From Fish To Philosopher
Homer Smith is considered the Father of Renal Physiology. He was a PhD (rather than an MD) whose studies on the fish renal system are amongst the first renal physiology experiments. For instance, his work on the goosefish…
Reporting Live from Mount Desert Island Biological Laboratories
I’m coming to you live for the next week from Mount Desert Island Biological Lab (MDIBL) in Maine, where I’m taking a course entitled “Origins of Renal Physiology.“ The course is designed for renal fellows such as myself…
Ampho-terrible
Amphotericin is one of those medications which keeps nephrologists in business by virtue of its predictable nephrotoxic effects. The mechanism of amphotericin-induced renal failure is felt to be acute tubular necrosis (ATN); the drug binds to sterols in…
Statins in CKD: the 4D Study & More.
Cardiovascular disease is by far and away the #1 killer for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD_. Therefore, HMG coA reductase inhibitors (a.k.a. “statins”)–with their impressive track record of clinical trials showing a…
First Use Syndrome
I have never seen “First Use Syndrome” firsthand, but it usually comes up as a topic when discussing “Complications of Dialysis.” It refers to a severe IgE-mediated anaphylactoid reaction which occurs during the first use of a dialyzer,…
Isopropyl Alcohol
Isopropyl alcohol is unique amongst the toxic alcohols (e.g., ethylene glycol, methanol, etc) in that it causes an osmolar gap WITHOUT causing an anion gap. In addition, unlike the toxic alcohols listed above, it is the isopropanol itself…
UPJ Obstruction
UPJ obstruction is another common congenital abnormality which under some circumstances can lead to significant renal scarring and chronic kidney diseases. About 50% of ultrasounds during pregnancy which detect antenatal hydronephrosis turn out to have UPJ obstruction. UPJ…
Horseshoe Kidney versus Crossed Fused Ectopia
Horseshoe kidney is a relatively common (1 in 400 live births) congenital malformation of the kidney in which the kidneys are fused together. 90% of the time the fusion occurs at the lower poles (upper left photo) and…
ANCA-negative vasculitis
Pauci-immune disease–a common cause of glomerulonephritis–refers to the histologic finding that there is an absence of glomerular immune staining (e.g., no immune complex or anti-GBM staining). Usually this is accompanied by positive ANCA titers, but not necessarily. When…
Intra-abdominal Compartment Syndrome
The case: a 60 year-old woman with a history of metastatic ovarian cancer who presents with a markedly tense, distended abdomen and acute-on-chronic kidney injury, with a Cr which had risen from 1.4 mg/dL to 4.5 mg/dL and…