A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable.  A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.

Clinical question: Does tamsulosin result in faster expulsion of symptomatic ureteral stones in patients presenting to the emergency department?

Dr. Chavez discusses pearls and pitfalls of testicular torsion. 

Dr. Mansfield discussed Rhabdo

A middle-aged woman with history of unilateral nephrectomy presents with a week of malaise progressing to disorientation, and is found to have a large obstructing kidney stone in her remaining kidney coupled with signs of severe sepsis and renal failure.  Read ahead for management tips and additional pearls....   

It can be frustratingly difficult to obtain hemostasis in bleeding dialysis fistulas. Here are some pearls to help you next time you see this patient!

Last week we wrote about how to approach hyponatremia, the differential and signs and symptoms to watch out for. The post this week reviews the treatment of hyponatremia including the dreaded osmotic demyelination syndrome. Read on for more!

Hyponatremia is defined as Na < 138 mEq/L and occurs in 15-30% of hospitalized patients. Read on for a quick overview of how to approach it and the clinical signs and symptoms to look for!

Chvostek’s sign is momentary contraction of the nose and/or lips in response to tapping the facial nerve at the angle of the jaw.  Associated with hypocalcemia, it has been found to be poorly sensitive and specific.  It is seen in 10-25% of healthy individuals with normal calcium levels, whereas approximately one third of patients with hypocalcemia will not demonstrate this sign.

How should we manage a suspected line infection in a dialysis patient? This week our great nephrology team provided us pearls regarding catheter related bloodstream infections in addition to other valuable renal associated tips.