxicities, one of which is nephrotoxicity. Nate Hellman also…
Imipenem – why can’t we use it alone?
Imipenem is a beta-lactam antibiotic that has a wide spectrum of activity against gram negative and gram positive organisms and is commonly used in an ICU setting. It is always given in combination with Cilastatin and in most…
Drug-induced hyponatremia
When reviewing a consult patient with hyponatremia, the first thing I look at is the medication list to see if the culprit is to be found there. Along with the usual suspects – diuretics, NSAIDs, SSRIs and anti-convulsants,…