Dispelling Myths about Thoracentesis and Pleural Fluid Analysis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Featured, medical procedures, Nephrology, Respiratory diseases
More Tags – , , , , , , , , , ,
There are two myths that have persisted about thoracentesis and pleural fluid analysis that must be dispelled. The first myth is that a large volume thoracentesis should not remove more than 1,500 mL fluid due to the risk of re-expansion…
Read More

IV Contrast CT Scans Do Not Significantly Increase the Risk of Acute Kidney Injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, medical procedures, Nephrology
More Tags – , , ,
Researchers from the Mayo Clinic Rochester performed a retrospective study of data from 5758 adults with chronic kidney disease (CKD; stages 1−5) who underwent either noncontrast CT or iodixanol-enhanced contrast CT and who had pre- and post-CT serum creatinine measurements. All of…
Read More

Iso-osmolar Contrast Rarely Causes Contrast-induced Nephropathy

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Featured, medical procedures, Nephrology
More Tags – , ,
Several studies in 2014 suggested that intravenous iodinated contrast use in computed tomography (CT) scanning was not associated with acute kidney injury.  Now, the Mayo Clinic has performed a retrospective study of data investigating 5758 adults with chronic kidney disease…
Read More

Choosing Wisely Recommendations by American College of Emergency Physicians

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Medical General, medical procedures, Nephrology, Respiratory diseases, Traumatology
More Tags – , , , , , ,
Choosing Wisely is an initiative by the American Board of Internal Medicine that solicits evidence-based recommendations by other specialty associations to identify tests or procedures in their field which are unnecessary.  The following are a set of five recommendations that…
Read More

Blood Cultures are Not Recommended for Most Non-Severe Cases of UTI, Cellulitis, or Pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Infections, medical procedures, Nephrology, Respiratory diseases
More Tags – , , , , ,
In many hospitals, blood cultures have become a reflexive habit for patients presenting to the ER with any suspected infection.  This was, in part, due to the inappropriate addition of routine blood cultures as a core measure in 2001 by…
Read More

Higher Baseline Serum Creatinine Increases Mortality for Hospitalized Patients with Cirrhosis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Gastrointestinal diseases, medical procedures, Nephrology
More Tags – , ,
The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by more than 50% in <48 h from a stable value within 3 months. North…
Read More

Accuracy of Urine Electrolytes to Assess Etiology of Acute kidney injury

Joseph Esherick, M.D., FAAFP, FHM
More Articles – medical procedures, Nephrology
More Tags – , , , , , ,
Both the fractional excretion of sodium (FENa) and the fractional excretion of urea (FEUrea) have an established role as part of the work-up for determining if acute kidney injury (AKI) is due to a prerenal or intrarenal cause. Although both…
Read More

Serum Procalcitonin Can Help to Differentiate CHF from Pneumonia in ED Patients Complaining of Dyspnea

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Medical General, medical procedures, Nephrology, Respiratory diseases
More Tags – , , , , , ,
Previous trials have investigated the use of B-type natriuretic peptide (BNP) to assess patients with dyspnea in the ED. The sentinel trial was the BNP (Breathe Not Properly) trial that evaluated nearly 800 patients presenting to the ED with complaints…
Read More

IV Contrast May Have Lower Risk of Contrast-Induced Nephropathy than Previously Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – medical procedures, Nephrology
More Tags – , , ,
In a recent retrospective study from Mayo Clinic, researchers demonstrated that intravenous contrast material was not associated with acute kidney injury (i.e., increase in serum creatinine level of ≥0.5 mg/dL) during the 72 hours after computed tomography (CT) of the…
Read More

How to Reduce Recurrent Nephrolithiasis

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Medical General, medical procedures, Nephrology
More Tags – , , , ,
Advise patients to drink at least 2 L daily; consider thiazide diuretics, citrate therapy and allopurinol for patients with “active” calcium stone formation. American College of Physicians (ACP) Key Recommendations Increased fluid intake to achieve 2 L of urine output daily…
Read More