Mineral bone disease in dialysis patients refers to assessment and management of Phosphorus, Calcium, and Parathyroid Hormone (PTH) Pathophysiology The kidney normally is responsible for excretion of phosphorus and conversion of inactive - 25- hydroxyvitamin D to active - 1,25-hydroxyvitamin D via the enzyme 1 alpha-hydroxylase. Therefore with kidney failure there is: Impaired
Diabetic kidney disease is the most common cause of kidney failure. 20-40% of diabetics get diabetic kidney disease. It typically occurs after 5 years of diabetes. Remember that the true duration of diabetes is often not known in patients with type 2 as the patient may have had the condition undiagnosed for a
See my story about how I went from thinking intermittent fasting was impossible to making it a routine habit. What I learned Intermittent Fasting is Not Hard The Body Adapts It Gave Me Confidence The health benefits of intermittent fasting are outlined in this article from the New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMra1905136
This article will address: Diagnosis of metabolic alkalosis and assessment of compensation. Approach to differential diagnosis/ underlying cause of metabolic alkalosis. Metabolic Alkalosis Diagnosis Elevated pH (>7.42) Elevated serum HCO3- (>26) Elevated pCO2 (compensation) What you will initially see (either in the hospital or outpatient setting) is an elevated serum HCO3. This can
Nutrition is an important part of managing chronic dialysis patients so much so that each unit has a registered dietician. Things that I focus on when rounding on a dialysis patient include: Albumin - Malnutrition and protein energy wasting Potassium Bicarbonate - Acid Base status Vitamins - B complex/ C Diabetes Albumin -
MPGN is not a specific disease, it is a pattern of injury seen on light microscopy of kidney biopsy. Membrano - Diffuse thickening of glomerular capillary walls Proliferative - Increased number of cells in the glomeruli Therefore MPGN is when glomeruli have both thickened capillary walls and an increased number of cells. This
You’ve evaluated an acid base disorder. You diagnosed a metabolic acidosis: pH: Low Serum Bicarbonate (HCO3): Low pC02: Low How do you figure out what caused it? This article will provide a framework for differential diagnosis - looking at the: Anion Gap - Is it elevated? Delta - Delta - What’s that? Osmolar
Anemia is an almost universal finding in patients with End Stage Renal Disease requiring dialysis. The following factors contribute: Erythropoietin deficiency: The kidneys normally secrete erythropoietin which stimulates the bone marrow to produce red blood cells. When the kidneys fail, erythropoietin deficiency occurs with resultant anemia. Iron deficiency: Patients on hemodialysis have ongoing
IgA Nephropathy may be the most common glomerulonephritis (GN) in the world. It is most common in East Asians (Chinese and Japanese), relatively common in Caucasians and relatively rare in people of African descent. IgA nephropathy can have a wide range of presentations with variable prognosis. This article will discuss: Clinical presentations Prognosis
Nephrotoxicity from Chemotherapy There are many different mechanisms of nephrotoxicity from chemotherapeutic drugs. These include indirect and direct renal toxicity. Indirect mechanisms Prerenal AKI due to hypovolemia from chemo induced nausea, vomiting, and diarrhea Ischemic acute tubular necrosis (ATN) from neutropenic sepsis or cytokine release syndrome (seen in CAR-T therapy) Direct mechanisms Nephrotoxic
