Pearls

	January 2006 `In case of proteinuria, think of: ACE inhibitors A2 receptor blockers Diltiazem Aldosterone Amlodipine (Norvasc) may worsen proteinuria.`
	`December 2005 Old belief debunked? "No linear association between caffeine consumption and incident hypertension was found." JAMA 2005; 294; 2330-2335 (Nov 9)`
	November 2005 The incidence of ESRD (end stage renal disease) is four times higher in Afro-Americans than in Caucasians. Causes of ESRD: Diabetes mellitus: 47% Hypertension: 24% Etc. `October 2005 Which one(s) of the following is (are) important in prescribing anti-hypertensive meds? (a) sex, (b) age, (c) race, (d) co-morbidities, (e) occupation, (f) marital status, (g) all of the above.`
	August 2005 Cardiovascular dieases account for nearly 40% of deaths among renal transplant recipients
	July 2005 Heparin and LMWH (eg. Lovenox) may cause hyperkalemia due to hypoaldosteronism. Consider fludrocortisone
	June 2005 One (1) out of five (5) dialysis patients dies every year Annual mortality rate: 20%.
	May 2005 Benign peri-ankle edema is seen in 15% of women and 6% of men on amlodipine (Norvasc®).
	April 2005 If your patient’s BUN is high, while the serum remains normal, think of GI bleeding and corticosteroid catabolic effect among your differential diagnoses.
	January 2005 If your patient presents with both hematuria and hemoptysis, think of Wegener’s granulomatosis. It responds to steroids and Cytoxan.
	November 2004 If the patient complains of bubbles in the urines, or of urines looking like liquid soap, think of significant PROTEINURIA. Quantify it.
	October 2004 Hypertensive men have lower testosterone levels than normotensive men. Counterintuitive? No.
	September 2004 In hypernatremia: Na>150, urine SG must be >1020. If it is <1020, in absence of renal failure, think of diabetic insipidus (DI).
	May 2004 In Sepsis Xigris ($1,000/day) improves ICU mortality by 29%. Tight Glycemic Control ($10/day) improves ICU mortality by 29%
	April 2004 Bacterium, due to its trimetoprim moiety, increases serum creatinine without affecting renal function; BUN remains normal. Just do not worry about it.
	March 2004 A serum creatinine level of 1.0 mg/dl is abnormal in 80% of women and 50% of men above the age of 60. Call a nephrologist. Earlier is better than later.
	July 2003 A patient with nephrotic range proteinuria (3.5 grams or more) MUST have a renal biopsy, unless he/she is diabetic or HIV positive.
	June 2003 A simple fundoscopy in a diabetic with hypertension says much of his renal status. *Please, remember to do one.*
	May 2003 Don’t give Demerol to your patients with renal failure. It makes them seize. So does Imipinem (Primaxin), in non-adjusted dosage. And remember to change Digitalis to only q.o.d.
	April 2003 Your ICU patient develops new onset seizures. Which one of his several drips is the cause? Answer: the bicarb drip. Alkalosis indirectly buffers ionized calcium. This is exacerbated by hyperventilation. Rx: Give IV CaCi (not gluconate). Quick, quick.
	October 2002 All Beta blockers (atenolol) increase *LDL* All Alpha blockers (doxazosyn) decrease *LDL* Diuretics (furosemide, HCTZ) increase cholesterol ACE inhibitors are neutral.
	September 2002 If your patient's BP becomes suddenly uncontrolled, check his new glaucoma medications (drops). Some of them, such as Iodipine, Efiprin, Propine are sympathomimetic, therefore vasoconstrictors, and hypertensive. Some anti-rhinitis drugs do the same. Now you hold your culprit...
	August 2002 In hypernatremia: Na>150, urine SG must be >1020. If it is <1020, think of diabetic insipidus (DI). Give DDAVP: 5U SQ, and heck UOsm before and after. If UOsm changes, it is central DI; Rx:nasal DDAVP. If UOsm does not change, it is nephrogenic DI; Rx: thiazide, chlorpropramide.
	June 2002 Clonidine is a bad drug. It often causes bradycardia, impotence, fluid retention, rebound HTN, depression, myocardial ischemia, edema, sedation. It should be used only in last recourse in the treatment of HTN. Even then, only the patch CATAPRES TTS (o.3-0.6 weekly) should be used. *Don't use the PO form.* Never, never.
	May 2002 Lasix has to be filtered to reach the loop of Henle. Before you give Lasix, or any diuretic, look at the SCr. If it is high, give a higher dose; 40 mg Lasix does not work with SCr>2. In renal failure (SCr>5), give 160. Never push more than 80 mg of Lasix I.V. The patient may go deaf!!! Infuse IVSS over 1/2 hour.
	April 2002 I.V. repletion of magnesium (Mg) must be done at least *3 hours* otherwise it is wasted in the urines. Serum Mg does not reflect total body Mg. Give Mg in persistent hypokalemia. Give Mg first, when both Mg and K are low. PO Mg causes diarrhea.
	February 2002 Most studies in therapy of renal failure were done on patients with a serum creatinine between 1.5 to 2.5. Therefore there is no real datum beyond these parameters. They stand as the best indicators on when to refer a patient to a nephrologist.
	November 2001 A serum creatinine level of 1.0mg/dl is abnormal in 80% of women and 50% of men above the age of 60. Call a nephrologist. Earlier is better than later.