Using Concept Maps and trying to understand what the medical student already knew and then after reading and doing a renal elective, improved on her "concepts".
Friday, September 30, 2011
Thursday, September 29, 2011
The American Society of Transplantation Blog
Welcome to the blog sphere!
American Society of Transplantation starts a blog for interaction with their members!
http://members.a-s-t.org/blog/beginning-conversation
TOPIC DISCUSSION: SIROLIMUS , not all that benign
The complications that can occur with use of sirolimus are not that benign. The agent is good in certain cases but not all. Besides the known side effects of FSGS, proteinuria and TMA in the kidney, there are other non renal side effects that one needs to be aware of.
1. Leukopenia, Anemia, Thrombocytopenia
2. Impaired wound healing
3. Mouth Ulcers
4. Oligospermia
5. Interstitial Pneumonitis
6. Hyperlipidemia( all increased LDL, HDL and VLDL)
7. Hyperglycemia
Remember to monitor especially for lipids and glycemic control
1. Leukopenia, Anemia, Thrombocytopenia
2. Impaired wound healing
3. Mouth Ulcers
4. Oligospermia
5. Interstitial Pneumonitis
6. Hyperlipidemia( all increased LDL, HDL and VLDL)
7. Hyperglycemia
Remember to monitor especially for lipids and glycemic control
Wednesday, September 28, 2011
In the NEWS: A novel treatment for Pre eclampsia- A renal method
Soluble fms-like tyrosine kinase 1 (sFlt-1), an alternatively spliced variant of the vascular endothelial growth factor receptor 1, induces a preeclampsia-like phenotype in experimental models and circulates at elevated levels in human preeclampsia. This is the factor that leads to decreased VEGF in pre eclampsia and causes the kidney related findings. Mice studies have shown that giving VEGF can alleviate the findings; but giving VEGF might pose significant risk to the fetus. Investigators at Harvard have shown for the first time that sFLT-1 can be removed via apheresis. Dextran sulfate apheresis lowered the levels of sFlt1 and reduced proteinuria, blood pressure and allowed for fetal growth in their observational paper. This pilot study is published in the August Circulation Issue and further testing is needed in a randomized fashion with more subjects to prove this will work.
Tuesday, September 27, 2011
Consult rounds: Secondary causes RULE
When one thinks about glomerular diseases in Nephrology; its interesting that we always have found some secondary causes for everything. All diseases from Membranous GN, Minimal Change, MPGN and igA Nephropathy have known secondary causes and one has to rule them out first. If no cause is found, we hence call it "idiot"iopathic - since we are idiots about the cause. If one looks at each disease specifically, IgA Nephropathy probably has the least known secondary causes and MPGN likely has the most known secondary causes. The rest would fall somewhere in between. Perhaps one day- the list of primary idiopathic will be smaller and known causes can be identified.
Of all the glomerular diseases, when one encounter's MPGN, think secondary and go back to the history and see if there are clues to an underlying secondary cause.
IN THE NEWS:- Renal Cell Cancer Research Update 2011
Renal Cell Cancer(RCC) has been in the limelight recently. Two recent studies provided some interesting links. In a large prospective study, regular use of NSAIDs was associated with a 51% increased risk of RCC after adjusting for multiple variables, according to a report in Archives of Internal Medicine 2011 issue.
The absolute risk differences for regular users compared with nonusers of nonaspirin NSAIDs were 9.15 per 100,000 person-years for the women and 10.92 per 100,000 person-years for the men. This was an analysis of over >75,000 patients. In addition, longer use of nonaspirin NSAIDs was associated with increasing risk. This is the largest prospective trial to look at this link.
In another study recently, researchers have identified an association between RCC and multiple myeloma. They looked at over 57,000 patients diagnosed with RCC as a primary malignancy and over 33,000 diagnosed with multiple myeloma as a primary malignancy. The researchers found 88 multiple myeloma cases in the RCC cohort. Multiple myeloma was 1.51 times more likely to be found in RCC patients than in the general population, according to the investigators. They identified 69 RCC cases in the multiple myeloma cohort. RCC was 1.89 times more likely to be present in patients with multiple myeloma than in the general population.
The absolute risk differences for regular users compared with nonusers of nonaspirin NSAIDs were 9.15 per 100,000 person-years for the women and 10.92 per 100,000 person-years for the men. This was an analysis of over >75,000 patients. In addition, longer use of nonaspirin NSAIDs was associated with increasing risk. This is the largest prospective trial to look at this link.
In another study recently, researchers have identified an association between RCC and multiple myeloma. They looked at over 57,000 patients diagnosed with RCC as a primary malignancy and over 33,000 diagnosed with multiple myeloma as a primary malignancy. The researchers found 88 multiple myeloma cases in the RCC cohort. Multiple myeloma was 1.51 times more likely to be found in RCC patients than in the general population, according to the investigators. They identified 69 RCC cases in the multiple myeloma cohort. RCC was 1.89 times more likely to be present in patients with multiple myeloma than in the general population.
The first study is suggests a link we knew all along but a prospective study confirms it. The second study is novel and not a common association usually thought about. In other words, should we be screening for RCC in MM patients or vice versa?
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