Background: Many end stage renal disease (ESRD) patients present with complaints related to missed or incomplete hemodialysis (HD). Inpatient HD units often are not credentialed for outpatient use which results in extra cost and consumes additional resources for a standard outpatient procedure. Delays in patient throughput in emergency departments (ED) can cause boarding in the [...]

Case Presentation: A 79-year-old male with vasculopathy, hypertension, diastolic heart failure, and dialysis-dependent end stage renal disease presented after having hypotensive syncopal episodes during initiation of his last 3 outpatient dialysis sessions. Upon dialysis cessation, he quickly awakened fully oriented with a normal hemodynamics. On arrival, physical exam findings were unrevealing, as were a subsequent [...]

Background: Venous excess ultrasound score (VExUS) is an emerging point-of-care volume assessment tool that utilizes inferior vena cava diameter and doppler waveforms within the hepatic, portal, and renal veins to predict venous congestion. High VExUS grades have previously been validated against elevated filling pressures during right heart catheterization in patients with steady-state fluid balance; however, [...]

Background: Peripherally inserted central catheters (PICCs) are associated with central vein stenosis and failure to establish a functioning arteriovenous fistula. Thus, guidelines recommend avoiding PICC placement when patients with chronic kidney disease (CKD) are likely to require hemodialysis. We sought to describe the current practice of PICC placement in hospitalized patients with an estimated glomerular [...]

Case Presentation: 68-year-old white female presented with upper respiratory tract symptoms which progressed to cough in 4 days and she was found to have a right lower lobe pneumonia. Her sputum culture revealed MSSA (Methicillin Susceptible Staphylococcus Aureus) and she was treated with ceftriaxone and azithromycin. But her pneumonia worsened and she developed parapneumonic effusion, [...]

Case Presentation: Our patient is a 65 year old male with history of end stage renal disease on hemodialysis, peripheral arterial disease complicated by bilateral below knee amputations, and type 2 diabetes mellitus admitted with limited flow on his right AV fistula. An IR fistulagram revealed moderate stenosis of the basilic vein outflow, and mild [...]

Case Presentation: A 45 year old woman with a past medical history of ESRD on hemodialysis, antiphospholipid syndrome on warfarin, and type 2 diabetes presented with severe, diffuse, intermittent abdominal pain. Physical exam was notable for tender subcutaneous nodules in the lower abdomen associated with overlying violaceous patches and central necrosis. Labs were notable for [...]

Case Presentation: A 54-year-old male was diagnosed with left renal pelvic, caliceal and ureteral transitional cell carcinoma(CA) 3 years before presentation. Patient had a history of transitional cell CA of the bladder that had extended to both kidneys despite local intervention. Patient underwent left sided nephroureterectomy 2 years later because of massive disease burden. Renal function [...]

Case Presentation: A 20-year-old female with systemic lupus erythematosus and end stage renal disease (ESRD) secondary to lupus nephritis on hemodialysis via left upper extremity arteriovenous graft presented to the emergency department for pain, erythema, and swelling of the right inferior breast. She was initially treated for cellulitis with resolution of erythema and warmth of [...]

Case Presentation: 47 year-old male with PMH of hypertension, DM, CAD and ESRD on peritoneal dialysis, presented with altered mental status for 1 day. He had developed a vesicular rash in the right upper extremity and was diagnosed with herpes zoster at another facility 2 days prior, for which he was prescribed valacyclovir that was [...]