Rethinking the consultation paradigm: Validity evidence for a new framework, a multimethods study.

Background: In-hospital consultation is essential for patient care. We previously proposed a framework of seven specific consultation types to classify consult requests to improve communication, workflow, and provider satisfaction.

Methods: This multimethods study's aim was to evaluate the applicability of the consult classification framework to real internal medicine (IM) consults.

Effects of Reduced Dietary Sodium and the DASH Diet on GFR: The DASH-Sodium Trial.

Key Points: Sodium reduction over a 4-week period decreased eGFR. Combining sodium reduction with the Dietary Approaches to Stop Hypertension diet resulted in larger reductions in eGFR. Changes in diastolic BP seem partially responsible for the observed dietary effects.

The times they are K+-changin': bringing the potassium curriculum out of the 20th century.

Purpose Of Review: Although most of the current medical education literature has focused on teaching strategies, little attention has been devoted to selecting appropriate course content. Despite elegant descriptions of physiologic mechanisms in recent decades, medical school curricula and students continue to rely on outdated textbooks and certification examination study aids composed to fit an antiquated exam blueprint.

Recent Findings: Advances in our understanding of potassium physiology offer multiple examples of key concepts that deserve to be included in the modern-day renal physiology curriculum, including the relationship of potassium to blood pressure and the potassium 'switch', the aldosterone paradox, and novel pharmacologic agents that target dietary potassium absorption and potassium handling in the kidney.

Feasibility of a Nephrology Faculty Peer Observation of Teaching Pilot Program.

Awareness of being observed led to enhanced faculty preparation of teaching sessions. Any discomfort about being observed was generally outweighed by receiving observer input. Variable quality of feedback given to observed suggests need for more faculty development with next iteration of peer observation.

What's Old Is New Again: Harnessing the Power of Original Experiments to Learn Renal Physiology.

Although medical schools across the United States have updated their curricula to incorporate active learning techniques, there has been little discussion on the nature of the content presented to students. Here, we share detailed examples of our experience in using original experiments to lay the groundwork for foundational concepts in renal physiology and pathophysiology. We believe that this approach offers distinct advantages over standard case-based teaching by (1) starting with simple concepts, (2) analyzing memorable visuals, (3) increasing graphical literacy, (4) translating observations to "rules," (5) encouraging critical thinking, and (6) providing historical perspective to the study of medicine.

Decreasing Surgical Management of Secondary Hyperparathyroidism in the United States.

Background: Secondary hyperparathyroidism (SHPT) commonly occurs in end-stage renal disease (ESRD), leading to vascular calcification and increased mortality. For SHPT refractory to medical management, parathyroidectomy improves symptoms and decreases mortality. Medical management has changed with the release of new guidelines and advent of novel medications.

Receiving Real-Time Clinical Feedback: A Workshop and OSTE Assessment for Medical Students.

Background: Many programs designed to improve feedback to students focus on faculty's ability to provide a safe learning environment, and specific, actionable suggestions for improvement. Little attention has been paid to improving students' attitudes and skills in accepting and responding to feedback effectively. Effective "real-time" feedback in the clinical setting is dependent on both the skill of the teacher and the learner's ability to receive the feedback.

When ESKD complicates the management of diabetes mellitus.

Given the increased incidence and prevalence of ESKD (end-stage kidney disease) attributed to diabetes mellitus, it is important to consider the physiological and global sociodemographic factors that give rise to unique challenges in providing excellent care to this population. The individual with diabetes and ESKD faces alterations of glucose homeostasis that require close therapeutic attention, as well as the consideration of safe and effective means of maintaining glycemic control. Implementation of routine monitoring of blood glucose and thoughtful alteration of the individual's hypoglycemic drug regimen must be employed to reduce the risk of neurological, cardiovascular, and diabetes-specific complications that may arise as a result of ESKD.

Magnesium and Drugs Commonly Used in Chronic Kidney Disease.

As with other electrolytes, magnesium homeostasis depends on the balance between gastrointestinal absorption and kidney excretion. Certain drugs used commonly in patients with CKD can decrease gastrointestinal ingestion and kidney reclamation, and potentially cause hypomagnesemia. Other magnesium-containing drugs such as laxatives and cathartics can induce hypermagnesemia, particularly in those with impaired glomerular filtration and magnesium excretion.

Proton-pump inhibitor-induced hypomagnesemia: Current research and proposed mechanisms.

Since the early reports nearly a decade ago, proton-pump inhibitor-induced hypomagnesemia (PPIH) has become a well-recognized phenomenon. While many observational studies in the inpatient and outpatient populations have confirmed the association of PPI exposure and serum magnesium concentrations, there are no prospective, controlled studies to support causation. Molecular mechanisms of magnesium transporters, including the pH-dependent regulation of transient receptor potential melastatin-6 transporters in the colonic enterocyte, have been proposed to explain the effect of PPIs on magnesium reabsorption, but may be a small part of a more complicated interplay of molecular biology, pharmacology, and genetic predisposition.

Magnesium Deficiency and Proton-Pump Inhibitor Use: A Clinical Review.

The association of proton-pump inhibitor (PPI) use and hypomagnesemia has garnered much attention over the last 5 years. A large body of observational data has linked chronic PPI use with hypomagnesemia, presumably due to decreased intestinal absorption and consequent magnesium deficiency. However, despite the increasing prevalence of this highly popular class of medicine, and despite potential significant risks associated with magnesium depletion, including cardiac arrhythmias and seizures, there are no well-designed studies to delineate the nature of this observed association.

Keeping an eye on dialysis: the association of hemodialysis with intraocular hypertension.

Intraocular hypertension is common during hemodialysis. Dialysis disequilibrium syndrome and intraocular hypertension occur via similar pathophysiologic mechanisms. These mechanisms may contribute to the development of glaucoma and cataracts in a patient population already at high risk for ocular abnormalities, given the common risk factors for chronic kidney disease and impaired aqueous humor outflow.

Proton-pump inhibitor use is associated with lower urinary magnesium excretion.

Aims: Although multiple recent studies have confirmed an association between chronic proton-pump inhibitor (PPI) use and hypomagnesaemia, the physiologic explanation for this association remains uncertain. To address this, we investigated the association of PPI use with urinary magnesium excretion.

Methods: We measured 24-hour urine magnesium excretion in collections performed for nephrolithiasis evaluation in 278 consecutive ambulatory patients and determined PPI use from contemporaneous medical records.

How we make nephrology easier to learn: computer-based modules at the point-of-care.

Background: Novel educational tools, such as case-based learning in a web-based module format, are an effective approach to teaching clinical concepts to medical trainees, especially if the situations are clinically relevant and the intervention is delivered at the point-of-care. Though studies have evaluated the effectiveness of point-of-care reference materials, limited literature addresses active web-based interventions designed for completion at the point-of-care.

Aims: By taking advantage of existing technological resources and integrating an effective learning modality into the clinical environment, we can increase trainee understanding of high-yield topics in clinical nephrology.

Proton-pump inhibitor use is associated with low serum magnesium concentrations.

Although case reports link proton-pump inhibitor (PPI) use and hypomagnesemia, no large-scale studies have been conducted. Here we examined the serum magnesium concentration and the likelihood of hypomagnesemia (<1.6 mg/dl) with a history of PPI or histamine-2 receptor antagonist used to reduce gastric acid, or use of neither among 11,490 consecutive adult admissions to an intensive care unit of a tertiary medical center.