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Graham Abra

The Brave New World of Renal ACOs

This past week CMS announced the formation of a new form of payment and service delivery for patients with ESRD – the ESRD Seamless Care Organization (ESCO) – essentially an ACO specifically and exclusively for individuals with ESRD….

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Pearls for Boards

1) Surreptitious vomiting or diuretic abuse – metabolic alkalosis, Laxative abuse – non-gap metabolic acidosis. 2) Aquaporin 2 –  apical membrane of collecting duct, Aquaporins 3 and 4 – basolateral membrane of collecting duct, Aquaporin 1 – proximal tubule….

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Phosphorous Binder Equivalent Dose

Ever encountered this situation?  You’re going about your daily business and discover that one of your patients on hemodialysis has an elevated phosphorous. You skim through the list of prerequisites and see that yes, the nutritionist has been…

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Pearls for Boards

1) In diabetic glomerular disease you can see linear staining of GBMs with IgG, Kappa and Lambda. 2) The three C3 immunoflourescence patterns of post strep GN 1) Starry Sky (most common) 2) Garland (less common) 3) Mesangial (resolving Starry…

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Pearls for Boards

1) Icodextrin sometimes causes a desquamating rash on the palms and soles. 2) Sirolimus, five side effects to watch 1) Poor wound healing 2) Lung toxicity 3) Hyperlipidemia 4) Proteinuria 5) Anemia/Thrombocytopenia. 3) Classic EM finding in post infectious GN: Large…

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Pearls for Boards

1) Monoclonal Immunoglobulin Deposition Disease breakdown – 80 to 90% LCDD, 10 to 20% LHCDD, <5% HCDD. 2) Small studies suggest tamoxifen and steroids may be of benefit in management of Encapsulating Peritoneal Sclerosis in patients on PD. 3) Sodium restriction…

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Pearls for Boards

1) Alkaline urine encourages calcium phosphate nephrolithiasis. Three predisposing factors to watch for – 1) distal RTAs 2) Acetazolamide 3) Topiramate. 2) IgA nephropathy, common in Asians and Native Americans, rare in African Americans. 3) Stay alert for triphasic pattern of…

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Pearls for Boards

1) Topiramate – Watch for non-gap acidosis, nephrolithiasis and hyperammonemia. 2) Jak2 – the intracellular kinase activated by the binding of Epo to the Epo receptor. 3) Live vaccines are contraindicated in kidney transplant recipients – these include MMR, Varicella, Yellow…

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Differentiation Syndrome

I was recently rounding on a gentleman in the ICU with acute promyelocytic leukemia (APL) who, after starting induction therapy with tretinoin (all-trans retinoic acid), developed fever, hypotension, new pulmonary infiltrates with associated respiratory failure and AKI requiring…

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