Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits

By Martina McGrath, MD
October 18, 2017

The typical US diet is comprised of 3.4g of sodium per day on average, whereas current recommendations suggest that sodium intake should be limited to <2g/day for the general population1 and possibly lower for those with hypertension or cardiovascular disease.2 Continue reading “Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits”

Vancomycin as a Rare Cause of Drug-Induced Cytopenias

By Martina M. McGrath, MD
May 30, 2017

Vancomycin is a glycopeptide antibiotic, with activity against gram positive organisms, including MRSA. It is widely prescribed for hospital-acquired infections, device-related infections, and treatment of resistant organisms. While side effects such as red man syndrome, ototoxicity, and nephrotoxicity are well recognized, immune thrombocytopenia is a less common, but potentially severe, complication of vancomycin therapy. Indeed, because many affected patients are critically ill or treated with other potential culprit agents such as heparin, vancomycin-induced platelet destruction can go unrecognized. Continue reading “Vancomycin as a Rare Cause of Drug-Induced Cytopenias”

Hep C Positive Kidneys into Hep C Negative Patients: Pushing the Boundaries of Transplantation

[Photo by Bill Branson, NIH Medical Arts, National Institutes of Health. Pictured are Robert Colbert, M.D., Ph.D., Amy Petrik, Ph.D., and Grace Kwon, Ph.D. ]

By Martina M. McGrath, MD
May 4, 2017

Currently, over 97,000 patients are awaiting kidney transplant.1 Hepatitis C (HCV) infection is prevalent in the community, and it has been reported that >3000 kidneys from HCV+ donors were offered between 2005 and 2014.2 Prior to the current era of direct-acting antiviral agents (DAAV), patients with HCV who underwent renal transplantation had poorer outcomes, and antiviral treatment with interferon was associated with increased risk of rejection. Likely related to these risks, it has been reported that over 500 kidneys from HCV+ donors are discarded annually.2 However, DAAVs have transformed the management of HCV infection. Greater than 90 percent cure rates have been reported with many of these medications, which are generally well-tolerated. With the availability of safe and effective antiviral therapy for HCV, the question has arisen, could these kidneys now be safely used in HCV-negative recipients? Continue reading “Hep C Positive Kidneys into Hep C Negative Patients: Pushing the Boundaries of Transplantation”

The Link Between Proton Pump Inhibitors and Kidney Disease

By Lea Borgi, MD
April 27, 2017

Proton pump inhibitors (PPI) are among the most prescribed medication in the United States1, with an increasing proportion of US adults reporting using prescription PPI (3.9% in 1999 to 7.8% in 2012) according to the National Health and Nutrition Examination Survey (NHANES).2 However, overall PPI use is most likely underestimated, given their widespread over-the-counter availability. Continue reading “The Link Between Proton Pump Inhibitors and Kidney Disease”

Metformin: Meta-Analysis of Benefits in Comorbid Patients

Broadening access: Meta-analysis suggests benefits of metformin therapy in patients with comorbid kidney or heart disease.

By Martina M. McGrath, MD
February 9, 2017

Metformin is a safe, effective and well-tolerated agent, which is recommended as the first line oral hypoglycemic in treatment of newly diagnosed Type II diabetes. Its central role is underpinned by research showing reductions in long-term cardiovascular mortality in patients treated with metformin, as compared to sulphonylureas or placebo. Continue reading “Metformin: Meta-Analysis of Benefits in Comorbid Patients”

Kidney Transplants from Deceased Donors: How Old is Too Old?

Are older deceased donors an underused resource?

By Martina M. McGrath, MD
December, 29, 2016

Since publication of Robert Wolfe’s landmark paper in 19991 demonstrating a doubling of life expectancy post-renal transplantation compared with remaining on dialysis, demand for renal transplants has continuously grown. Over 99,000 individuals are currently awaiting renal transplantation in the US.2 Kidneys from deceased donors previously termed ‘extended criteria donors’ (ECD), provide good outcomes with acceptable duration of function for selected, older recipients or those not expected to survive on long-term dialysis. ECD kidneys come from donors over 60 years old or from those aged 50-59 years old with coexisting medical conditions such as hypertension, cerebrovascular disease, or creatinine >1.5mg/dL. Despite good short-term outcomes, the rates of discard for these kidneys remain high. For those in the transplant community, these kidneys may be a precious resource that is being wasted. So the question remains—when it comes to deceased donation, how old is too old? Continue reading “Kidney Transplants from Deceased Donors: How Old is Too Old?”

Pushing the envelope across HLA boundaries: HLA-incompatible renal transplants

By Martina M. McGrath, MD
July 6, 2016

The deceased-donor renal transplant waiting list continues to expand inexorably, and currently, up to 15% of wait-listed patients are awaiting their second or subsequent kidneys. With this changing demographic, the challenge of transplanting patients with increasing levels of HLA sensitization becomes ever more prevalent. Continue reading “Pushing the envelope across HLA boundaries: HLA-incompatible renal transplants”