Thursday, June 27, 2013

IN THE NEWS: The FACEBOOK EFFECT on Organ Donation

Facebook entered the transplantation world sometime back to allow for members to specify organ donation status on their pages. A recent article in the AJT discusses the impact of those changes on organ donor registration. In planning with John Hopkins, Facebook team allowed folks to update their Facebook timeline and decide on what organs they wanted to donate. If they did, it took them to their appropriate state donor registry and they were made aware of materials that offered information regarding donation. The study aimed to evaluate the immediate effect of this status update change on donation. Many updated their status but may have changed their mind but never registered with their state DMV or organ donation website. The online registration was increased with the Facebook effect but varied from state to state. As one reads the entire study, keep in mind this is the "immediate" effect they are talking about. Can this effect be sustainable? This is an observational approach and is it possible that other factors played a role cannot be ruled out. Can there be privacy concerns regarding this approach? Some food for thought...

Interestingly, 2 other studies have been done regarding this connection of Facebook with organ donation. A set of researchers looked at  Facebook for publicly available English pages seeking kidney donors, and information on recipient, page characteristics and if donors were tested. 
Only 91 pages met criteria in their study. What do college students think?- another study looked at that..

Thursday, June 20, 2013

Wild Nephrology explored again

















Soil samples from this locale provided material for WHAT renal immunosuppressive agent?

This is rapamune( sirolimus).  Most of you got this one. It was discovered by Brazilian researchers as a prodcut of bacterium streptomyces hygroscopius in the soils of the Easter Island also known as Rapa Nui.




The US President who died of Bright's disease is Chester A Arthur.
He was the 21st US President. ( 1881-85)

Tuesday, June 18, 2013

Clinical Case 72: Answer and Summary

A 62 year old male with sole microscopic hematuria is asked to seek renal consultation. He has had 3-4 urine samples in the last year with this finding. What would you do next?

Seroligcal workup           0%
Kidney biopsy                2%
Follow closely, nothing specific now        7%
ACEI or ARB therapy                            2%
Urological workup                               87%

This is a common situation faced by many. This can be seen mostly in primary care settings and usually in this age group, urological workup to rule out malignancy of the GU track is likely the first thing to do. But then again, the role of cystoscopy is uncertain in patients with unexplained persistent microscopic hematuria who have no risk factors for malignancy( smoking history, weight loss, B symptoms). The AUA recommendations on asymptomatic microscopic hematuria included the following risk factors for malignancy: ( coutesy AUA and uptodate.com)
  • Age >35 years
  • Smoking history in which the risk correlates with the extent of exposure
  • Occupational exposure to chemicals or dyes (benzenes or aromatic amines)
  • History of gross hematuria
  • History of chronic cystitis or irritative voiding symptoms
  • History of pelvic irradiation
  • History of exposure to cytoxan
  • History of a chronic indwelling foreign body
  • History of analgesic abuse, which is also associated with an increased incidence of carcinoma of the kidney 
 Following that being negative, the choices can be variable. Most would likely follow closely and do nothing specific or potentially do a kidney biopsy. Usually the renal disease with just the above findings has a limited differential and usually benign. 


Tuesday, June 11, 2013

Image Quiz: Wild Nephrology Part 5

Only US president to die from renal failure (Bright’s disease).

Wild Nephrology Explored

Last week we had three questions regarding plants that were related to Nephrology.

Wild Nephrology Part 1: Name the " Electrolyte disorder" most commonly associated with this plant.
This is FloxGlove, the plant that is where we get digoxin from. The best-known species is the common foxglove, Digitalis purpurea. This biennial plant has vivid flowers which range in color from various purple tints through various shades of light gray, and to purely white.
Digoxin inhibits Na-K ATPase as a results K remains outside the cells and results in hyperkalemia. Since K and digoxin compete for the same pump, hypokalemia can make digoxin toxicity worse. So, both Kalemias are associated with this agent- one that worsens the toxicity and other as a result of toxicity. 
 http://circ.ahajournals.org/content/48/4/830.full.pdf



Wild Nephrology Part 2: Name the "electrolyte disorder" associated with this plant.
This is Opium Poppy and the most likely disorder is hyponatremia as a result of extreme nausea. 








Wild Nephrology Part 3: The drug from this plant has to be dose adjusted in CKD. Name the plant and the drug
This is Pacific Yew(Taxus brevifolia)The chemotherapy drug paclitaxel (taxol), used in breastovarian, and lung cancer treatment, is derived from Taxus brevifolia. Dose adjustment is needed for this chemotherapy in CKD patients. There are no FDA-approved labeling guidelines for dosage adjustment in patients with renal impairment. Experts recommend no dosage adjustment necessary for adults with Clcr<50 mL/minute but many do adjust. 

Sunday, June 9, 2013

Image Quiz: Wild Nephrology Part 4

Soil samples from this locale provided material for WHAT renal immunosuppressive agent.


Friday, June 7, 2013

Image Quiz: Wild Nephrology Part 3

The drug from this plant has to be dose adjusted in CKD. Name the plant and the drug


Thursday, June 6, 2013

Detective Nephron: Next venture



Check out the next adventure of Detective Nephron in ASN kidney news June 2013 issue as he tackles a case of hypokalemia

Wednesday, June 5, 2013

Tuesday, June 4, 2013

Image Quiz: Wild Nephrology Part 1

Name the " Electrolyte disorder" most commonly associated with this plant.
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