A quick & dirty guide for what kidney transplant patients should be on for prophylaxis: 1. PCP Prophylaxis: should be given to all patients for as long as they are on steroids. The standard is Bactrim SS given…
It doesn’t take long for the renal fellow to realize that a huge chunk of ESRD hospital admissions are due to catheter-related bacteremia, and a number of different algorithms exist for the management of dialysis catheter-related infections. Typically,…
Interesting case for the weekend: young woman with known lupus, baseline normal kidney function; admitted initially with headaches and “feeling more lupusy than usual”, found to have a creatinine of 2.5 on admission with some dysmorphic RBCs on…
Here’s a video describing basic renal anatomy. Reviewing the vasculature is always a good idea: renal artery–>segmental arteries–>interlobar arteries–>arcuate arteries–>interlobular arteries–>afferent arterioles–>glomerular capillaries–>efferent arteriole.
Saw a patient today in clinic who was s/p simultaneous pancreas-kidney transplant about 15 years ago. The kidney is hanging in there (Cr 2.5mg/dl) and the patient does not require insulin, so we have to consider the transplant…
The ONTARGET trial was on the major trials looking at the potential benefits of dual ACE-inhibitor (ACE-I)/angiotensin receptor blocker (ARB) therapy. Although it was not intended to specifically examine the effects of dual blockade of the renin-angiotensin system…
I heard a great talk today detailing possible changes in store for the national policy for kidney transplant allocation, as set forward by the Organ Procurement and Transplanation Network (OPTN) (the organization which helps administer UNOS). The current…
Schistosoma species–also known as blood flukes and bilharzia–can cause some interesting forms of renal disease. Although this is not so common in the United States, it is a very common public health problem in Africa and Asia. Chronic…
In the U.S., erythropoietin is typically delivered as 3x/week intravenous injections in the ESRD population. This turns out to be a fairly significant cost, as Medicare-related payments for EPO comprise about 25% of the ESRD budget, which itself…
Intradialytic hypotension is a relatively common complication in dialysis patients. Here are some of the common therapeutic options to deal with this: 1. Increase the dry weight: one cause for intradialytic hypotension is simply over-ultrafiltration–if a patient is…
