This document summarizes several topics in nephrology: 1) A case of a hemodialysis patient presenting with vomiting is discussed. Possible causes of vomiting in hemodialysis patients include inefficient dialysis, fluid retention, high BUN, acidosis, and medications. 2) Guidelines for infection control in hemodialysis are mentioned. 3) Diet recommendations for patients with calcium-containing kidney stones are provided, including reducing sodium, animal proteins, and foods high in oxalate while ensuring sufficient calcium intake. 4) Causes and management of hypoglycemic coma are reviewed, including drug durations of action and non-antihyperglycemic agents that can

1. Nephrology capsules
By
Salwa Mahmoud Elwasif, MD

2. 1st capsule

3. Case presentation
• A 57 years gentleman
• Known to have CKD secondary to diabetic
nephropathy for last 5 years.
• Starting hemodialysis 3weaks ago
• C/O : persistent vomiting.

4. Vomiting in hemodialysis patient
• Inefficient dialysis
1. Fluid retention
2. High BUN (Blood Urea Nitrogen) level
3. Acidosis
4. as a side effect of some medications
5. hyperkalemia
• Hypercalcaemia

5. 2nd capsule

6. Infection control

7. Guidelines in infection control

8. 3rd capsule

9. Diet in calcium containing renal stone
• What about calcium restriction?

10. Calcium Oxalate Stones Calcium Phosphate Stones
reducing sodium
reducing animal protein, such as meat, eggs, and fish
getting enough calcium from food or taking calcium
supplements with food
avoiding foods high in oxalate,
such as spinach, rhubarb,
nuts, and wheat bran

12. 4th capsule

13. Hypoglycemic coma
• In emergency
• Follow up

14. drug Duration of action
Glibenclamide 12 - 24 hours
Gliclazide 12 - 24 hours
Glimepiride about 24 hours
Repaglinide 4 - 5 hours
Nateglinide 5-6 hours

15. Drugs other than antihyperglycemic agents and
alcohol reported to cause hypoglycemia
• Moderate quality of evidence
• Cibenzoline
• Gatifloxacin
• Pentamidine
• Quinine
• Indomethacin
• Very low quality of evidence
• Angiotensin converting enzyme inhibitors
• Angiotensin receptor antagonists
• β -Adrenergic receptor antagonists
• Levofloxacin
• Mifepristone
• Disopyramide
• Trimethoprim-sulfamethoxazole
• Heparin
• 6-Mercaptopurine

16. 5th capsule

17. Drug/drug interaction
• Antibiotics with Spironolactone
• Antiplatelet with proton pump inhibitors
• Warfarine and sulphonylureas.
• Drugs causing ESA resistance.

19. 6th Capsule

20. Our patient presented on admission with acute
kidney injury and rhabdomyolysis with first
discovered Type 2 diabetes mellitus and HHS as
initial presentation.

21. Non-exertional and non-traumatic causes of
rhabdomyolysis include drugs and toxins,
infections, electrolyte abnormalities,
endocrinopathies, inflammatory myopathies,
and others.

22. Potassium release from muscle cells during exercise
normally mediates vasodilation and the appropriately
increased blood flow to muscles.
Decreased potassium release due to profound
hypokalemia promotes the development of
rhabdomyolysis by decreasing blood flow to muscles in
response to exertion, in both hypokalemic and
hypophosphatemia rhabdomyolysis with myonecrosis

25. Thank you