"OK, one more patient to go," I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major ...

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Dear John Oliver, First of all, thank you for your recent segment on dialysis. Kidney disease deserves much more attention and discussion than it currently receives. Thank you also for your full-throated support of transplantation and the need for more kidney donors. As a practicing nephrologist, there is nothing better than hearing that one of my patients has been given a transplant. Finally, thank you for pointing out that end-stage renal ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he ...

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I felt a gust of sharp pain a couple of centimeters to the right of my belly button. It will subside, I thought. All pain subsides. It was an easy dictum to follow as a 39-year-old pediatric eye doc who last spent a night in the hospital as a patient in 1977. I’d undergone bilateral laparoscopic inguinal hernia repair ten days earlier, so I was accustomed to brief squalls of discomfort ...

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Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life. It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often "blackballed" from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a ...

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Acute kidney injury (AKI) is hard. Things that seem like they should work often don't. Just ask Perry Wilson. And even the most predictable cases of AKI are resistant to intervention. Look at bypass surgery. We know days in advance the time and place the AKI will occur and despite that foreknowledge, like Cassandra, we are powerless to prevent the AKI. Same with contrast administration (or not). Same ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated for a diagnosis of acute kidney injury. He was diagnosed with gastroesophageal reflux disease 3 weeks ago and was prescribed omeprazole. Several days ago he noticed lower extremity swelling and decreased frequency of urination. Laboratory evaluation showed a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia of several weeks' duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. A couple of months ago I received a Facebook invitation to “like” a page. That was not unusual, and usually the pages are on silly or obscure topics, but this page was different. The name of the page was New Kidney for Stu. Stuart ...

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If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, "UnitedHealthcare Sues Dialysis Chain Over Billing," provides a pre-made case study. In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A ...

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