March 20, 2017

Background: Use of contrast media in CT scans has been cited as one of the most common causes of iatrogenic acute kidney injury.  Its use however improves the diagnostic accuracy of CT scans.  Some studies have even reported an incidence of contrast induced nephropathy (CIN) as high as 14%.  Many of the studies coming to these conclusions were performed before the use of low- and iso-osmolar contrast agents. Also to date, all controlled studies on this topic have been observational and not randomized controlled trials.  More recent propensity-scored analyses have had conflicting results. One study found no increased risk of acute kidney injury, dialysis or mortality regardless of baseline renal function, while others have found increased acute kidney injury in patients with renal dysfunction. This current study tried to clarify the incidence of acute kidney injury attributable to IV contrast media administration.

January 16, 2017

Background: Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and, more commonly, alpha adrenoreceptor antagonists (i.e. tamsulosin) have been employed in the treatment of ureteric colic for their potential ability to increase stone passage, reduce pain medication use and reduce urologic interventions. These interventions were mostly based on poor methodologic studies and meta-analyses of these flawed studies.

Over the past 3-4 years, a small number of higher-quality RCTs have been published (Ferre 2009, Pickard 2015, Furyk 2016). These studies have demonstrated a lack of benefit for routine use of alpha blockers. However, secondary outcomes suggest a possible benefit in larger stones (> 6 mm). In spite of recent multiple studies, the use of alpha blockers remains an area of active debate.

December 6, 2016

Background : For anyone who has taken care of a patient with renal colic, the agony they experience is indelible.  I have had several female patients even tell me that the pain is worse than child birth.  Treatment of renal colic comes down to two key components: treatment of pain and expediting passage of the stone.  Many medications have been tested for the former, and we have discussed the latter on our blog before (HERE and HERE). We had a recent resident journal club discussing a trial comparing IV lidocaine (1.5mg/kg) vs IV morphine (0.1mg/kg) for treatment of pain.

REBEL Review 72: Treatment of Low-Flow (Ischemic) Priapism

Created November 1, 2015 | Renal and Genitourinary | DOWNLOAD

August 17, 2015

Welcome to the August 2015 REBEL Cast, where Swami, Matt, and I are going to tackle a couple of topics. First topic: renal colic. Renal colic is a commonly seen condition encountered in emergency departments and the use of medical expulsive therapy (MET) is commonly recommended by our urology colleagues. Proponents of MET in the treatment of ureteric colic advocate for them due to their potential ability to increase stone passage, reduce pain medication use, and reduce urologic interventions. Second topic: pediatric weights. In pediatric resuscitations many of use the Broselow tape to predict weights for dosing of medications.  With the increasing weights in pediatric patients seen in developed countries around the world, does the commonly used Broselow tape accurately predict weights?   So with that introduction today we are going to specifically tackle:

Topic #1: MET for Renal Colic Topic #2: Use of the Broselow Tape to Estimate Pediatric Weights

0