New guidelines for lupus nephritis

The American College of Rheumatology has recently published guidelines on the screening, treatment, and management of lupus nephritis. A few of the key findings include the need for a biopsy for all new diagnosis, the use of ACE/ARBs with proteinuria, the need for hydroxychloroquine for all patients, and meticulous BP management (<130/80). The full guidelines can be found at (ACR)

NaCl better than Hco3 for reducing contrast nephropathy, but duration matters

In this randomized trial of patients with renal insufficiency undergoing procedures with IV contrast, they were randomized to normal saline (1cc/kg/hr for 12 hours before and after procedure), or Hco3 (2 different regimens; 3cc/kg an hour before and 1cc/kg/hr for 6 hours after, or 3cc/kg 20 minutes before and oral Hco3 after at 500mg/10kg). The saline group was significantly less likely than either Hco3 group to develop contrast induced nephropathy (1% vs 9% in both Hc03 groups) and had less change in gfr (abstract)

Fibrates and renal failure

This large cohort study of patients >age 65 found those with a new outpatient prescription for a fibrate were >2 times more likely to be hospitalized with an increased creatinine within 90 days, which was most pronounced in those with chronic kidney disease. New fibrate use in the elderly should carefully weigh the risk and benefit in light of these new findings, especially in those with chronic kidney disease (abstract)

Higher death rates after 2 non-dialysis days

In this large analysis of US dialysis patients, mortality rates were analyzed by day of week, and were found to be highest on the day after the 2 day "dialysis holiday" (eg Monday in a Mon/Wed/Fri schedule). Longer inter-dialysis duration is associated with higher rates of death. The typical long-standing 3 day-a-week dialysis schedule may need to be re-examined (abstract)

Inhaled anticholinergics increase risk for urinary retention

In this large population based case control study, recent initiation of an inhaled anticholinergic medication increased the odds of acute urinary retention (OR 1.4, CI 1.2-1.7), which was even higher in men with existing BPH (OR 1.8, CI 1.5-2.2). Men using both short and long acting had 3 times the odds of acute retention compared to non-users (OR 2.7, CI 1.9-3.8). New or ongoing inhaled anticholinergics should be considered causative in men with acute urinary retention (abstract)