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phosphorus metabolism

Poor phosphate control, or is it?

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…

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Journal Club: Cinacalcet

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…

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I recommend some nuts

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…

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Bone Scan for Diagnosis of Calciphylaxis?

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…

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Re-Evaluating the Ca x P Product

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…

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Lipid-Lowering Effect of Renagel

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…

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Refeeding Syndrome

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…

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