I was reviewing the treatment of diabetes insipidus the other day, and was reminded of the paradoxical effect of thiazide diuretics on urine output in diabetes insipidus. How does this work? The traditional thinking is that thiazide-induced blockade…
A woman in her 30’s presented with five years of severe hypertension, uncontrolled on trials of four or five agents over the past few years. She had had preeclampsia nine years ago that resolved after delivery, and for…
I recently admitted a dialysis patient to a general medicine service for shortness of breath. When receiving signout from the ED resident, she told me that his troponin T was elevated, but since he had had prior high…
At renal grand rounds today, we heard about a case of severe hypomagnesemia in a patient who was on chronic omeprazole therapy. While the etiology of the low Mg2+ was likely multifactorial, I was surprised to find out…
As usually happens when the renal fellows help with the medical student nephrology block, I found myself confronted last week with questions I couldn’t answer. One involved the pathophysiology of posterior urethral valves (PUV), which came up in…
One of my patients has recently presented a treatment conundrum. She is a young woman with lupus that has required chronic low-dose steroids and mycofenolate mofetil at maximum dose to prevent relapse, a regimen she has been taking…
I recently saw a biopsy for a patient who was suspected of having myeloma-related kidney disease, whose biopsy slides were sent to the pathology department at BWH. Along with them came results from a slew of screening tests,…
And now for a discussion of a burning nephrology question: what happens to a bear’s renal function when it goes into hibernation? (Thank my brother for raising the question while he was a medical student.) The simple answer…
And now for some board review tidbits! Below are some genetic causes of hypertension attributable to specific gene mutations. Glucocorticoid-remediable hyperaldosteronism (GRE)- Autosomal dominant condition caused by uneven crossing over on chromosome 8. A chimeric protein is created…
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…
