Showing posts with label Nephrology. Show all posts
Showing posts with label Nephrology. Show all posts

17 April 2016

Tubulointerstitial injury Ppts and published articles





Tubulointerstitial injury

Urinary Biomarkers in Experimental Diabetes
http://www.augusta.edu

Tubulointerstitial Diseases
http://www.mona.uwi.edu

Obesity and Renal Failure
David Shure
https://www.med.nyu.edu

Acute Renal Failure
Deb Goldstein
http://faculty.georgetown.edu

Medicine Grand Rounds
Hamid Moradi M.D.
https://www.medicine.uci.edu

Altered Renal Function
http://www.clt.astate.edu
http://www.clt.astate.edu

Renal Disease:  Overview and Acute Renal Failure
http://www.auburn.edu

Laboratory Evaluation of Renal Function 
S .POPLI. M.D.,F.A.C.P.
http://www.stritch.luc.edu

Alterations of Renal and Urinary Tract Function
http://users.ipfw.edu/

Diabetic Nephropathy
Yiming Lit, M.D.
http://imed.stanford.edu

Chronic Kidney Disease
Sandeep Vetteth
https://www.utoledo.edu

Chronic Renal Failure
https://vmw-lmsc.duhs.duke.edu

Renal Pathophysiology II
Iain MacLeod, Ph.D
http://isites.harvard.edu/

Chronic Renal Failure
http://www.hsc.unt.edu

Categories of Volume Disorders
https://www.med.unc.edu

Idiopathic Membranous Nephropathy
Paul M. Johnson
https://www.med.unc.edu


238 Published articles on Tubulointerstitial injury

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03 October 2014

Hyperphosphatemia Ppts and latest published articles



Hyperphosphatemia: Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood.

Chronic Kidney Disease
Sandeep Vetteth
https://www.utoledo.edu

Vascular Calcification
Kristina Boström, MD, PhD
https://www.mcdb.ucla.edu/VBTG/VascCalc_Bostrom.ppt

Hem/Onc Emergencies
Peter Newburger, MD, Venee Tubman, MD
https://www.umassmed.edu

The Cellular Environment: Fluids and Electrolytes, Acids and Bases
http://users.ipfw.edu

Dyatrophic Calcinosis
Dr Abdelaziz Elamin, MD, PhD
http://www.pitt.edu/

Functions of the Kidneys 
http://www.austincc.edu

Chronic Renal Failure
http://www.hsc.unt.edu

Regulation of Phosphate Transport in Proximal Tubule
Alexander Usorov, MD
http://medicine.med.nyu.edu

Nephrology Grand Rounds
http://medicine.med.nyu.edu

Minerals
Dr Reed Berger
https://www.uic.edu/depts/mcam/nutrition/ppt/Minerals1_add.ppt

Hem/Onc Emergencies
Saulius Girnius
http://www.bumc.bu.edu

Fluid, Electrolyte & Acid-Base Balance
http://academic.evergreen.edu

Polycystic Kidney Disease
http://www.smccd.net

Stressors Affecting
Fluid & Electrolyte Balance
K. Burger, MSEd, MSN, RN, CNE
http://www2.sunysuffolk.edu

Chronic Renal Failure
Matt Crowley, Doug Srygley , Vijay Reddy
https://vmw-lmsc.duhs.duke.edu

Electrolyte Abnormalities in the Hospitalized Patient
Cynthia Seitz MD
http://medicine.nevada.edu

Kidney Function & Disease
McCafferty
http://www.csuchico.edu

200 Latest Published articles of Hyperphosphatemia

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01 March 2014

Hypovolemic hypernatremia ppts and 200 latest published articles



Hypovolemic hypernatremia

Hypernatremia is strictly defined as a hyperosmolar condition caused by a decrease in total body water relative to electrolyte content.  Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body.

Electrolyte Abnormalities in the Hospitalized Patient
Cynthia Seitz MD
http://www.medicine.nevada.edu/
Metabolic Abnormalities
Asha Bale, MD
http://njms.rutgers.edu

Approach to 
Hyponatremia
https://www.medicine.uci.edu/

Hyponatremia
James Yost, MD, MS, MBA
http://www.fpm.emory.edu/

Fluids, Electrolytes and Shock
Tom Archer, MD, MBA
http://anes-som.ucsd.edu/

Hyponatremia
Debra Bynum,MD
http://www.med.unc.edu/

Fluids and Electrolytes
Charles Hobson MD MHA
http://education.surgery.ufl.edu/

Fluids Therapy
Dan Belz
http://www.unmc.edu/familymed/docs/IV_Fluids.ppt

Hyponatremia SIADH
Koorosh KamgarMD
http://www.nephrology.med.ucla.edu/
Fluids and Electrolytes
Warren Gasper
http://www.surgery.ucsf.edu

Fluids and Electrolytes
R. Lawrence Reed, II, MD, FACS, FCCM
http://www.meddean.luc.edu

Fluids & Electrolytes
http://www.bu.edu/fammed/peds/fluids&Lytes.ppt

Fluid and Electrolyte Abnormalities
https://webcampus.med.drexel.edu/ 

Basic Fluids and Electrolytes
Douglas P. Slakey
http://tulane.edu/

Latest 200 Published articles of Hypovolemic hypernatremia

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28 July 2013

Obstructive nephropathy Ppts and publications



Nephrolithiasis
Adnan Alsaka M.D.
http://www.utoledo.edu

Introduction to Dialysis
Melissa M. Schnell, MD
http://www.med.wright.edu

CKD Board Review
Suneel M Udani MD MPH
http://medchiefs.bsd.uchicago.edu

MKSAP Review – Glomerular Diseases
Patrick Cunningham M.D.
http://medchiefs.bsd.uchicago.edu

Hypertension In  Children
http://pediatrics.med.unc.edu

Chronic Renal Failure in Children
Maria Ferris, MD
http://pediatrics.med.unc.edu/

Bad Beans Acute Renal Failure
http://www.unmc.edu

Partnering with Children & Families
Jane W. Ball, Ruth C. Bindler
http://w3.salemstate.edu


26 Published articles on Obstructive nephropathy

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24 April 2013

Acute pyelonephritis Renal failure UTI Ppts Published articles



Tubulointerstitial Diseases
http://www.mona.uwi.edu/

Renal Pathology
http://www.dent.ohio-state.edu/

Nursing Management of Genitourinary Dysfunction
http://www.bhslr.edu/

Introduction to Clinical Laboratory Practices - Renal Diseases
http://colleges.weber.edu/

Urinary Tract Infections & Tubulointerstitial Kidney Diseases
Francisco G. La Rosa, MD
http://pathinformatics.com

Acute Renal Failure
Malcolm Cox, M.D.
http://mycourses.med.harvard.edu

Fever During and After Childbirth
http://www.hawaii.edu/

Diseases of the Kidney Major Determinants of Disease
http://nhscience.lonestar.edu

Drug Therapy of Urinary Tract Infections
http://www.epcc.edu/

Altered Renal Function
http://clt.astate.edu

Renal Pathology
Greg Balko, MD
http://www.med.wright.edu

Renal & Urologic Problems
http://faculty.msmc.edu

Urinary System Diseases
https://sharepoint.btc.ctc.edu20Diseases.ppt

Urinary Tract Infection (UTI)
http://www.smccd.edu

Overview of Acute Renal Failure
http://www.med.unc.edu

Acute Abdominal Pain
http://www.med.unc.edu/

Renal Pathology
http://zoomify.lumc.edu

Urine & Body Fluid Analysis
http://webmedia.unmc.edu/

Urinary tract infection in children
Professor Abdelaziz Elamin
http://www.pitt.edu/

Renal Failure
Miss Fatima Hirzallah
http://elearning.najah.edu

Disorders of Renal Function
http://www.morgancc.edu

Drug Therapy of Urinary Tract Infections
http://sst.nsu.edu


Published articles

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19 July 2012

Membranous Nephropathy



Idiopathic Membranous Nephropathy
Paul M. Johnson
https://medicine.med.unc.edu/

Idiopathic Membranous Glomerulonephritis!
http://www.infoplex.northwestern.edu

Treatment of Idiopathic Membranous Nephropathy
Alexander Usorov, MD
http://medicine.med.nyu.edu

Glomerular diseases
http://www.meddean.luc.edu

MKSAP Review – Glomerular Diseases
Patrick Cunningham M.D.
http://medchiefs.bsd.uchicago.edu/

Renal Pathology
Greg Balko, MD
http://www.med.wright.edu

Glomerular  Disease and Glomerular  Case Studies
Arthur  S. Schneider, M.D.
http://cmspath.edu

Battling the B cell- New biologic therapies for Lupus
Jennifer  H. Anolik, MD, PhD
http://www.urmc.rochester.edu

Glomerulo-pathies
Dr. Vivo
http://www.ttuhsc.edu/

Renal Pathology Glomerular Disorders
http://student.ttuhsc.edu

HIV associated nephropathy
Oleg Rubin, MD
http://intmedweb.wfubmc.edu

Nephrology Board Review
Palak Parikh
https://medicine.med.unc.edu

Extrapulmonary Sarcoidosis
Darrell Laudate
https://medicine.med.unc.edu/

The Great Imitator
Eric Edwards, MD
http://www.med.unc.edu/

207 free full text published articles on Membranous Nephropathy

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04 July 2012

Renal cysts




Polycystic renal disease
Anjali Shinde, MD
http://cmspath.edu/

GU Imaging
http://radiology.med.sc.edu/2012
http://radiology.med.sc.edu/2011

Renal Cysts Progressive Disorder
http://zircon.mcli.dist.maricopa.edu

Human Genetics of Urinary Tract Malformation
Ali Gharavi, MD
http://www.columbia.edu

Disorders of Renal Function
http://www.morgancc.edu/

Case Presentation
http://hematology.im.wustl.edu/

Hyperparathyroidism
Sarah Rodriguez, MD, Shawn Newlands, MD, PhD
http://www.utmb.edu/

Renal Tumors
Anjali Shinde, MD
http://cmspath.edu

Hematuria
Sarah Swartz, MD
http://www.bcm.edu/

Renal Cell Carcinoma
http://www.infoplex.northwestern.edu

Medical Nutrition Therapy for Renal Disorders
http://www3.uakron.edu

Morbidity and Mortality Conference
Gregory Friberg, M.D.
http://geiselmed.dartmouth.edu

Tumor-to-Tumor
Steven Sorscher
http://hematology.im.wustl.edu

Angelman Syndrome, Rett Syndrome, and Tuberous Sclerosis
Jennifer A. Vickers, MD
http://som.unm.edu

Urinary System
http://faculty.ccri.edu

A Case Study about Cystinuria by Amy Albright
http://www.medlabcareers.msu.edu

Renal cysts and Tumors
http://www.mona.uwi.edu

Kidney and Upper Urinary Tract
J. Stuart Wolf, Jr., M.D.
http://open.umich.edu/


78 Free full text published articles on Renal Cysts

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16 June 2012

Obstructive Uropathy



Nephrolithiasis
Adnan Alsaka M.D.
Nephrolithiasis obstructive_.ppt

Obstructive Uropathy
Anjali Shinde, MD
Obstructive_renal_disease-3.ppt

External Defects in the Urinary System
Genitourinary_disorders/documents/pediGU_000.ppt
Genitourinary_disorders/documents/pediGUF10.ppt
GU09.ppt

Morbidity & Mortality Case Conference
John C. Araujo MD, Ph.D.
Morbidity & Mortality Case Conference.ppt

Alterations of Renal and Urinary Tract Function
Alterations of Renal and Urinary Tract Function.ppt

Nephrology Board Review
Sidharth Shah, MD.
Nephrology Board Review.ppt

Overview of Acute Renal Failure
So Yoon Jang, MD
Overview of Acute Renal Failure.ppt

Extrapulmonary Sarcoidosis
Darrell Laudate
Extrapulmonary Sarcoidosis.ppt

Thyroid & Parathyroid
COLIN G. THOMAS, JR., MD
Thyroid-Hyperparathyroidism.ppt

Renal Failure
Michele Ritter, M.D.
Renal_Failure.ppt

Acute Renal Failure
Shahzad Qureshi M.D.
Acute Renal Failure.ppt

Renal Tubular Acidosis
Kathleen Wren
Renal Tubular Acidosis.ppt

Laboratory Evaluation of Renal Function
S .POPLI. M.D.,F.A.C.P.
Laboratory Evaluation of Renal Function.ppt

Altered Renal Function
Altered Renal Function.ppt

Alterations of Renal and Urinary Tract Function
Alterations of Renal and Urinary Tract Function.ppt

Chronic Kidney Disease Definition, Early Intervention & Measurement
Andrea Easom Ma, MNSc, APN, BC. CNN
Chronic Kidney Disease revised.ppt

Fungal Urinary Tract Infections Diagnosis and Management
Tristan T. Berry
Fungal_GR.PPT

Applications of Bedside Ultrasonography
Jay Pershad, MD, FAAP
Applications of Bedside Ultrasonography.ppt

Diagnosis and Management of Hypertension
Davin Haraway DO,FACOI,CWS
Diagnosis_Management_of_Hypertension.ppt

Nephrology Board Review
Ryan Griffiths
Nephrology Board Review.ppt

Acute Renal Failure for the Intern
Things to think about before you call that consult…
Vimal Derebail, MD
Acute Renal Failure for the Intern.ppt

Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency
Adrienne Trustman, MD
Efficacy and Safety of Benazepril.ppt

Medical Nutrition Therapy for Renal Disorders
Medical Nutrition Therapy for Renal Disorders.ppt

Laboratory Evaluation of Urinary Tract Infection
Dr. John R. Warren
Laboratory_Evaluation_of_Urinary_Tract_Infection_v1-_3.ppt

Tumor Lysis Syndrome
SANDY KELLY, MSN, RN-BC, OCN
Tumor Lysis Syndrome.ppt

Drugs for Disorders and Conditions of the Male Reproductive system
Drugs for Disorders and Conditions.ppt

A Few Salient Points About: Pediatric UTIs
Elizabeth Bogel, MD
PedsUTI.ppt

Emergency Ultrasound
Mary Ann Edens, M.D.
Emergency Ultrasound.ppt

Renal & Genitourinary Problems
Ravi Mangal Patel, MD
Renal & Genitourinary Problems.ppt

72 Obstructive Uropathy published articles free access

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Liddle’s Syndrome



USMLE Step 1 Review
Renal Physiology and Tubular function
James Paparello, M.D.
USMLE Step 1 Review 2009.ppt
USMLE Step 1 Review 2010.ppt

Protein Targeting and Function: Ubiquitin Modifications
Jim Collawn
Protein Targeting and Function: Ubiquitin Modifications.ppt

Monogenetic Causes of Hypertension: What Do They Tell Us ?
John M. Hamlyn Ph.D., FAHA
Monogenetic Causes of Hypertension.ppt

Electrolyte management in the PICU
Electrolytes_Resident_Lecture.ppt

Acid-Base Disorders
NITIN BHATT, M.D.
ACID BASE Disorders.ppt

Liddle's syndrome
Liddle's syndrome.ppt

Genetics of Hypertension
Yen-Pei Christy Chang, Ph.D.
Genetics of Hypertension.ppt

Case Study
Acid-Base cases.ppt

Children with Electrolyte Problems
Larry Greenbaum, MD, PhD
Children with Electrolyte Problems.ppt

Neurocutaneous Syndromes
Neurocutaneous Syndromes.ppt

Electrolyte Abnormalities in the Hospitalized Patient
Cynthia Seitz MD
ElectrolyteAbnormalitiesintheHospitalizedPatient.ppt

Identification of Genetic Hyperlipidemias
Robert E.Ferrell, Ph.D
Identification of Genetic Hyperlipidemias.ppt

Liddle’s Syndrome
Victor L. Schuster, MD
Liddle’s Syndrome.ppt
27 free full text articles on Liddle’s Syndrome

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04 June 2012

Pyelonephritis



Renal Pathology
http://www.dent.ohio-state.edu/courses/path655/Path%20655%20Renal%20II.comp.ppt

Case Study
Tania Guevara, Anthony Edmund
http://instructional1.calstatela.edu/nmcquee/Micro302/Group%20cases/Case%201.PPT

Urinary System
http://instructional1.calstatela.edu/kkholle/384N/13)%20Urinary%20System.ppt

Urinary tract infection in children
Professor Abdelaziz Elamin
http://www.pitt.edu/~super7/43011-44001/43861.ppt

Introduction to Clinical Laboratory Practices Renal Diseases
http://colleges.weber.edu/chp/cls/clsonline/1113/Renal%20Disease.ppt

Urinary Tract Infection
Michele Ritter, M.D.
http://www9.georgetown.edu/faculty/wheltosa/Shelly_UTI.ppt

Infections of the Urinary Tract
Denise Schain MD
http://www.mgm.ufl.edu/~gulig/mmid/lectures/UTI_MMID_2011_rev.ppt

Acute Pyelonephritis
RenalPathology-Labs3,4,5.ppt

Radical Nephrectomy
PATHOLOGY-ANSWER.ppt

Diseases of the Urinary System
Diseases of the Urinary System.ppt

Chronic renal failure
Stephen P. DiBartola, DVM
Chronic renal failure.ppt

Fever During and After Childbirth
Fever During and After Childbirth.ppt

Laboratory Evaluation of Urinary Tract Infection
Dr. John R. Warren
Laboratory_Evaluation_of_Urinary_Tract_Infection_v1-_3.ppt

Staphylococcus and Micrococcus
Dr. John R. Warren
Staphylococcus_and_Micrococcus_v1-_3____.ppt

Pediatric urinary tract infection
Scott Weissman, MD
Pediatric urinary tract infection.ppt

Preterm labor
Joseph Breuner, MD
Preterm labor.ppt

Meningitis and UTI
emergency_lecture_series/Meningitis and UTI.PPT

Complement Inhibition for the Treatment of Paroxysmal Nocturnal Hemoglobinuria
Monica Bessler, MD, PhD
Complement Inhibition.ppt

UTI
Lindsay Chase MD
UTIppt

Top Ten Rules of a CPC
Clinical Pathology Conference
Lisa L. Willett, MD
Top Ten Rules of a CPC.ppt

Pediatric Urinary Tract Infections
Eddie Needham, MD, FAAFP
Pediatric Urinary Tract Infections.ppt

Empiric Treatment: Pneumonia
Empiric Treatment: Pneumonia.ppt

Urinary Disorders
Infectious Urinary Disorders
Urinary Disorders.ppt

Diseases of the Urinary and Reproductive System
Diseases of the Urinary and Reproductive System.ppt

600 Published free text articles

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21 May 2012

Autosomal Dominant Polycystic Kidney Disease



Effects of Epidermal Growth Factor in Polycystic Kidney Disease
Michael Kelsey
Kelsey_Michael_Presentation.ppt
KelseyM-Presentation2.ppt

Renal cysts and Tumors
Renal cysts and Tumors.ppt

Renal Pathology
Renal Pathology.ppt

Nephrology
Sharla Hays, M.D.
cystic_disease.ppt

Kidney Disease: Polycystic Kidney Disease
Benny DeShazer Jr
Kidney Disease: Polycystic Kidney Disease.ppt

Polycystic Kidney Disease
John Aris
Polycystic Kidney Disease.ppt

Congenital Renal Abnormalities
Scott Wenderfer, MD/PhD
Congenital Renal Abnormalities.ppt

Polycystic Kidney Disease is associated with Mitral Valve Prolapse
Polycystic Kidney Disease.ppt

Chronic Renal Failure
Valerie Kolmer RN BSN BC
Chronic Renal Failure.ppt

Urinary Path Review
Urinary Path Review.ppt

Human Genetics of Urinary Tract Malformation
Ali Gharavi, MD
Human Genetics of Urinary Tract Malformation.ppt

Genetics and Altered Immune Responses
Susan Wise, RNC, PhD
Immune-endo.ppt

Renal masses and cysts
J. Stuart Wolf, Jr., M.D.,
GUDis.KidneyUpperUT.ppt

Pathology Review Flash Cards Renal, LUT, Male Genital, Endocrine
Renal_male_endo.ppt

Renal Cell Carcinoma
Tim Fenske
Renal Cell Carcinoma.ppt

Genetics and Pathogenesis of Polycystic Kidney Disease
Maria Abreu
Genetics and Pathogenesis of Polycystic Kidney Disease .ppt

Left facial numbness
Ann Schmidt
Left facial numbness.ppt

ATP Synthase (Bovine F1-ATPase )
By Ashley, David, and Angela
ATP Synthase (Bovine F1-ATPase ) .ppt

Renal & Genitourinary Problems
Ravi Mangal Patel, MD
Renal & Genitourinary Problems.ppt

How Genes Are Transmitted from Generation to Generation
How Genes Are Transmitted.ppt
Latest 500 published articles

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25 March 2012

Lupus Nephritis



Lupus Nephritis

Cyclophosphamide vs Mycophenylate mofetil for lupus nephritis
Mary Anne Dooley
Lupus Nephritis.ppt

Lupus Nephritis
Emily Chang
Lupus Nephritis.ppt

Systemic Lupus Erythematosus
Justin A. Crocker
Systemic Lupus Erythematosus.ppt

Glomerulonephritis
PPTs/morning_report_repository/Glomerulonephritis.ppt

Glomerulonephritis
Scott Wenderfer
Glomerulonephritis.ppt

Systemic Lupus Erythematosus (SLE)
Systemic Lupus Erythematosus.ppt

Microscopic Polyangiitis
Saori Kobayashi
Microscopic Polyangiitis.ppt

Renal Board Review
Dr. Alyssa Riley-Kothari
Renal Board Review.ppt

Electrolyte Abnormalities in the Hospitalized Patient
Cynthia Seitz MD
ElectrolyteAbnormalitiesintheHospitalizedPatient.ppt

Read more...

04 March 2012

Renal paraneoplastic syndrome



Tumor Pathology  and Histology
Path_n_Histology.ppt

Renal  Failure
Michele Ritter,  M.D.
Shelly_Renal_Failure.ppt

Renal  Cell Carcinoma
Jennifer  L. Rogers
Renal  Cell Carcinoma  Rogers.ppt

Acute Renal Failure
Acute Renal Failure.ppt

Renal/ Urinary  System
Renal-Urinary.ppt

Management of  Patients with Renal Disorders
Management of  Patients with Renal Disorders.ppt

Tumor  Host Interactions
Husni Maqboul,  M.D
Tumor  Host Interactions.ppt

Read more...

20 February 2012

Interstitial nephritis Ppts and Latest 50 Published articles



Interstitial nephritis (or Tubulo-interstitial nephritis) is a form of nephritis affecting the interstitium of the kidneys surrounding the tubules. This disease can be either acute, meaning it occurs suddenly, or chronic, meaning it is ongoing and eventually ends in kidney failure.

Acute  Interstitial nephritis
by Zae  Kim, MD
http://medicine.med.nyu.edu/nephrology/files/med_nephrology/attachments/acute_interstitial_nephritis.ppt

Acute  Interstitial Nephritis
by Sally  Ravanos, MD
http://www.med.unc.edu/medicine/web/3.28.08%20AIN%20Ravanos.ppt

Acute  Renal Failure
by Malcolm  Cox, M.D.
http://mycourses.med.harvard.edu/ResUps/CIC/ppts/HMS_1480.ppt

Chronic  renal failure
by Stephen  P. DiBartola, DVM
http://vet.osu.edu/assets/courses/vm602/ppt/crf/crfvm602.ppt

Acute Renal  Failure
by Deb Goldstein
http://www9.georgetown.edu/faculty/wheltosa/Acute%20Renal%20Failure.ppt

Bugs and Drugs
by Michael  S. Wang, MD
PPTs/July_emergency_lecture_series/Bugs%20and%20Drugs.ppt

Urine Physical Properties
http://www.austincc.edu/mlt/clin2/Clin2UA_micro_WBCs.ppt

NSAID Nephropathy and COX-2 Inhibitors
by Kellie A Goldsborough, MD
http://intmedweb.wfubmc.edu/download/nsaid.ppt

Acute Kidney Injury
http://www.medicine.uci.edu/residency/powerpoint/AKI.ppt

Acute Renal Failure Intern Emergency Lecture Series
http://www.med.wayne.edu/elab/impeds/content/presentations/intmed/ARF.ppt

Acute Renal Failure
by John K. Amory MD
Lectures/AmoryRenalFailurelecture.ppt

Read more...

05 January 2012

Rapidly Progressive Glomerulonephritis - Nephrology Presentations



Rapidly Progressive Glomerulonephritis ppts

Anti-GBM  Antibody Crescentic Glomerulonephritis.
by Paul Ossman
http://www.med.unc.edu/medicine/web/1.7.09%20Ossman%20Anti-GBM%20GN.ppt

Glomerulonephritis and Nephrotic Syndrome
by Jack DeRuiter, PhD
http://www.duc.auburn.edu/~deruija/download/renal_part4.ppt

Diseases of  the Kidney
http://nhscience.lonestar.edu/biol/durham/docs/biol2305/19%20Diseases%20of%20the%20Kidney.ppt

Acute  Renal Failure
http://www.unmc.edu/familymed/docs/Acute_Renal_Failure(1).ppt

Acute Renal  Failure
by Deb Goldstein, Argy Resident
http://www9.georgetown.edu/faculty/wheltosa/Acute%20Renal%20Failure.ppt

Acute Renal  Failure
by Jayanti Jasti,  M.D.
http://www.fpm.emory.edu/Family/didactics/powerpint/Acute%20Renal%20Failure.ppt

Renal  Pathology
by Greg  Balko, MD
http://www.med.wright.edu/sites/default/files/medu/USMLE/WSU_Renal_Review.ppt

Altered Renal  Function Overview of  Kidney Diseases
http://www.clt.astate.edu/mgilmore/pathophysiology/Renal%20Pathology.ppt

Glomerulonephritis
by Scott Wenderfer
http://ped1.med.uth.tmc.edu/nephrology2/Documents/Glomerulonephritis.ppt

Chronic  Renal Failure
http://www.hsc.unt.edu/tcom2006/04Chronic%20Renal%20Failure.ppt

Nephrology Rounds 
by Riki Buchwald
http://medicine.med.nyu.edu/nephrology/files/med_nephrology/attachments/IgA_GN-renal_confrence_12-08.ppt

ANCA-Associated  Vasculitis
http://www.med.unc.edu/medicine/web/11.18.08%20Dehmer.%20ANCA%20vasculitis.ppt

Renal Pathology II
http://www.dent.ohio-state.edu/courses/path655/Path%20655%20Renal%20II.comp.ppt

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30 April 2010

Renal Replacement Therapy



Renal Replacement Therapy

* What is it?
* How does it work?
Where did it come from?
History of Pediatric Hemofiltration
Mechanisms of Action: Convection
* Hydrostatic pressure pushes solvent across a semi-permeable membrane
* Solute is carried along with solvent by a process known as “solvent drag”
* Membrane pore size limits molecular transfer
* Efficient at removal of larger molecules compared with diffusion
* Solvent moves up a concentration gradient
* Solute diffuses down an concentration gradient

Mechanisms of Action: Diffusion
Semi-permeable Membranes
o Urea
o Creatinine
o Uric acid
o Sodium
o Potassium
o Ionized calcium
o Phosphate
o Almost all drugs not bound to plasma proteins
* Allow easy transfer of solutes less than 100 Daltons
o Bicarbonate
o Interleukin-1
o Interleukin-6
o Endotoxin
o Vancomycin
o Heparin
o Pesticides
o Ammonia
* Sieving Coefficient
* Sieving Coefficient is “1” for molecules that easily pass through the membrane and “0” for those that do not
* Continuous hemofiltration membranes consist of relatively straight channels of ever-increasing diameter that offer little resistance to fluid flow
* Intermittent hemodialysis membranes contain long, tortuous inter-connecting channels that result in high resistance to fluid flow

How is it done?
* Peritoneal Dialysis
* Hemodialysis
* Hemofiltration
* The choice of which modality to use depends on
o Patient’s clinical status
o Resources available

Peritoneal Dialysis
* Fluid placed into peritoneal cavity by catheter
* Glucose provides solvent gradient for fluid removal from body
* Can vary concentration of electrolytes to control hyperkalemia
* Can remove urea and metabolic products
* Can be intermittent or continuously cycled
* Simple to set up & perform
* Easy to use in infants
* Hemodynamic stability
* No anti-coagulation
* Bedside peritoneal access
* Treat severe hypothermia or hyperthermia
* Unreliable ultrafiltration
* Slow fluid & solute removal
* Drainage failure & leakage
* Catheter obstruction
* Respiratory compromise
* Hyperglycemia
* Peritonitis
* Not good for hyperammonemia or intoxication with dialyzable poisons

Intermittent Hemodialysis
* Maximum solute clearance of 3 modalities
* Best therapy for severe hyperkalemia
* Limited anti-coagulation time
* Bedside vascular access can be used
* Hemodynamic instability
* Hypoxemia
* Rapid fluid and electrolyte shifts
* Complex equipment
* Specialized personnel
* Difficult in small infants

Continuous Hemofiltration
* Easy to use in PICU
* Rapid electrolyte correction
* Excellent solute clearances
* Rapid acid/base correction
* Controllable fluid balance
* Tolerated by unstable patients
* Early use of TPN
* Bedside vascular access routine
* Systemic anticoagulation (except citrate)
* Frequent filter clotting
* Vascular access in infants

SCUF:Slow Continuous Ultrafiltration
* Pros
* Cons
Continuous Venovenous Hemofiltration
Dialysis Fluid
Continuous Venovenous Hemodialysis
Continuous Venovenous Hemodialysis with Ultrafiltration
Is there a “Best” Method?
Indications for Renal Replacement Therapy
Indicators of Circuit Function
Filtration Fraction
QP: the filter plasma flow rate in ml/min
Blood Flow Rate & Clearance
Pediatric CRRT Vascular Access: Performance = Blood Flow!!!
Urea Clearance
Solute Molecular Weight and Clearance
Cytokines (large) adsorbed minimal clearance
Replacement Fluids
Physiologic Replacement Fluid
Anticoagulation
Mechanisms of Filter Thrombosis
Heparin - Problems
Sites of Action of Citrate
Anticoagulation: Citrate
What are the targets?
Unknowns of Hemofiltration for Sepsis
Pediatric CRRT in the PICU
Renal Replacement Therapy in the PICU Pediatric Literature

Renal Replacement Therapy.ppt

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Renal Replacement Therapy



Renal Replacement Therapy
Trauma Conference
By:Amanda Wheeler, MD

Principles
4 Main Modalities in ICU
* HD
* PD
* CVVH
* CVVHD

Definition of Terms
* SCUF- Slow Continuous Ultrafiltration
* CAVH- Continuous Arteriovenous Hemofiltration
* CAVH-D- Continuous Arteriovenous Hemofiltration with Dialysis
* CVVH- Continuous Venovenous Hemofiltration
* CVVH-D- Continuous Venovenous Hemofiltration with Dialysis

Indications for Continuous Renal Replacement Therapy
* Volume Overload
* Electrolyte Imbalance
* Uremia
* Acid-Base Disturbances
* Drugs

Hemodialysis vs Hemofiltration Membrane
The hemofiltration membrane consists of relatively straight channels of ever-increasing diameter that offer little resistance to fluid flow.
Hemodialysis membranes contain long, tortuous inter-connecting channels that result in high resistance to fluid flow.
Hemodialysis allows the removal of water and solutes by diffusion across a concentration gradient.

Hemodialysis
* maximum solute clearance
* best tx for severe hyper-K+
* ready availability
* limited anti-coagulation time
* bedside vascular access
* hemodynamic instability
* hypoxemia
* rapid fluid + solute shifts
* complex equipment
* specialized personnel

advantages
disadvantages

Peritoneal Dialysis
* simple to set up + perform
* easy to use
* hemodynamic stability
* no anti-coagulation
* bedside peritoneal access
* unreliable ultrafiltration
* slow fluid + solute removal
* drainage failure, leakage
* catheter obstruction
* respiratory compromise
* hyperglycemia
* peritonitis

advantages
disadvantages

CVVHD vs CVVH
CVVH
* 1. near-complete control of the rate of fluid removal (i.e. the ultrafiltration rate)
* 2. precision and stability
* 3. electrolytes or any formed element of the circulation, including platelets or red or white blood cells, can be removed or added independent of changes in the volume of total body water

CVVH
* easy to use in ICU
* rapid electrolyte correction
* excellent solute clearances
* rapid acid/base correction
* controllable fluid balance
* tolerated by unstable patients
* early use of TPN
* bedside vascular access routine
* systemic anticoagulation *
* citrate anticoagulation new
* frequent filter clotting
* hypotension

advantages
disadvantages

Renal Replacement Therapy.ppt

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03 April 2010

Renal Failure and Dialysis in Pregnancy



Renal Failure and Dialysis in Pregnancy
By:David Shure

Differential Diagnosis
* FSGS -
Pro: HTN, non-remitting, albumin close to NL
Con: expected creatinine to be higher after several years

* Membranous Nephropathy -
Pro: wax/waning course
Con: often with lower albumin, edema

* Diabetic Nephropathy -
Pro: proteinuria, time course
Con:poor evidence for DM
4. FMD - Pro: unequal sized kidneys, young female, HTN hx, renal arteries not commented on in US

Nephrology Consult
* Is there any indication and/ or benefit to the fetus if we begin HD at this time?
* Can we preserve any residual maternal renal function?
* OB team trying to prolong in-utero growth/ length of pregnancy, not sure if pt is masking severe preeclampsia

Why did Ob Deliver the Baby?
* 7/21 pt c/o HA, and 7/23 severe RUQ tenderness and epigastric pain, decision made to deliver fetus based on:
* Severe superimposed Preeclampsia in setting of chronic HTN
* Also, mild thrombocytopenic further led to diagnosis of severe preeclampsia

Normal Physiologic Alterations of Pregnancy
Normal Renal Alterations in Pregnancy

Changes in GFR
* GFR and RBF rise markedly
* Glomerular hyperfiltration results in normal reduction in the plasma creatinine concentration to about 0.4 to 0.5 mg/dL
* Blood urea nitrogen (BUN) and uric acid levels fall for the same reason

Effects of Pregnancy on Renal Disease
* ― cases proteinuria worsen
* ž cases HTN develops
* Worsening edema if nephrotic
* 0-10% women with NL or mild reduction in GFR have permanent decline in renal function

Views on Pregnancy and Dialysis
* ‘Children of women with renal disease used to be born dangerously or not at all - not at all if their doctors had their way’, Lancet, 1975
* ‘Show me a method of birth control more effective than end stage renal disease’, Roger Rodby MD, 1991
* ‘Even if a woman on CAPD ovulates, doesn’t the egg just float away?’, Rodby, 1992

Why don’t uremic women get pregnant?
* Most beyond child bearing age
* Libido/ frequency of intercourse reduced
* Don’t ovulate
* Absence of increase in basal body temperature during the luteal phase of cycle
* Elevated circulating prolactin concentrations
* Elevated PRL impairs hypothalamic-pit function

Actually, they do get pregnant!
* 1st successful term pregnancy in 35 y/o dialysed pt in 1971, Confortini, et al.
* Yr 2000: >15,000 women of childbearing age getting dialysis
* For every person w/CKD 5, 20 have CKD 3 or 4 w/GFR <60, suggesting ~300,000 women w/CKD potentially able to bear children Course of Renal Disease in Pregnancy * Baseline azotemia = more rapid deterioration * As renal dz progresses, ability to maintain nl pregnancy deteriorates, and presence of HTN incr likelihood of renal deterioration * Renal dysfunction - greater risk for complications incl preeclapsia, premature delivery, IUGR Pregancy during dialysis: case report and management guidelines; Giatras, et al. 1998 * 32 y/o AA woman, G4, P2, A1 * FSGS and chronic interstitial nephritis * Renal/obstetric protocol implemented * Increased HD to 4 hrs/ 4 sessions/ week maintain prediaysis BUN <50 * At each HD session, blood flow gradually increased over 1st 30 minutes of HD, from 180 to 300 ml/min * Kt/V 1.02 - 1.66 Giatras Protocol * Dialysis performed in left lateral decubitus position * Est maternal dry wt incrased by 500 g every 10d * EPO administered at each HD session, to maintain HCT 32-34% * Vit D, folic acid and MVI admin * Evid of malnutrition prior to pregnancy, so 3000kcal/day diet w>100g protein/ day

Obstetric Surveillance
* From 25 wks gestation
* Serial BP
* Uterine and umbilical artery perfusion evaluation
* Cont fetal heart rate tracing before, during and after HD
* There were no signif changes in uterine or umbilical artery S/D ratios at any time of HD, and no sig alteration in maternal MAP during HD
* Pt delivered at 32 wks gestation, due to PROM

Common Themes in Dialysing Pregnant Patients

1. Keeping BUN < 50 2. Increasing dialysis time and frequency 3. BP control 4. Managing anemia with increasing doses of ESA 5. Fetal monitoring once viability reached BUN <50 Hypothesis? * 1963 150 women varying degrees of CKD, none on dialysis, found the single most important factor influencing fetal outcome was BUN * Fetal mortality directly proportional to BUN * Hypothesis: intensive dialysis in pregnant women w/renal dz might improve fetal outcomes Increasing frequency and time on dialysis? * May be beneficial in reducing incidence of polyhydramnios by reducing urea and water load * Less dialysis-induced hypotension * More liberal diet * American Jrnl Kid Diseases * Spurred by the report of 5 pregnancies in 5 pts on chronic HD in 2 dialysis units bet 1989-1996 * 1st national survey of its kind which revealed a total of 15 pregnancies in HD - all dialysis centers in Belgium questioned for pts bet 1975-1996 Study Population Figures Case Characteristics/ Outcomes Dialysis Dosing * 15 pregnancies went beyond 1st trimester * Frequency of HD was increased immediately or progressively to 16 to 24 hrs * No difference bet successful pregnancies and failed ones for # mths on HD prior to conception or age at conception. * For successful pregnancies + correlation bet birth wt and excess dialysis hrs delivered over entire pregnancy. Success Rate * 80% (4/5) when HD initiated after onset of pregnancy (pregnancy first) * 50% (5/10) when HD was the first event * ‘‘Pregnancy first’ cases have a significant residual renal function and even may benefit from ‘preventive dialysis’, to be taken on dialysis at a stage of renal failure that would not justify dialysis in the eyes of many were it not for the very special setting of a pregnant state’’ Obstetrical Problems * Main Problem: premature births * In this study 3 died due to severe prematurity * Polyhydramnios present in almost all cases, may be cause of preterm labor * Growth retarded babies at highest risk for intrauterine death * Maternal prognosis is good Should we Initiate Dialysis in Pts w/Low Cr Clearance? * Hou, S., Pregnancy in Women on Hemodialysis, 1994, revealed better outcomes of pregnancy in women w/ significant residual renal function or who initiate pregnancy before they need dialysis. * May reduce incidence of polyhydramnios, lower urea and lowers water load, also reducing risk of dialysis-induced hypotension Registry of Pregnancy in Dialysis Patients USRDS Frequency of Prematurity and Low Birth Rate is less in those conceived before beginning dialysis Women who Start Dialysis During Pregnancy * Likelihood of infant surviving is good * Termination of a pregnancy after renal function has begun to deteriorate rarely rescues the kidneys * NEJM, Jones and Hayslett, 1996, looked at 82 pregnancies in 67 women w/CRI, only 15% of those w/deteriorating renal function had a return of renal function to baseline in 6 mths post partum Survival Statistics Renal Failure and Dialysis in Pregnancy.ppt

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01 July 2009

Urinary Tract Infections



Urinary Tract Infections
By: Charles S. Bryan, M.D.

Overview of UTI by age and sex
Terms
* Urinary tract infection
* Significant bacteriuria
* Asymptomatic bacteriuria
* Acute pyelonephritis
* Chronic pyelonephritis
* “Upper” versus “lower” UTI
* Urethral syndrome
* UTI: the finding of microorganisms in bladder urine with or without clinical symptoms and with or without renal disease
* Significant bacteriuria: the finding of > 105 cfu/ml of urine (but lower counts can be significant)
* Asymptomatic bacteriuria: Significant bacteriuria without clinical symptoms or other abnormal findings.
* Acute bacterial pyelonephritis: a clinical syndrome of fever, flank pain, and tenderness, often with constitutional symptoms, leukocyte casts in the urine, and bacteriuria; or histologic findings thereof
* Chronic bacterial pyelonephritis: Long-standing infection associated with active bacterial growth in the kidney; or the residuum of lesions caused by such infection in the past
* Chronic interstitial nephritis: renal disease with histologic findings resembling chronic bacterial pyelonephritis but without evidence of infection
* “Upper UTI”: infection above the level of the bladder
* “Lower UTI”: infection at or below the level of the bladder
* “Urethral syndrome”: clinical manifestations of lower UTI (dysuria, frequency, urgency) without significant bacteriuria
* Pyuria: the presence of pus (WBC’s [leukocytes] in urine, which may or may not be caused by UTI. The preferred method for quantitation is enumeration in unspun urine using a counting chamber. The leukocyte esterase nitrite test has a sensitivity of between 70% and 90% for symptomatic UTI

Asymptomatic bacteriuria
Frequency of significant bacteriuria
Screening for significant bacteriuria
Urinary tract bacteriology
Etiology of community-acquired UTI
Etiology of nosocomial UTI
Urease-producing microorganisms
UTI in children
UTI in adults
Role of bacterial virulence in UTI
The role of bacterial virulence (2)
Host defenses: antibacterial properties of urine
Host defenses: anti-adherence mechanisms
Host defenses: miscellaneous
Routes of urinary tract infection
Mechanisms of lower UTI
Mechanisms of upper UTI
Localization of upper versus lower UTI
Acute uncomplicated cystitis in young women
Acute uncomplicated pyelonephritis in young women
White blood cell casts
Recurrent UTIs in women
Complicated UTIs
Catheter-associated UTI
Long-term bladder catheterization
Prostatitis

Urinary Tract Infections.ppt

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Alterations of Renal and Urinary Tract Function



Alterations of Renal and Urinary Tract Function

Urinary Tract Obstruction
* Urinary tract obstruction is an interference with the flow of urine at any site along the urinary tract
* Severity based on:
o Location
o Completeness
o Involvement of one or both upper urinary tracts
o Duration
o Cause
* Hydroureter
* Hydronephrosis
* Compensatory hypertrophy
* Postobstructive diuresis
* Kidney stones
Kidney Stone Formation
Kidney Stones
* Treatment
Lower Urinary Tract Obstruction
Tumors
Urinary Tract Infection (UTI)
Chronic Pyelonephritis
Glomerular Disorders
Nephrotic Syndrome
Acute Renal Failure (ARF)
Chronic Renal Failure

Alterations of Renal and Urinary Tract Function.ppt

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