Pseudo-anion gap metabolic acidosis from severe hypertriglyceridemia corrected by plasma exchange .

Background: Falsely low or even unmeasurable serum bicarbonate has been described in patients with severe hypertriglyceridemia or paraproteinemia. This phenomenon, known as pseudo-hypobicarbonatemia, is believed to be due to interference by these components when the commonly used enzymatic assay is utilized for serum bicarbonate measurement. The calculated bicarbonate derived from blood gas machines is not affected.

Risk of percutaneous renal biopsy of native kidneys in the evaluation of acute kidney injury.

Background: Percutaneous renal biopsy (PRB) of native kidneys (NKs) to better understand and treat acute kidney injury (AKI) is being advocated, but little is known about the risk of complications.

Methods: We performed a retrospective study of PRB of NKs in 955 adults from 1991 to 2015 at an academic medical center with real-time ultrasound and automated biopsy needles. Patients undergoing PRB for evaluation of AKI ( = 160) were compared with 795 patients biopsied for other reasons (not-AKI) for postbiopsy complications [need for transfusion of packed red blood cells (PRBCs), an interventional radiologic or surgical procedure, readmission or death].

Membrane-based therapeutic plasma exchange (mTPE): Technical and clinical experience.

Therapeutic plasma exchange (TPE) has long been utilized to manage a variety of immune-mediated diseases. The basic principle relies on removal of circulating pathogenic substances from the bloodstream. Methods of plasma separation include centrifuge (cTPE) and membrane (mTPE).

Membrane-based Therapeutic Plasma Exchange: A New Frontier for Nephrologists.

Therapeutic plasma exchange has long been utilized to manage a variety of immune-mediated diseases. The underlying principle is the removal of a circulating pathogenic substance from the plasma and substitution with a replacement fluid. Different methodologies of plasma separation include the use of centrifuge, which relies on the variation in the specific gravity of blood components, and membrane-based separation, which relies on particle size.

Effects of high blood flow and high pre-dilution replacement fluid rates on small solute clearances in hemofiltration.

Background/aims: In pre-dilution hemofiltration (HF), solute clearance is less than the HF rate. While the amount of this loss is predictable, it has not been validated in high-volume HF associated with high blood flow rates.

Methods: Using isovolemic pre-dilution HF, we studied small solute clearances using combinations of blood flow (Q(B); 150, 250, 350, 450 ml/min) and replacement fluid (RF) flow (Q(RF); 2, 4, 6 l/h) to determine clearance losses we entitled 'measured efficiency' (E(M)).

Accelerated venovenous hemofiltration: early technical and clinical experience.

Background: Renal replacement therapies other than intermittent hemodialysis are often required in hemodynamically unstable patients. Continuous renal replacement therapies use a slow blood flow rate, necessitating anticoagulation and prolonged treatment times that may create difficulties with staffing and limit patient diagnostic and therapeutic procedures. We developed an alternative strategy based on a higher blood flow rate that allows increased rates of hemofiltration, no anticoagulation, and a shorter ("accelerated") treatment period.

The role of calcium antagonists in chronic kidney disease.

Purpose Of Review: To review goals of antihypertensive treatment in chronic kidney disease in the context of what role calcium antagonists play toward reducing progression of kidney disease.

Recent Findings: All recently published guidelines recommend a blood pressure goal of less than 130/80 mmHg in patients with chronic kidney disease. Use of calcium antagonists is not recommended as part of the initial armamentarium.