Hypokalemic Metabolic Alkalosis and Hypertension in Blacks

NKF 2017 Spring Clinical Meetings Abstracts 1528 Steroid Combined Induced CT and Scleroderma Fluoroscopy Renal Guided Crisis Percutaneous Trans29 peritoneal Jaros, Nephrostomy Tube Insertion and Subsequent Antonin Christos Argyropoulos, Kamran Shaffi, HYPOALDOSTERONISM PRESENTING WITH RENAL SALT WASTING Nephrolithotomy in a Patient withUniversity Left Ectopic Pelvic Kidney Rawan Al-Odat, Edgar Fischer. of New Mexico, DISEASE AND ABSENCE OF HYPERKALEMIC HYPERCHLOREMIC Albuquerque, Ishtiaq Huda Ahmed, Ebadur USA Tarek Zahrani. ACIDOSIS: Arif,NM, David Leehey,Rahman, Loyola University Medical Centre, Prince Chicago, IL, USA Sultan Military Medical City, Riyadh, Saudi Arabia 154 Acute Renal Failure from Supplement Induced Bile Cast We are presenting a case of isolated hypoaldosteronism with 10hyporeninemia Hemorrhagic Shock and Hemoperitoneum as a Fatal ManiSucessfully Treated Apheresis presenting withwith orthostatic hypotension and renal salt wasting festation Granulomatosis with Polyangiitis without cerebralof disease. Adrenal insufficiency was ruled by normal ACTH Caroline Johnson, Theresa Kinard, JilloutAdamski, Mira andKeddis. cortisolAl levels. Emad Jaber,Clinic Gaurav Jain, Souheil Saddekni. University Mayo Hospital, Phoenix, AZ, USA A 61-year-old withBirmingham, no significant medical except for mild of Alabamagentleman Hospital, AL, history USA 156essential Non-HCV Cryoglobulinemic Cold Agglutinin hypertension was referred to theMPGN renal clinicwith after multiple visits to the 13emergency A Rareroom Case of ANCA Associated inisotonic a Patient – Association or Vasculitis Cause? Hemolytic Anemia for symptomatic orthostatic hypotension requiring with Systemic Sclerosis saline infusion. Evaluation inRahim clinic showed orthostatic hypotension withGeorge an Ghassan Kabbach, Dhanani, Israel Kasago, intact autonomicAli, response. He reported polyuria with approximately 3-4L daily Sadeem Austin Rice, Romualdo Talento, Nauman Soryal, Vivek Bose, Rafia Chaudhry, Monrroy, urine output. Laboratory evaluation revealed persistent Mauricio hypoaldosteronism with Shahid. Carolina University and Vidant Medical Foulke L,East Hongalgi K. Albany Medical College, Albany, plasma aldosterone levels <1 ng/dL, low plasma renin activity (0.23-1.10 Center, Greenville, NC, USA NY, USA ng/mL/h), and normal ACTH and cortisol levels. He had normal renal function normal plasma potassium and total carbon dioxide levels. plasma as 14andAtypical Hemolytic Uremic CanHis Present 159 Zero Tolerance on Anion Gap Syndrome sodium levels were generally normaland withRenal occasional mild hyponatremia noted. Malignant Hypertension Dysfunction Karmegam, Collazo-Maldonado. Methodist He Sathish had persistently elevated Roberto urinary sodium concentrations (> 20 mmol/L) in Ali, Farhang Ebrahimi, Azmir, El theShehzad face of hypotension, and 24h urine sodium aldosterone excretions Health System, Dallas, TX, USA andMohammad were 164 mgRichmond and < 1 mcg,University respectively. Medical He was treated with fludrocortisone Saadi. Center, Staten Island, 1600.1Aldosteronism in Polycystic Kidney Disease: Hypertension mg daily with marked improvement in orthostatic symptoms. Attempts to NY, USA Hiding in Plain Sightin recurrence of symptoms which resolved with taper fludrocortisone resulted 20restoration An Unusual Cause of Cast Nephropathy of the usual therapeutic Chandrashekar Kashyap,dose. James Lynch Bailey, Frederic 1 2 1 Aldosterone causes 1reabsorption of sodium chloride and ,Emory Faisal University, Anwar , and Nada Bader .excretion University Rawan Al-Odat Rahbari-Oskoui. Atlanta, GA, USAof 2 potassium andMexico, hydrogen ions in the distal convulated tubule. Selective or University of of New Albuquerque, NM, USA; 161isolated Recognition Reverse Pseudohyperkalemia aldosteroneof deficiency result from a deficiency in renin secretion Missouri, Kansas City,canMO, USA or decreased adrenal synthesis. In adults, most patients have hyporeninemic Siddhartha Kattamanchi, Joshua L. Rein, Joseph A. 21hypoaldosteronism. Granulomatous Nephrotic Syndrome to The characteristic findings of Secondary this disorder Vassalotti. Icahn School of electrolyte Medicine at Mount Sinai, are New hyperkalemic hyperchloremic acidosis and occasionally mild hyponatremia, Sarcoidosis York, NY, USA usually in the setting of impaired renal function. Although aldosterone promotes Omer Alrawi, Walid Ibrahim, Nehal Altaie, Nashat Imran, typically Due associated prominent 164sodium Highretention, Anionhypoaldosteronism Gap Metabolicis not Acidosis to 5-with Oxoproline Yahya Osman Malik.Wayne Stateof the University, Detroit sodium wasting (except in young children) because compensatory action with Low Dose Acetaminophen Medical Center, Detroit, MI, USA of other sodium-retaining factors. This case illustrates the importance of Sobia the N diagnosis Khan, ofArun Kottarathara, Opeyemi hypoaldosteronism in adult patients with Oladele, 23considering A Rare Case of Spontenous Tumor Lysis Synrome in a Sandeep Mallipattu, Stony Brook symptoms and signs of renal salt Nand wasting inKthe Wadhwa. absence of hyperkalemic Patient with Poor-Risk Germ Cell Cancer hyperchloremic Medicine, acidosis. Stony Brook, NY, USA Mohammed Alzubaidi1, Bhavna Bhasin2. 1Medical Univer165 Thrombotic Thrombocytpopenic Purpura in a Patient with sity of South Carolina, Charleston, SC, USA; 2Medical Goodpasture’s Disease: An Uncommon Association 30 College of Wisconsin, Milwaukee, WI, USA Aakanksha Khanna, Nicholas Matthew D’Costa, QUALITY AND Tan, OF RCARE IN 24IMPROVING Type B Lactic Acidosis Due to ACCESS Dialysis-Induced Thiamine Sandra M Herrmann. Mayo Clinic, MN, USA NEPHROLOGY THROUGH THE USE Rochester, OF THE ELECTRONIC Deficiency in a Patient with Seminoma RECORD, A Rapidly SINGLEProgressive CENTER 167HEALTH An Unusual Case ofE-CONSULTS: Proteinuria with EXPERIENCE Brigani Amante, Isaac Teitelbaum. University of Colorado Renal Failure 1 1 1 , Javier Mendez , Mabel Labrada2, Antonio Armstrong Hospital, Aurora, CO, Pagan USA , Lumen 2 2 Ravkiran Khurana, Andrew Herman, Fernando E. Pedraza , MarcoTushar A. LadinoThakur, 251University Autosomal Miami, Dominant Polycystic Disease Presenting Miami, FL,Tanphaichitr. USAKidney and 2Miami Veterans Affair Rupesh of Raina, Natthavat Cleveland Clinic as a Spontaneous Acute Blood Loss Anemia and HemorMedical Miami, FL, USA AkronCenter, General Akron, OH, USA Background: rhagic Shock E-consults are consultative, provider-to-provider 171communications Prolonged Ketoacidosis Associated with SGLT-2 Inhibition: within shared electronic medical record It Ahmad Anjak, K. a Gaitonde, A. Malhotra, C.V. system. Thakar. A Case Report allows primary care providers to communicate and obtain specialist Cincinnati VA Medical Center, Cincinnati, OH, USA advice without the need for face-to-face Our study evaluates the Jatinder Kohli, Stanley Goldfarb.visits. Hospital of University of efficiency and provider satisfaction with Salt the nephrology 29effectiveness, Hypoaldosteronism Presenting with Renal Wasting Pennsylvania, Philadelphia, PA, USA E-consult service in the Miami Veterans Affair Medical Center (Miami Disease and Absence of Hyperkalemic Hypercholremic 173VAMC). An “Atypical” Case of Exit Site Infection in Peritoneal Acidosis Methods: Dialysis Retrospective review of 368 E-Consults(2013-2016) Huda Arif, Leehey. Loyola Medical answered by theDavid Nephrology service at theUniversity Miami VAMC was AbhilashChicago, Koratala, Chornyy, Amir Kazory. Centre, IL, Volodymyr USAincluded demographics, performed. The data collected estimated GFR University of Florida, Gainesville, USAtime and need for time of consultation, reason forAlkalosis consult,FL, response 32at Hypokalemic Metabolic and Hypertension in to faceAcute referral. A questionnaire was developed to assess provider 175face Severe Kidney Injury from TURP-Associated Heme Blacks satisfaction areas for improvement. The primary objective of the Pigment and Nephropathy 1 1 , Huzaif the Qaisar , Vikas Singh1, Mayur K.facilitate Patel1, Arifwas Asif study to determine ability of the E-consult process to 1 1 need for Sidney Anubhav Kumar, Behdad Besharatian, a timely consult response and Mehandru decrease the clinic , Suhsil , Awais face-to-face Masud1Kobrin, , Loay Indu Sharma 2 Palmer, Matthew Jonathan Hogan. University of Pennsylevaluations. Salman . 1Jersey Shore University Medical Center, Seton Results: On retrospective of 364 out of 368 patients, the vania, Philadelphia, PA,review USA Hall-Hackensack-Meridian School of Medicine, Neptune, average length2of time for E-consult response was 1.4 days vs. a 2-4 178 NJ, A Rare Case of Macrophage Activating Syndrome with Albany Medical College, USA; week time period for outpatient face to face Albany, referrals. NY, 78% USA of the ERenalresolved Failure the reasonNeuropathy: for the referralAwithout the need for face33consults Ischemic Monomelic Long-Term Follow of to-face evaluation. The questionnaires showed primary providers Franklin Lam, Katherine Rafia that Chaudhry, Krishna 2 Patients Without Fistula Wang, Ligation were very satisfied with the E-consults. The majority 1 1 of the questions Hongalgi, Mehta. Albany Medical College, Vikas Singh , Huzaif Quaisar , NinaAlbany, Jube2, Arif Asif1,Swati showed 93-100% referring provider satisfaction. 1 1 1 NY, USA Mayur K. Patel , Indu E-consults Sharma , improve Suhsil the Mehandru , Awais Conclusions: Nephrology quality and access 1 2 1 180to Masud Acare Rare Fibrillary Glomerulonephritis Presenting Loay of Salman . Jersey Shore University Medical of, Case patients with multiple renal conditions. Primary care with Hemoptysis physicians were satisfied with the E-consult process, with the Center, Seton Hall-Hackensack-Meridian School ofmajority Mediof Swathi consults being resolved in 1.42Albany days.Saleha They decrease costs and time to cine, Neptune, NJ, USA; Medical College, Albany, Lavudi, Chris Webster, Rizwan, James Reilly, patient and the provider. E-consults show to be a promising process for NY, USA Tina Ko. Allegheny Health Network, Pittsburgh, PA, USA a safe and an efficient patient evaluation. A2 A4 A24

37 Amyloidosis Treatment of Presenting Intracardiacwith Mycetoma a Post Renal 181 Nephroticin Syndrome and Transplant Patient of Systemic Nocardiosis with the ComVentricular Hypertrophy A RARE CAUSE OF ANURIA IN A PATIENT WITH MARFAN bination ofVittal Imipenem Terry Le, Chundru, Phani Morisetti. Louisiana State SYNDROME: Ashour T, Fattoum S,and AudiTrimethoprim-Sulfamethoxazol A, Choudhry W. Rochester Regional Health, Unity Hospital, Rochester, NY, USA University Health Sciences Center, Shreveport, LA, USA Ashraf Attia, Ebadur Rahman, Muddassar Mahboob; Prince A 42 year old male with Marfan syndrome presented to the emergency Sultan Military Medical City, Riyadh, Saudi Arabia 182 Preeclampsia in Association with Mirror Syndrome and department with anuria. Past history included St. Jude aortic valve (on warfarin), prosthetic with Hypertonic replacement due to aorticHydrops regurgitation Nonimmune Fetalis 40 Desalination and Polyuria Associated aortomesenteric and bilateral aortorenal bypass in 2008 due to aortic Saline and Vasopressin in 3with Hypervolemic Children Julia dissection, andL. renalLeddy, artery graftRajesh thrombosisGovindasamy, subsequent rightJamie kidney A. Green. Geisinger Center, Danville, PA, anuria USAand of Physiatrophy. He presented to the emergency department with acute John ScottMedical Baird. Columbia University College lower abdominal pain of 1 day duration. On examination, he was thin, tall, cians & Surgeons, New York, NY, USA 190 Pancreatic Adenocarcinoma Mimicking Granulomatous with and had disproportionately long extremities. He had a temperature of 36.7, 43 A Unique Case Renal Failure a Patient with pulse Polyangitis of 53, respiratory rate of of 18, room air oxygen in saturation of 98%, and Hepatitis C blood Sadichhya pressure of 197/84. He hadIuliana mild left CVA tenderness.Sami His peripheral Lohani, Niculescu, Zarouk.ofWilliam Krishna Baradhi, Christopher Girgis. University Oklapulsations on both upper and lower limbs were symmetric and intact. The Beaumont Hospital, Royal Oak,7.42 MI, USA homa, Tulsa, OK, USA laboratory test results were as follows: Creatinine mg/dl, BUN 61 mg/dl,Irrelevant potassium 5.3ANCA mg/dl, Hemoglobin 12.6 g/dl, 153 x Crescentic 193 Negative Pauci Immune GNinina 44 ‘Calcinosis Cutis’: A Marker ofPlatelet Systemic Calcification 10(3)/mm3, INR 2.13. Two months prior to his presentation, serum a Man with Rheumatoid Arthritis Dialysis Patient creatinine was 1.8 mg/dl. Renal ultrasonography in the emergency department revealed an empty bladder, an atrophic rightChester kidney andWasko,ofBarbara Dipesh Maan, Mark Bunker, Mary Krishna Baradhi, Christopher Girgis. University OklanormalClark. sized left kidney, with noGeneral signs of obstruction in either kidney. homa, Allegheny Tulsa, OK, USA Hospital, Pittsburgh, PA, USA The diagnosis of acute anuric renal failure was presumed to be 199 Refractory Hyponatremia with Female Fungating secondary to a dissecting aortic aneurysm. CTinangiography of the Aged 45 Spontaneous Renal Infarction ina a Patient Middle on abdomen revealed complete thrombosis of the patient's vascular graft Metastatic Melanoma Oral Contraceptives (OCs) from the lower thoracic aorta to the left renal artery. He was evaluated by a Rui Mao, P that Tran, Krishna University of Khalid Bashir, Chamberlain Obialo, Nwaohiri. vascular surgeon whoThao determined his left kidney wasBaradhi. not Nnamdi salvageable—ultimately the patient hemodialysis. Oklahoma, School Community Medicine, Tulsa, OK, Morehouse School ofofrequired Medicine, Atlanta, GA, USA Marfan syndrome (MFS) is an autosomal dominant disorder of USA 46 Colorful Surprises: DrugtheRelated Urine connective tissue. The syndrome involves skeletal, ocular, and Pigmentation in 201 Low onsystems, ‘Lytes: Etiology for Proteinuria cardiovascular withA aortic aneurysm and dissection being its Outpatient Clinic, aRare Case Series most life-threatening manifestations. Renal lesions previously described in Kirea Mazzolini, Elie dissection Saber, Samaya Qureshi, Sheryl Jaime Baynes-Fields, Jonathan Lee, Poorvanshi Alag, with renal insufficiency, patients with MFS include FSGS, aorticAl Rajeev Raghavan. Baylor College of Medicine, and anCaberto, association with PCKD. Patients with MFS andDrexel thoracoabdominal Irfan Ahmed, Sandeep Aggarwal. University College aortic Houston, aneurysm (TAAA) to have an increased incidence of aortic TX,tend USA of Medicine, Philadelphia, PA, USA dissection. Eighteen percent of all patients with TAAAs (with and without 204 Nephritis a artery Patient withDisease Crohn 48 Atypical HUSInterstitial in a superior Patient with Inflammatory Bowel MFS) Paradoxical have concomitant celiac, mesenteric, orin renal Disease occlusive disease. Acute renal artery occlusion in a patient with MFS could Kelly Beers, Kevin Zarrabi, Yezina Nigatu, Lea Baer, represent a new dissection or thrombosis. Despite a therapeutic INR, our Chaitanya Mishra, Maria J. Thomas, Dominick Santoriello, Lieberthal. Brook Medical patientWilfred had a thrombosis of his graft.Stony Renal artery occlusion requires Center, Stony Zanger, Lawrence Weisberg. instantRon diagnosis and intervention becauseS. prolonged ischemia Cooper can cause University Brook, NY, USA irreversible renal dysfunction. USA Complex Glomerulonephritis 49 Hospital, P-ANCA Camden, Positive NJ, Immune 209 Role of Dialysis in Acute Toxic Associated with Levamisole UseEncephalopathy Secondary to Hyperammonemia 32 Kelly Beers, Arun Kottarathara, Wilfred Lieberthal, Rajeev Gayatri Rebecca Blonsky, Sevag Demirjian. The Rohatgi. Nair, Northport Medical Northport, Hypokalemic MetabolicVA Alkalosis andCenter, Hypertension in NY, Cleveland Clinic Foundation, Cleveland, OH, USA USA Blacks 212 Pneumoperitoneum Patient On CCPD,ofTreated 52 Massive Granulomatous Prostatitis asina aRare Presentation Gran1 Guided Needle Aspiration Arifwith Asif1CT , Huzaif Qaisar , Vikas Singh1, Mayur K. Patel1, Indu ulomatosis with Polyangiitis 1 1 1 1Mehandru 1MasudIzuchukwu 12. Sharma , Suhsil , Awais , Loay Salman Charles Neustein, Kachur, Nwakoby. , RafiaPatricia Chaudhry , Richard Blinkhorn , Loay Anum Bilal 1 1 University 1,2 1 Jersey Shore Medical Center, Seton HallOcala Health, Ocala, FL, USA Salman , Elvira Gosmanova . Albany Medical College, 2 Hackensack-Meridian School of Medicine, Neptune, NJ, USA; 213 Relapse of IgA Nephropathy Following an Episode of Albany, NY, USA; Albany Stratton VA Medical Center, 2 Albany Medical College, Albany, NY, USA Rhabdomyolysis Albany, NY, USA Thu-Cuc Nguyen, Nwakoby. University of 53 Skin Rash: A hypokalemic Rare Izuchukwu Presentation of Post-Transplant LymHypertension with metabolic alkalosis is not rare. Central Health, Ocala, [3males, FL, USA1 female, phoproloferative Disorder We present 4Florida/Ocala hypertensive black patients age=38, 42],Bilal, BMI=25, 24, noFoulke, metabolic syndrome, peripheral 214 Fibrillary Glomerulopathy and Renal Cell Homan, Cancer inSungeun a Situs Anum Llewellyn Suzanne edema or sleep apnea) with K=2.9-3.1 bicard=28-32 mm Inversus Totalis Patient Kim, David Conti, Loay Salman,mEq/L, Rafia Chaudhry. Albany Eq/LDmitri and BP=158-180/90-105 mmHg. All had been on adequate Medical Center, Albany, NY, USA Nikolaenko, Mony Fraer. University of Iowa dosage of three BP meds (calcium channel blocker, ACE-I/ARB, andThe Clinics, Iowa USA 54 Hospital It Runs in Family: A City, Case IA, of Hyperkalemic Periodic metoprolol/carvedilol). All had a negative MRA for renal artery Paralysis – An Unfriendly 215 Staphylococcus Pseudintermedius stenosis, aldosterone/renin=12-14 (normal<20) and urinary Companion Rebecca Blonsky, Georges Nakhoul. The ng/dl). Cleveland Clinic aldosterone=8-10 ng/l (reference abnormal>14 Because Foundation, Cleveland OH, USAwas notDilek Dmitri Nikolaenko, Shaun Ince,inM. Lee of normal aldosterone/renin, CT Fernandes, scan obtained these Sanders. University of Iowa, Iowa IA,Peritonitis: USAdid notFirst patients. Treatment withand eplerenone (50-100 mg/day) – City, Related 55 Peritoneal Dialysis Pet BITE reduce BP at 4Change weeks replacement with with amiloride (10 from Reported Case ofbut Rhizobium Infection 218 Minimal Disease in a Radiobacter Patient Systemic Lupusa mg/day) normalized A theCase pressure (130-135/84-90 mmHg). While Cat Bite Erythematosus: Report aldosterone is an important mediator of hypertension, overBenjamin Bluen, Lukasz Hans Schlecht, Michelle Odianosen Obadan, RulaKiljanek, Abdulrahman, Jose Pace, Rajbir activity of distal tubule sodium channel (ENaC) must be Fuentes, Saint Kyle Krevolin, Larry Krevolin. University Chopra. John’s Episcopal Hospital,Drexel Far Rockaway, considered with hypokalemic metabolic alkalosis College of Medicine, Philadelphia, PA, USAin blacks. It NY, USA has been suggested that amiloride provides better BP control in 56 Anti-Thymocyte Globulin Induced Acute in a 220 Blood Pressure Control After Removal of Kidney RenininInjury Secreting resistance hypertension in blacks compared to aldosterone Patient providing withKidney Aplastic Anemia Atrophied antagonists validity to ENaC over-activity in blacks. Genetic testing was Bohra, declined by the payors to investigate Chandrashekar Verma, Bassil. Eshetu Obole, Robin Sean Shah, JasonClaude Prosek. OhioUniverState Liddle’s syndrome. sity of South Florida, Tampa,Center, FL, USA University Wexner Medical Columbus, OH, USA 57 A Immune Complex Glomerulonephritis with Persistently – A Case 221 Severe but Nonfatal Case of Hypermagnesemia Negative ANA Assay Report

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Am J Kidney Dis. 2017;69(4):A1-A105