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Differentiation Syndrome

I was recently rounding on a gentleman in the ICU with acute promyelocytic leukemia (APL) who, after starting induction therapy with tretinoin (all-trans retinoic acid), developed fever, hypotension, new pulmonary infiltrates with associated respiratory failure and AKI requiring…

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Hypercalcemia of Malignancy

Cancer-associated hypercalcemia is the #1 cause for hypercalcemia in the inpatient setting (in the outpatient setting, the main cause is primary hyperparathyroidism). In general, hypercalcemia of malignancy portends a poor prognosis, and there are three main mechanisms by…

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Bence-Jones Protein

I had always assumed that the “Bence-Jones” protein–essentially, the demonstration of monoclonal light chains on urine protein electropheresis (UPEP)–was named after two doctors, Bence & Jones.  However I recently found out that actually it was named after a…

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Genetics of Wilms Tumor

Wilms Tumor–named after the German surgeon/pathologist Max Wilms (pictured at left)–is an embryonal tumor that derives from developing kidney tissue. Wilms was the first to postulate that tumors may arise from precursor cells which arise during development, and…

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Serum Free Light Chain Assay

The dilemma:  there are a subset of patients with some type of paraproteinemia–e.g., light chain deposition disease or amyloidosis, for instance–which are NEGATIVE by SPEP & UPEP.  When there is renal involvement, the diagnosis can potentially be made…

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The Erythropoietin Receptor

As we all know, erythropoietin is secreted predominantly by the kidney (85% from the kidney, 15% from the liver) in response to hypoxia and its function is to stimulate erythropoiesis in the bone marrow.  What  is the receptor…

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How much Cytoxan is too much?

Cytoxan is a very potent but also potentially toxic medication used for a variety of immune-mediated (and nephrology-relevant) diseases. It is often classified as a “cytotoxic agent”, as it works as an alkylating agent that explains its utility…

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