Dialysis access is the lifeline for patients on dialysis. The goal is to have a durable arteriovenous access (ideally an arteriovenous fistula). However, this is not always possible. The majority of patients initiate dialysis with a catheter and there may be complications that impair the use of the arteriovenous access in prevalent patients.
FSGS is a pathologic description meaning a part (segment) of some of the glomeruli (focal) are scarred (sclerosis). Since scarring is the end result of most glomerular injury, anything that is severe enough for long enough will end up causing sclerosis. It’s like minimal change disease, but worse. It is a more common
This is a topic that is often given as a reason by students and residents for choosing a nephrology elective, wanting to understand acid base disorders. There are multiple ways to assess acid base status. Physiologic Approach Base Excess Approach Stewart Method Nephrologists use the Physiologic approach. What is this? There is an
How do we decide the treatment time or duration of dialysis? How do we assess if a patient is getting sufficient dialysis? Dialysis adequacy refers to the clearance of uremic toxins. Although we use BUN, creatinine and eGFR to assess the degree of kidney function, we don’t use these parameters to assess the
Minimal change disease is a glomerular disease that causes nephrotic syndrome and the first one I’ll be reviewing in this series. Called minimal change as the glomeruli look normal (there are minimal glomerular changes) on light microscopy. Also referred to NIL disease, not sure why they called it that. NIL might be an
Just like in hyperkalemia A useful framework for evaluating nephrology electrolyte issues like hypokalemia is: Too little in Cellular shifts Too much out Before we get to that there also can be artifactual hypokalemia. This happens when the potassium in the body is normal, but enters the cells ex vivo, in the collection
It has become more common for patients with dialysis requiring acute kidney injury (AKI) to be dialyzed in the outpatient setting. With more medically complex patients and the incentive to decrease length of hospitalizations it is not uncommon for patients with dialysis requiring AKI to be discharged from the hospital prior to recovery
So some people don’t think contrast nephropathy is real (Don’t look up). The American College of Radiology and National Kidney Foundation looked at the data: Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation It is also reviewed
Endocrine disorders are in the differential diagnosis of hyponatremia. These need to be distinguished from SIADH (Syndrome of Inappropriate Antidiuretic Hormone). In the article on the laboratory evaluation of hyponatremia read here and watch here, we learned that in hypotonic hyponatremia if the urine osmolarity is > 100 ADH is present and that
What is your differential for nephrotic proteinuria? First: Nephrotic proteinuria > 3.5 grams/ 24 hrs or random urine protein creatinine ratio >3.5 grams per gram Nephrotic syndrome: Nephrotic proteinuria with associated clinical manifestations of hypoalbuminemia, edema, hyperlipidemia As mentioned here: Proteinuria What it is and How I Treat Begin considering these diagnoses when
