I recently saw a patient in our peritoneal dialysis clinic who had been ultrafiltering about a liter a day but who was now consistently draining 100ml less than his instilled PD solution volumes despite extended drain times and…
The complete removal of a substance expressed as volume per unit time is known as clearance. The hemodialysis machine is built to be a urea clearance machine and typical urea clearance rates range from 200-260 ml/min, far more…
I recently saw a patient in the emergency department with chronic lithium toxicity and took the opportunity to do some review. Three broad patterns of lithium toxicity are recognized: Acute toxicity – Seen in patients not previously taking…
Elevations in serum calcium, phosphorous and PTH have all been associated with increased morbidity and mortality in observational studies of ESRD patients. A variety of agents are available to control these serum parameters including phosphorous binders, intravenous vitamin…
I had a moment of panic a while back when one of my patients had a seizure after his second ever hemodialysis treatment. I was concerned that perhaps the dialysis disequilibrium syndrome (DDS) might have contributed to the…
As a new renal fellow I’ve felt fairly comfortable with the list of NSAID associated renal conditions. But after taking care of a patient this past month with fulminant hepatic failure due to a Tylenol overdose it’s been…
Hemolytic Uremic Syndrome is characterized by the triad of Microangiopathic hemolytic anemia Thrombocytopenia Renal failure. The disease is broken down into Typical, or diarrhea associated Atypical, or diarrhea negative cases. 90% of HUS cases in the United States…
There are three commonly promoted strategies used in the treatment and prevention of AKI in rhabdomyolysis: 1) Normal saline 2) Bicarbonate containing solutions 3) Mannitol. Volume resuscitation is clearly paramount when treating rhabdo, but whether bicarbonate or mannitol…
