Concept Map: Lithium and the Kidney

Topic Discussion: Intravenous Fluids and the Kidney

Specific fluid	Fluid Type	Effect on the kidney	Evidence
Lactate Ringers	Crystalloid	None	SMART  and SALT-ED trial, NEJM 2018 and SPLIT trial JAMA 2015
0.9% Saline	Crystalloid	? more metabolic acidosis, ?AKI	SMART and SALT-ED trial, NEJM 2018 and SPLIT trial JAMA 2015
Albumin	Colloid	None to our knowledge	SAFE study, FEAST study
Hydroxyethyl starch	Colloid	Bad, AKI, osmotic nephrosis leading to more RRT	Perner et al, NEJM 2012
Pentastarch( low molecular weight Hydroxyethyl starch)	Colloid	Bad, AKI, osmotic nephrosis leading to more RRT	VISEP study NEJM 2008
Dextrand	Colloid	Bad, AKI, osmotic nephrosis	First described by Mailloux et al,  NEJM 1967
PlasmaLyte	Crystalloid	None	Shaw et al, Ann Surg 2012

Topic Discussion: Renal Cell Cancer for the Nephrologist

An amazing review just published in Kidney International is a must read for all nephrologists. It takes us from an oncology and urology world and how the world of RCC ties into the renal hands.

The first part of the review focuses on the genetics and molecular aspects of RCC
In the risk factor section, besides genetics, it is important to remember some of the other non genetic risk factors such as Chronic end-stage renal disease on dialysis, Obesity,Smoking,Hypertension
Exposure to dry cleaning solvents,Exposure to trichloroethylene,Diuretics( this is interesting), Radiation therapy,Phenacetin,Arsenic,Cadmium,Sickle cell trait and disease,Nephrolithiasis
Chronic hepatitis C infection( another interesting point).

A bidirectional link is discussed with CKD and RCC that is very important to remember


The best part of the paper is how one approaches a patient with RCC and potential for AKI or CKD post.


Unfortunately, the treatment options for RCC post nephrectomy are potentially also nephrotoxic-- anti VEGF agents, TKIs, and now check point inhibitors. 

http://www.kidney-international.org/article/S0085-2538(18)30139-X/fulltext

A must read for all!