ABSTRACT
Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at the bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice, including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum, including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, is needed before POCUS training is universally incorporated across nephrology fellowship programs.
Subject(s)
Nephrology , Point-of-Care Systems , Curriculum , Point-of-Care Testing , UltrasonographyABSTRACT
PURPOSE OF REVIEW: The purpose of this review is to provide a brief summary about the current state of knowledge regarding the circadian rhythm in the regulation of normal renal function. RECENT FINDINGS: There is a lack of information regarding how the circadian clock mechanisms may contribute to the development of diabetic kidney disease. We discuss recent findings regarding mechanisms that are established in diabetic kidney disease and are known to be linked to the circadian clock as possible connections between these two areas. Here, we hypothesize various mechanisms that may provide a link between the clock mechanism and kidney disease in diabetes based on available data from humans and rodent models.
Subject(s)
Circadian Clocks , Diabetes Mellitus , Diabetic Nephropathies , Circadian Rhythm , Humans , KidneySubject(s)
Brain/diagnostic imaging , Kidney Calculi/chemically induced , Liver Transplantation/adverse effects , Sulfadiazine/adverse effects , Toxoplasmosis, Cerebral/blood , Aftercare , Antimalarials/therapeutic use , Antiprotozoal Agents/adverse effects , Antiprotozoal Agents/therapeutic use , Atovaquone/administration & dosage , Atovaquone/therapeutic use , Brain/parasitology , Brain Edema/diagnostic imaging , Female , Humans , Kidney Calculi/diagnostic imaging , Magnetic Resonance Imaging/methods , Middle Aged , Pentamidine/adverse effects , Pentamidine/therapeutic use , Pneumonia, Pneumocystis/prevention & control , Sulfadiazine/therapeutic use , Toxoplasmosis, Cerebral/cerebrospinal fluid , Toxoplasmosis, Cerebral/drug therapy , Toxoplasmosis, Cerebral/parasitology , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Ultrasonography/methodsABSTRACT
Drug-induced acute interstitial nephritis is an important cause of unexplained acute kidney injury in hospitalized patients. It can present with nonspecific clinical features, and renal biopsy should be considered for definitive diagnosis. Removal of the offending agent along with early initiation of corticosteroid therapy is the mainstay of treatment.
ABSTRACT
Bullous pemphigoid has been linked to allograft rejection, as well as membranous nephropathy in renal transplant recipients. Although there is a possibility of multiple distinct autoimmune processes, immune stimulation induced by allograft rejection or antibasement zone antibody interactions are possible mechanisms for the simultaneous skin and renal involvement.
Subject(s)
Kidney Failure, Chronic/complications , Vascular Calcification/complications , Fingers/diagnostic imaging , Gangrene/etiology , Genitalia, Male/diagnostic imaging , Hemodialysis, Home , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Thiosulfates/administration & dosage , Toes/diagnostic imaging , Treatment Failure , Vascular Calcification/therapySubject(s)
Aortic Diseases/complications , Kidney Failure, Chronic/therapy , Pain/etiology , Renal Dialysis/adverse effects , Testicular Diseases/etiology , Testis/blood supply , Vascular Calcification/complications , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/physiopathology , Computed Tomography Angiography , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/diagnosis , Male , Pain/diagnosis , Pain/physiopathology , Regional Blood Flow , Testicular Diseases/diagnosis , Testicular Diseases/physiopathology , Ultrasonography, Doppler , Vascular Calcification/diagnostic imaging , Vascular Calcification/physiopathologyABSTRACT
Calcific uremic arteriolopathy (CUA) or Calciphylaxis is a rare disease typically seen in end stage renal disease patients on dialysis and is associated with high mortality rates, mainly because of sepsis. Medial calcification of the dermal arterioles is the characteristic histologic finding together with vascular thrombosis and ischemic necrosis. CUA involves legs, abdomen and gluteal region in majority of the patients. Herein, we present a case of CUA of the glans penis in a uremic patient. Unfortunately, the patient died of sepsis in a few weeks after initiating dialysis.
