Pearls from Dr. Anjali Ganda

Metformin-associated lactic acidosis in a diabetic patient with shock


  • NSAID-related renal dysfunction: AIN, ATN, papillary necrosis, nephrotic syndrome (minimal change disease and membranous nephropathy)

    Posted 05/29/16 03:25:44 PM by Matthew Cummings

  • CKD vs AKI? 

    Posted 05/29/16 03:26:18 PM by Matthew Cummings

  • AMS and ↑osmolar gap (measured – calculated osms)? Think ME DIE: Methandol, Ethylene glycol, Diuretics (mannitol), Isopropyl alcohol, Ethanol (and ketones)

    Posted 05/29/16 03:26:54 PM by Matthew Cummings

  • Metformin often one among many potential causes of lactic acidosis, but is more likely in patients with: Hx of taking metformin, lactate>15, AG>20, severe metabolic acidosis (pH<7.10, HCO3<10), renal insufficiency (Cr>2), and more common in patients with underlying CHF, cirrhosis, CKD

    Posted 05/29/16 03:27:31 PM by Matthew Cummings

  • For further reading...

    Clinical management of suspected toxic alcohol ingestion
    Metformin-associated lactic acidosis: retrospective case-series

    Posted 05/29/16 03:31:19 PM by Matthew Cummings

  • 57 y/o with ARF, glomerulonephritis, presumed IgA nephropathy


  • NSAIDs Inhibit prostaglandin release (prostaglandins dilate the Afferent arteriole). Can cause:
    1.  AIN
    2. ATN (especially with volume depletion)
    3. Papillary Necrosis
    4. Membranous/Minimal Change

    Posted 10/06/16 10:56:13 AM by Adam Faye

  • Nephritic: Injury/Inflammation of glomeruli which allows proteins, erythrocytes and leukocytes to pass through. Typical triad:
    1.  Hypertension (abnormal bp regulation)
    2.  Azotemia
    3.  Red Cell Casts

    Posted 10/06/16 10:59:22 AM by Adam Faye

  • Glomerulonephritis Low Complement:
    If normal complement GN
    1. Systemic - HSP, ANCA, Goodpasture's, vasculitis
    2. Renal only- Post-infectious GN, MPGN

    Posted 10/06/16 11:05:44 AM by Adam Faye

  • Acidosis in Renal Failure:

    Posted 10/06/16 11:06:43 AM by Adam Faye

  • ESRD:

    Posted 10/06/16 11:27:32 AM by Adam Faye

  • 70yo F w/ volume overload and AKI c/f cardiorenal syndrome


  • To help determine if someone has CKD vs. AKI look at comorbidities, prior history of anemia and Phos/Ca for signs of renal osteodystrophy

    Posted 05/18/17 12:48:32 PM by Emily Miller

  • When looking at a Renal Ultrasound: Small, shrunken kidneys are often seen in CKD.  In CKD can find large kidneys with amyloid, DM, PCKD and HIVAN.  Can see large kidneys acutely with AIN.

    Posted 05/18/17 12:49:48 PM by Emily Miller

  • For patients with decompensated heart failure w/ RV dysfunction and possible cardiorenal syndrome, be cautious with Lasix dose as these patients tend to be very preload dependent. Too much lasix can lead to a dangerous drop in blood pressure.  

    Posted 05/18/17 12:50:52 PM by Emily Miller

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