Nephrology Commons^™

A Rare Case Of Lithium Toxicity Inducing Complete Heart Block And Nephrogenic Diabetes Insipidus, Rohail A. Baig, Gurtej Dhaliwal, Nimra Shafi, Omar Siddiqui, Michelle L. Malnoske

Advances in Clinical Medical Research and Healthcare Delivery

Lithium is a commonly utilized mood stabilizer for the treatment of bipolar disorder. Although it is efficacious, elevated levels may lead to neurologic, cardiac, nephrogenic, and gastrointestinal side effects. Management of severe lithium toxicity has been an evolving topic of debate in terms of its clinical management. We report a case of a 23-year-old female who presented to the emergency department with severe lithium toxicity, who needed intensive intervention and a critical level of care. This case provides an example of how utilizing standardized care algorithms may provide great benefit to clinicians managing lithium toxicity in emergencies and critical care …

Bilateral Nephrectomy For Refractory Hypertension In A Patient With Esrd On Intermittent Hemodialysis, Kavya Balusu, Vijay Sheldon, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

In nearly 20 percent of patients with end-stage renal disease (ESRD), hypertension remains poorly controlled despite pharmacological therapy and volume reduction through dialysis. Further, morbidity from hospitalization for hypertensive crisis is significantly higher in patients with ESRD than in patients without ESRD. For those who fail conventional therapies for hypertension, therapeutic bilateral nephrectomy can be considered as a last resort option. With appropriate candidate selection, patients are expected to have improved quality of life. We describe the case of a 37-year-old African American male with ESRD on intermitted hemodialysis who underwent bilateral nephrectomy for the management of hypertension refractory to …

Mystery Of Maha: Hypertension’S Twist Over Cancer’S Shadow, Andrew Takla, Gabriel Vachon, John Hix, Nagesh Jadhav

Advances in Clinical Medical Research and Healthcare Delivery

Microangiopathic hemolytic anemia (MAHA) refers to nonimmune hemolysis resulting from the intravascular fragmentation of red blood cells. The etiology of such disorders can range from primary thrombotic microangiopathic syndromes (TMA) to various systemic conditions, posing a diagnostic challenge. Prompt identification requires a sharp clinical assessment to improve outcomes.

Coexisting Renal Artery Stenosis And Large Angiomyolipoma In A Solitary Kidney: A Therapeutic Dilemma, Yohannes B. Tilahun, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Title: Coexisting Renal Artery Stenosis and Large Angiomyolipoma in a Solitary Kidney: A Therapeutic Dilemma

Authors: Tilahun YB, Mentor/Attending: Sekar A

Background: Angiomyolipomas (AMLs) are the most common benign renal tumors, typically presenting as incidental findings. However, large AMLs can lead to life-threatening complications such as retroperitoneal hemorrhage, particularly in the setting of a solitary kidney. The presence of concomitant renal artery stenosis (RAS) further complicates management, posing a unique therapeutic challenge in balancing the need to prevent hemorrhage, preserve renal function, and optimize renovascular perfusion.

Case: A 77-year-old African American woman with a history of left nephrectomy for renal …

From Infection To Encapsulation; A Case Report On Encapsulating Peritoneal Sclerosis, Clinical Challenges And Management, Sidra Memon Md, Jacob Seth Psomiadis Md, Syed Uzair Mahmood, Jennifer Hoffman Md

Advances in Clinical Medical Research and Healthcare Delivery

Encapsulating Peritoneal Sclerosis (EPS) is a rare but deadly sequlae of peritoneal dialysis resulting in intraperitoneal inflammation and fibrosis. The disease itself can present in a variety of ways and is associated with significant morbidity and mortality. Here we present the case of a man in his 50's with a history of chronic peritoneal aspergillus as well as end-stage renal disease on peritoneal dialysis that had multiple admissions for abdominal fluid collections as well as bowel obstruction. After a multidisciplinary approach, the patient was diagnosed with encapsulating peritoneal sclerosis and then started the recommended therapy of tamoxifen and prednisone.

Pembrolizumab Induced Hyponatremia. A Case Report, Mouna Reghis, Taanvi Gowdar, Arjun Sekar

Advances in Clinical Medical Research and Healthcare Delivery

Hyponatremia is the most common electrolyte abnormality inpatient. Medications are a common cause of this. Cancer treatment has evolved with immune check point inhibitors replacing conventional chemotherapy agents. Pembrolizumab, which is a program cell death receptor-1 ligand has been shown to cause endocrinopathies. We describe a case of hyponatremia due to pembrolizumab

Defying The Vicious Cycle: An Intriguing Case Of Brash Syndrome, Ahmed Shehadah, Himal Kharel, Pulkit Gandhi

Advances in Clinical Medical Research and Healthcare Delivery

BRASH Syndrome is a rare and life-threatening condition marked by the combination of bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia. This case report presents a 79-year-old female with acute kidney injury, hyperkalemia, and severe bradycardia without typical EKG changes associated with hyperkalemia. The aim of this article is to provide a comprehensive overview of BRASH syndrome, including its clinical manifestations, underlying pathophysiology, diagnostic approaches, and management strategies. The patient's presentation, laboratory findings, and response to treatment support the diagnosis of BRASH syndrome. The syndrome's pathogenesis involves a vicious cycle of bradycardia, renal failure, AV nodal blockade, and …

A Case Of Maintenance Prednisone In Anca Glomerulonephritis, Arjun Sekar, Pulkit Gandhi, Vijay Sheldon, Aswanth Reddy, Ruth Campbell

Advances in Clinical Medical Research and Healthcare Delivery

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a rare condition that can cause rapid renal failure. Treatment involves steroids and other immunosuppressive agents. Agents for induction include rituximab, cyclophosphamide, pulse dose steroids and avacopan.

Maintenance regimens include tapered doses of steroids, azathioprine and rituximab

We present a case of severe AAV that maintained remission with a protracted course of low dose prednisone without maintenance rituximab or azathioprine.

A 70-year-old woman was admitted for acute kidney injury (AKI), with a serum creatinine (sCr) of 6.93 mg/dL (baseline sCr of 0.9 mg/dL, nil proteinuria.) Serologic work-up was positive for P-ANCA. She …