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Nailed It! – Nail Abnormalities and CKD

After some discussion from the NEJM’s Image Challenge from several weeks ago. I decided to very quickly discuss the difference between Terry’s nails, Lidnsay’s nails, and Meurcke’s bands. The lunula (latin for “little moon”) is the hypopigmented semi-circle located at the base of the nail bed and is abnormal or obliterated in several conditions.  …
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A Pain in the Bean – Analgesic Nephropathy Part 1

We recently saw a 68 y/o M with history of ibuprofen 800 mg PO daily for 12-14 years. He had been having long standing minor renal insufficiency for the last 10 years with a progressive worsening of his GFR for about 1 year. The patient was found to have proteinuria of ~ 1 gram/day. Prior…
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NephMadness 2015

Starting March 1st…Everyone get ready! www.NephMadness.com

Has Kayexlate Finally Pooped Out??

So I’ve talk to multiple students and residents and tried to convey the idea that we shouldn’t be so gungho to use kayexlate acutely for hyperkalemia in the hospital (same with the outpatient setting). There is a plaucity of evidence that this resin does very much outside of . Of course it is easier to…
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Big Dippers – Noctural Dipping and CV

There exist a normal physiologic variation in blood pressure and the wake-sleep cycle. There should be a normal decrease of approximately 20% in BP during sleep due to a decrease in sympathetic activity. Conversely there is an increase in BP just before waking and this is believed to be associated with an increase incidence of myocardial infarctions,…
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What is a Lump vs a Hump

A student recently asked me what is the difference between “lumpy bumpy” and “humps”.  These are buzzwords that used to describe pathology on kidney biopsy samples.  While meant to be descriptive, they can also be a bit vague. (Double click on pictures to see full size) 1)  “Humps” Type of imaging:  EM What they are:…
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Clinical Case: Nephrotic Syndrome

A 58 y/o F with history of HTN presents to an outside hospital for pancreatitis and LE edema. While there patient is found to have Hep C (genotype 3). After protracted course due to no improvement in pancreatitis she is transferred to our hospital. While here, a UA is done which shows 3+ proteins and…
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Nephrology Practice Board Question – FSGS Answers

As I’ve been studying I’ve been trying to make up questions of information that I found to be important or interesting (at least to me). These questions and those to follow are a random grouping of  multiple choice, true/false, or guess what I’m thinking. 1.) Collapsing FSGS is associated with what disease/drugs? 1.) HIV 2.)…
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Question of the Day?

Collapsing FSGS is associated with what disease/drugs? 1.) HIV 2.) Parvovirus B19 infection 3.) Interferon therapy 4.) Pamidronate toxicity

Question of the Day?

How does alkali therapy prevent further progression of CKD? A.) Decreases protein reabsorption B.) Decrease renal blood pressure C.) Decreases interstitial inflammation and complement activation D.) Increases renal perfusion Explanation There have been several studies now to support the use of bicarbonate therapy in CKD to prevent progression. On of the larger studies done by Brito-Ashurst…
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