Monday, May 7, 2018

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

Hydroxyethyl starch

Colloid
Bad, AKI, osmotic nephrosis leading to more RRT


Pentastarch( low molecular weight Hydroxyethyl starch)

Colloid
Bad, AKI, osmotic nephrosis leading to more RRT

Dextrand

Colloid
Bad, AKI, osmotic nephrosis

PlasmaLyte

Crystalloid
None



Tuesday, April 24, 2018

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!

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