Ultrasound appears to be best in most renal colic clinical scenarios. CT is best in older patients (especially with no stone history), those with tenderness on abdominal exam, and those with uncontrolled pain.
In this large population-based study, sodium polystyrene sulfonate use in elderly outpatients was associated with an almost 2-fold higher risk of serious adverse GI events within 30 days of initial prescription. The absolute risk increase was small, however.
Contrast-associated acute kidney injury is a controversial subject. The available evidence is reassuring that significant acute kidney injury, death, and need for renal replacement therapy are rare after IV contrast administration.
Once insured, undocumented immigrants with end-stage renal disease (ESRD) who were then able to get scheduled vs emergency-only hemodialysis (HD) has a drop in 1-year mortality (NNT = 7) and saved almost $6,000/person/month in healthcare costs.
Hyperlactatemia appears to arise from impaired oxygen utilization more often than decreased O2 delivery but doesn’t cause acidemia unless there is impaired renal function. The novel “alactic base excess” may give us an early way to tell when the kidneys are failing to compensate.
The combination of vancomycin plus piperacillin-tazobactam (VPT) was associated with increased risk of acute kidney injury (AKI) compared to either drug as monotherapy or other vancomycin - β-lactam combinations, NNH = 11.
This machine learning system accurately predicted which patients would develop acute kidney injury or need dialysis. And they did so 41 hours before the patients actually developed it! Imagine the ramifications not just for AKI but for predicting rapid response, need for ICU care, and more.
In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.
In non-critically ill patients that received IV fluids in the ED, there was a lower incidence of major adverse kidney events in the balanced crystalloid group compared to saline (4.7% vs 5.6%) with a NNT of 111. There was no difference in terms of hospital-free days between the groups.