Restricted Intravenous Fluid in Septic Shock
T.S. Meyhoff and Others
In this trial, a restrictive approach to intravenous fluid administration in critically ill patients with septic shock did not reduce deaths at 90 days.Jun 30
Case Records of the Massachusetts General Hospital
A Girl with Fever and Cough
M.C. Ottolini and Others
A 17-year-old girl was admitted because of prolonged fever and cough. She had an elevated creatinine level and a low hemoglobin level. What is the diagnosis?Jul 14
- Original Article Restricted Intravenous Fluid in Septic Shock T.S. Meyhoff and Others
Removal of Small Kidney Stones and Relapse
M.D. Sorensen and Others
Removal of small, asymptomatic kidney stones during surgery to remove ureteral or contralateral stones resulted in less relapse than nonremoval and in similar numbers of subsequent emergency department visits.Aug 11
- Original Article Removal of Small Kidney Stones and Relapse M.D. Sorensen and Others
Most Viewed in Nephrology
Acetazolamide in Acute Decompensated Heart Failure with Volume Overload
W. Mullens and Others
New Decongestion Strategies in an Evolving Heart Failure Landscape
G. M. Felker
Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes
B. Pitt and Others
- EditorialAug 27, 202210.1056/NEJMe2209997
Hospitalization for heart failure, usually due to volume overload, is among the most common reasons for hospitalization worldwide, and decongestion with loop diuretics is the primary focus of treatment in most patients.1 Despite the ubiquity of this clinical scenario in daily practice, high-quality data from randomized trials evaluating...
- Original ArticleAug 27, 202210.1056/NEJMoa2203094
In a randomized, placebo-controlled trial, patients with acute decompensated heart failure and volume overload who received intravenous acetazolamide plus a loop diuretic had a higher incidence of decongestion.
- N Engl J Med 2022; 387:506-513
- N Engl J Med 2022; 387:562-563
Asymptomatic kidney stones are often noted on imaging studies that are performed to screen for stones or when a patient presents with symptomatic stones. Patients frequently ask two questions about the asymptomatic stones: “Will my stones ever become symptomatic?” and “How do we get those stones to come out before...
- N Engl J Med 2022; 387:168-176
A 17-year-old girl was admitted because of prolonged fever and cough. She had an elevated creatinine level and a low hemoglobin level. A diagnostic test was performed.
- N Engl J Med 2022; 386:2316-2326
A 29-year-old woman presented with recurrent bone fractures and hypophosphatemia. The patient had been well until 19 months before admission, when pain in the right foot developed. During the next 19 months, multiple fractures of the metatarsal bones of the right foot occurred. On admission, the blood phosphorus level was...
- N Engl J Med 2022; 386:2295-2302
Three patients with Schimke immuno-osseous dysplasia who underwent sequential bone marrow and kidney transplantation continued to have normal renal function without immunosuppression at 22 to 34 months.
- N Engl J Med 2022; 386:2332-2333
Stunning advances in human transplantation have been tempered by the immunologic consequences of histoincompatibility between donor and recipient — namely, allograft rejection after solid-organ transplantation and graft-versus-host disease (GVHD) after hematopoietic stem-cell (bone marrow) transplantation (HSCT). The separation of GVHD from the graft-versus-tumor effect and the induction of functional immune...
- N Engl J Med 2022; 386:2120-2128
Testing for kidney disease is routine in clinical practice. This review focuses on advances in clinical evaluation of the glomerular filtration rate and albuminuria and their use in detecting acute and chronic kidney disease, designing trials of disease progression, and predicting risk in clinical practice.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1871-1873
In light of the recent clinical cases of pig-to-human kidney and heart transplantation, taking stock of progress in xenotransplantation can help us set realistic expectations for clinical adoption of this promising technology.
- N Engl J Med 2022; 386:1889-1898
Genetically modified pig kidney xenografts were transplanted into two brain-dead human recipients. The xenografts functioned immediately and showed no evidence of acute rejection on serial biopsy over a period of 54 hours. The serum creatinine level decreased in both recipients.
- N Engl J Med 2022; 386:1327-1338
Oral antibacterial agents that are active against antimicrobial-resistant bacteria are needed. In this double-dummy, randomized, controlled trial, tebipenem pivoxil hydrobromide (an orally bioavailable carbapenem) was noninferior to intravenous ertapenem for the treatment of complicated urinary tract infection.
- N Engl J Med 2022; 386:1165-1165
A 37-year-old man with cystinuria and a recent urinary tract infection presented to the nephrology clinic for follow-up. Microscopic examination of a spun urine specimen showed concomitant triple phosphate and cystine crystals.
- N Engl J Med 2022; 386:1034-1045
In a phase 2 trial of iberdomide in patients with moderate-to-severe SLE, a composite response (on the Systemic Lupus Erythematosus Responder Index–4) occurred in 54% of those who received iberdomide (0.45 mg), as compared with 35% in the placebo group, but this between-group difference was not significant at lower doses....
- N Engl J Med 2022; 386:964-975
Acute kidney injury can be accompanied by life-threatening electrolyte and metabolic abnormalities. Kidney-replacement therapy may be urgently needed to prevent death from uremia. This review considers treatment approaches, indications, and intensity in critically ill patients with AKI.
- N Engl J Med 2022; 386:976-976
A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. A diagnosis of primary hyperoxaluria was made...
- N Engl J Med 2022; 386:880-886
A 17-year-old girl with a history of anxiety and anorexia nervosa presented with anxiety, malaise, lightheadedness, and palpitations. Two weeks earlier, she had entered an intensive outpatient nutritional rehabilitation program. She was found to have hypokalemia, hypophosphatemia, and hypomagnesemia.
- N Engl J Med 2022; 386:879-879
A 79-year-old man was admitted to the intensive care unit for septic shock. Placement of a hemodialysis catheter ultimately led to the finding of an isolated persistent left superior vena cava.