Thiazide (and thiazide like) diuretics are important medications for the treatment of hypertension (HTN). Thiazide diuretics contain a benzothiadiazine core (hence the name thiazide). Thiazide-like diuretics have the same physiologic effect of blocking the Na+Cl- cotransporter in the distal convoluted tubule, but do not contain the benzothiadiazine core. This article will use the
NSAIDS are known to be nephrotoxic. 1-5% of NSAID users have an adverse kidney event Patients with kidney disease are often advised to refrain from NSAIDS. The thing is NSAIDS work. I’m a nephrologist who takes NSAIDS while advising my patients with CKD to avoid them. What gives? I recently was asked what
Hypotonic Hyponatremia In most cases of hyponatremia there is an excess of H20 relative to Na in the body. This decreases the tonicity (osmolality) of the serum. Water then moves from the extracellular to intracellular space down this osmotic gradient. This causes cellular swelling. Cellular swelling in the brain explains the adverse CNS
Lupus can affect the kidney in many ways. The pathologic classification of lupus nephritis is based on kidney biopsy. Lupus can also affect the kidney in other ways outside of the classification system. This article will provide an overview of pathologic and clinical findings associated with the different types of lupus nephritis. General
This article will provide an overview of diuretics including: Mechanism of action Clinical uses Adverse effects The majority of sodium that is filtered by the glomerulus is reabsorbed in the tubules. If you have normal kidney function and normal diet, less than 1% of the filtered sodium is excreted in the urine. Diuretics
The decision whether to give bicarbonate (HCO3-) for metabolic acidosis can be confusing. In some conditions, such as lactic acidosis, bicarbonate has not been shown to be beneficial, may be harmful, and is reserved for very severe acidosis. In other conditions such as Chronic Kidney Disease (CKD) treatment with alkali is recommended to
Infection associated glomerulonephritis. Patient presents with Acute Kidney Injury (AKI) and active urine sediment in the context of a current or recent infection. Pathophysiology and Clinical Presentation Antigen antibody immune complexes form with the antigen from the infection and the antibody from the immune response. These immune complexes deposit in the glomeruli
Hyperkalemia can be classified as mild, moderate and severe as well as acute and chronic. Severe hyperkalemia will be acute as it will require immediate treatment. This article will address treatment strategies based on the severity of hyperkalemia. Treatment of Hyperkalemia Treatment Options Stabilization of cardiac cell membrane Redistribution from extracellular to intracellular
Nephrologists generally use the physiologic approach to diagnosing acid base disorders. Check out this article for an overview of the physiologic approach. Understanding Acid Base Disorders | BCNephro However, there are two other approaches to diagnosis of acid base disorders. Base Excess Physicochemical (Stewart) The Base Excess is routinely reported with blood gas
What is rhabdomyolysis? Rhabdomyolysis is a condition where there is muscle necrosis with release of intracellular muscle contents into the systemic circulation. Most notably: CK (creatine kinase): detected in blood Myoglobin: detected in urine Others AST/ALT If severe: Potassium, Phosphorus, Urate, Lactic acid In rhabdomyolysis the CK is markedly elevated. When is the
