Here is great presentation on HRS by former fellow Damadar Kumbala.
The Gibbs-Donnan Equilibrium or Effect describes the behavior of charged particles near a semipermeable membrane. It explains the balance between electrostatic and osmotic forces. The effect is named after the American physicist Josiah Willard Gibbs and the British chemist Frederick G. Donnan. The Gibbs-Donnan Factor for monovalent cations is 0.95, for example this would mean…
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Scenario #1: Prophylactic dialysis in patients without ESRD Medicine: “Hey we have a patient with CKD that is getting IV contrast for a procedure today and we are consulting you for dialysis afterwards” Nephrology Fellow: “Huh, what are you talking about?” Medicine: “Doesn’t prophylactic dialysis prevent contrast induced nephropathy?” Redbeans: Let’s review some of the…
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We recently saw a 37 year old gentlemen with his second bout of acute alcoholic hepatitis that presented with altered mental status, elevated bilirubin/transaminases, and non-oliguric acute kidney injury. We were consulted as the primary team was concerned about hepatorenal syndrome. We decided that the patient didn’t have HRS given that he had almost 900…
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There is often the discussion of proper volume management in patients with ALI (acute lung injury) or ARDS (acute respiratory distress syndrome). We are often called when the patients develop worsening renal function for whatever reason or issues with volume management, so I thought it best to breifly review both ALI/ARDS and volume management in…
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For the second time in as many years we have seen a patient with Leptospirosis at Tulane Medical Center. This is a fairly rare disease that we are seeing in New Orleans more often that we probably should. Part of the reason is that there are so many gutted house being renovated. People are exposed…
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This week we had an interesting patient that present several months ago with HIV/AIDS with very low CD4 count off HAART for the last several years. The patient presents with nephrotic syndrome with lower extremity edema, normal renal function, and 13 grams proteinuria/day. Renal biopsy was done and showed membranoproliferative pattern with “full house”…
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