Renal

Synthetic marijuana, or “spice” has been linked to at least 16 cases of acute renal failure, according to the CDC. Unexplained renal failure in young otherwise healthy patients should prompt questioning about synthetic marijuana use (CDC site).

In this case-control study, patients on ACE/ARBs were significantly more likely than those not on ACE/ARBs to experience contrast-induced acute kidney injury (odds ratio 1.4, CI 1.1 to 1.8). However, this does not prove causality, and it is not clear that discontinuing ACE/ARBs before a contrast load would prevent the kidney injury (abstract).

In this large administrative database analysis of patients with non-valvular afib, patients with ESRD were significantly more likely to suffer stroke, system thromboembolism, and bleeding than those without ESRD; the risk of stroke/embolism was significantly lower for those on warfarin but not those on ASA, while the risk of bleeding was higher with both ASA […]

In this small prospective cohort of critically ill patients on antibiotics and CVVHD, researchers found wide variability in trough levels of various antibiotics, which did not appear to correlate with effluent flow rates; 15% were below minimum therapeutic levels, and 10% were excessive. Antibiotic dosing during CVVHD can be problematic, and should be supplemented by […]

In this trial of women with acute pyelonephritis, randomized to 7 or 14 days of ciprofloxacin, clinical cure was the same in both groups (96% and 97%). This should be a reasonable duration of treatment for women with pyelonephritis with an organism sensitive to ciprofloxacin, but should not be extrapolated to other antibiotics (abstract)

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 […]