One of the commonest calls that one gets as a renal fellow in the dialysis unit concerns poor flows from catheters. This is often related to catheter-related thrombus formation and there are a number of different strategies employed…
Elevations in serum calcium, phosphorous and PTH have all been associated with increased morbidity and mortality in observational studies of ESRD patients. A variety of agents are available to control these serum parameters including phosphorous binders, intravenous vitamin…
I recently saw a patient with proximal muscle weakness and mild hypophosphatemia, and I wondered whether a serum phosphorous level of 2.2 mg/dL could be the cause. We know that moderate hypophosphatemia is associated with skeletal and smooth…
I have a fresh case with great learning points that I would like to discuss today. So I will continue with the management of sensitized patients on my next blog. Case: This is a 70 yo female with…
Calciphylaxis (also called calcific uremic arteriolopathy) is a syndrome of vascular calcification, thrombosis, and necrosis, occurring almost exclusively in ESRD patients. The diagnosis is typically achieved by clinical exam–demonstrating painful, necrotic, and sometimes ulcerating lesions usually on the…
Heard an excellent presentation at our Renal Grand Rounds today by Dr. Charles O’Neill of Emory University, regarding the process of pathologic calcification in CKD/ESRD patients. One of the points I took away from this talk is that…
One of the hot topics in Nephrology over the past few years has been the epidemiologic and histopathologic studies suggesting oral sodium phosphate colonoscopy preparations as a cause of acute phosphate nephropathy. As evidence continued to mount, the…
This has been known for awhile, but it is worth repeating–sevelamer (Renagel), in addition to its ability to act as a phosphate binder, also results in LDL cholesterol-lowering effects. Two of the early articles (a 1998 Clinical Nephrology…
The clinical entity of refeeding syndrome was first described in U.S. POWs in Japan who had been starved for many months to years, then developed extreme electrolyte abnormalities upon the reintroduction of food. The most common electrolyte abnormalities…
I heard a talk today by one of the fellows in our program who is also the senior author on this recent JASN article: Phosphorus Binders and Survival on Dialysis. Interestingly, even though the current KDOQI Guidelines recommend…
