Fistula First Controversy
In 2003, the Fistula First Initiative was enacted, in which an attempt is actively being made to get as many dialysis patients as possible to get dialyzed via an AV fistula. As AV fistulas have been perceived to…
Vancomycin & Red Man Syndrome
Once a frequent culprit of acute interstitial nephritis, vancomycin is a very rare cause of renal failure with newer formulations which use a different vehicle for its iv administration. It still however has the potential to cause the…
Neonatal Lupus
Neonatal lupus occurs when autoantibodies are transmitted from the mother to the fetus; it usually manifests as a transient and mild lupoid rash which lasts 3-6 months, but can also result in more serious manifestations such as congenital…
Treating Lupus Nephritis During Pregnancy
It is somewhat controversial whether or not pregnant women with lupus experience flares more frequently than their non-pregnant counterparts. Regardless, however, the issue of a lupus flare in a pregnant patient is not uncommon, especially considering that the…
Sporadic Hypocalcemia and Gadolinium
It turns out that not only do gadolinium-based contrast agents result in nephrogenic systemic fibrosis (NSF), but certain ones can also interfere with some of the common assays for quantifying serum calcium, leading to sporadic hypocalcemia. The two…
Proof That Kidneys Are Important
As a 2nd year nephrology fellow I am now doing some work in a lab which studies zebrafish kidney development. Here is an example of a control (wild-type) zebrafish at 54 hours post-fertilization. If you use a morpholino…
New Mechanism for Cyclosporin in Proteinuric Disease
Cyclosporin A (CsA) has been a mainstay of therapy for nephrologists: it (along with tacrolimus) has become the cornerstone of immunosuppressant therapy for kidney transplant patients; in addition, it has also seen use as an effective agent in…
Cadmium Toxicity
Heavy metals & the kidney are an interesting topic all-around. Aberrant metabolism of heavy metals such as iron, copper, lead all contribute to significant renal pathology. And you can add the heavy metal cadmium to that list as…
Case of Hyperammonemia & Fanconi’s Syndrome
Quick case summary as presented in Renal Grand Rounds today: A 54 year-old man presents with altered mental status, a sky-high ammonia level (>200) and anemia requiring blood transfusion. Other unusual lab values include hypophosphatemia and hypokalemia with…
Adynamic bone disease
Adynamic bone disease is being increasingly recognized as the most common form of renal osteodystrophy. It is characterized by the reduced synthesis of bone matrix due to decreased osteoblastic and osteoclastic activity. Adynamic bone disease is distinct from…