Zachary Z. Brener

Nephrolithiasis: evaluation and management.

Nephrolithiasis is a major cause of morbidity involving the urinary tract. The prevalence of this disease in the United States has increased from 3.8% in the 1970s to 5.2% in the 1990s. There were nearly two million physician-office visits for nephrolithiasis in the year 2000, with estimated annual costs totaling

Rhabdomyolysis following clarithromycin monotherapy.

2 billion. New information has become available on the clinical presentation, epidemiologic risk factors, evaluative approach, and outcome of various therapeutic strategies. In this report, we will review the epidemiology and mechanisms of kidney-stone formation and outline management aimed at preventing recurrences. Improved awareness and education in both the general population and among health-care providers about these modifiable risk factors has the potential to improve general health and decrease morbidity and mortality secondary to renal-stone disease.

Acute non-occlusive mesenteric ischemia of the small bowel in a patient started on hemodialysis: a case report

Macrolide antibiotics inhibit the metabolism of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) that may result in myopathy and rhabdomyolysis. We report the first case of rhabdomyolysis related to the administration of clarithromycin without concurrent use of other medications. Inhibition of cytochrome P450 could be one of the potential causative mechanisms of myopathy in our case. Clinicians should be aware of this potential adverse effect of a widely used drug.

Residual Renal Function in Hemodialysis Patients

BackgroundNon-occlusive mesenteric ischemia is not uncommon in chronic hemodialysis patients and is the major cause of an acute abdomen in this population. Intensive ultrafiltration and intradialytic hypotension are usually the precipitation factors. A definite diagnosis is usually late and associated with high mortality. We present a rare case of a patient who developed abdominal symptoms during his first week on HD without having obvious hypotensive episodes.Case presentationA 76-year-old man was admitted with pulmonary edema and renal failure developed abdominal symptoms during his first week on hemodialysis without having obvious hypotensive episodes. Abdominal diagnostic procedures were all unrevealing. Mesenteric ischemia was diagnosed during laparoscopy done on the basis of physical findings and clinical suspicion. Ischemic small bowel of the distal ileum was resected and histopathology examination of the small bowel demonstrated transmural ischemic necrosis with hemorrhages and non-occluded mesenteric artery. Patient maid a steady recovery, and was discharged on the 11th post-operative day.ConclusionMesenteric ischemia should be systematically suspected in dialysis patients experiencing even mild and nonspecific abdominal symptoms with or without hemodialysis-induced hypotensive episodes. Identification of patients at risk and prevention of intradialytic hypotension may help to reduce the incidence of this potentially fatal complication in hemodialysis patients.

Hypokalaemia in a woman with eating disorder

The role of residual renal function (RRF) in the health and quality of life of both pre-dialysis and dialysis patients is equally important and now well established (Termorshuizen, Korevaar et al, 2003). RRF plays an important role in maintaining fluid balance, phosphorus control, and removal of uremic toxins in dialysis patients. The importance of RRF in hemodialysis (HD) patients is less well appreciated and it is believed that RRF declined rapidly in HD patients (Morduchowicz, Winkler et al, 1994; Wang, Woo, et al, 2005). Decline of RRF also contributed significantly to anemia, inflammation, and malnutrition in end-stage renal disease (ESRD) patients (Wang, Sea et al, 2001; Pecoits-Filho, Heimburger et al, 2003; Pecoits-Filho, Heimburger et al, 2002; Wang, Wang et al, 2004). More importantly, RRF has also been shown to be a powerful predictor of mortality, especially in patients on peritoneal dialysis (PD) (Bargman, Thorpe et al, 2001; Brener, Thijssen et al, 2011; Maiorca, Brunori et al, 19951). Glomerular filtration rate (GFR) measured by isotope clearance is considered to be the standard measure of renal function. Other tests, such as serum creatinine, creatinine clearance, urea clearance, an average of the creatinine and urea clearances, and urine volume have been used to assess RRF in chronic kidney disease (Levey, 1990). Despite its limitations, urine volume, the simplest measure of RRF, has been correlated to GFR in studies and most authors defined loss of RRF as urine volume < 200 ml/24 hours (Moist, Port et al, 2000). Urine collections (24 hours for PD, interdialytic for HD) to measure urea and/or creatinine clearance usually done at beginning of chronic dialysis and every 1-3 months in patients with RRF. In this chapter, we will review available data that have shown a positive impact of RRF on the survival and quality of life of dialysis patients, and outline the current strategies to preserve RRF in PD and HD patients.

Acute myocardial injury following penicillin-associated anaphylactic reaction in a patient with normal coronary arteries.

Chronic hypokalaemia often remains a diagnostic challenge, especially in young women without hypertension. A concealed diuretic abuse should be suspected, especially in young women with eating disorders. This case describes a woman with chronic hypokalaemia in whom a thorough medical history and proper laboratory tests were essential to early and accurate diagnosis.