Development of a Nephrology Team-Based Learning Activity for Medical Students: Assessment of the Learners’ Perception

NKF 2017 Spring Clinical Meetings Abstracts Gustavo Borda, Ashfaq Balla. Metrowest Medical Center, Framingham, MA, USA RECOGNITION OF REVERSE PSEUDOHYPERKALEMIA: 59Siddhartha Sevelamer Induced Diffuse Crystal Colitis:A.AVassalotti. Case Report of Kattamanchi, Joshua L. Rein, Joseph Icahn a Rarely Reported Side Effect School of Medicine at Mount Sinai, New York, NY, USA. Hyperkalemia is a potentially abnormality is a frequent Samir Brahmbhatt, Michaelfatal Cruise, James that Simon. Cleveland indication for nephrology consultation. The significant majority of Clinic Foundation, Cleveland, OH, USA potassium is intracellular and therefore both in vivo and in vitro 61hemolysis An Unusual Hyponatremia Attributed to can lead toCase elevatedofserum potassium levels. False elevations in potassium may be due to hemolysis orTherapy platelet rupture during Trimethoprim-Sulfamethoxazole coagulation. In vitro hemolysis can be identified by checking a plasma Adam Bsiso, Michael Sheffield, Roberto Collazolevel, collected in a tube containing heparin to prevent this occurrence. Dallas Medical Center, WeMaldonado. present a caseMethodist of reverse pseudohyperkalemia (PHK)Dallas, whereinTX, the USApotassium is elevated, while the serum potassium is normal. plasma 57 year-old woman wasCausing admittedBacterial-Endocarditis with acute kidney injury Asso62 AEnteroccous Species secondary to a rapidly progressive fungoides/Sézary ciated Glomerulonephritis in mycosis an At Risk Population Syndrome despite doxorubicin 1 week prior. On presentation, labs revealed a Emma Bueno, Keyrillos Rizg, Mario Cisneros, fromChique a serum K 5.2 mEq/L, TCO2 18 mEq/L, Cr 3.5 mg/dL (upJuan Figueroa, Ryan 4Kunjal, Andreea Raafat She didF baseline of 0.8 mg/dL days prior), and WBCPoenariu, 166 x 103/µL. Universityor supplements of Floridaknown College of hyperkalemia. MedicinenotMakaray. take any medications to cause Due to the aggressive nature of her malignancy, next line chemotherapy Jacksonville, Jacksonville, FL, USA was initiated with cyclophosphamide and dexamethasone. That day, 65 Recurrent Thrombotic Microangiopathy in a Renal Alloserum K was 5.6 mEq/L and a plasma K was 5.5 mEq/L. The following graft: Clinical Conundrum day, labs A revealed serum K 4.5 mEq/L, plasma K 6.7 mEq/L, TCO 2 16 3 /µL. EKG did reveal any mEq/L, 6.5 mg/dL,Jose and WBC 246 x 10University OliviaCr Campa, A. Morfin. of not California hyperkalemic changes. The plasma Davis, Sacramento, CA, USAand serum potassium gradually equalized as the WBC count decreased more than 60% in response to 68 A Rare Case of Neonatal Bartter Syndrome cyclophosphamide and dexamethasone. 1 2 1 Tushar PHK Chaturvedi , Rupesh Raina . Akron Nephrology Reverse is a phenomenon where the plasma potassium is higher 2 than the serum potassium due to an in vitro artifact. The few reported Clinic Akron Associates, Akron, OH, USA; Cleveland cases have been in patients with active chronic lymphocytic leukemia, General, Akron, OH, USA whereas our patient had cutaneous-T-cell lymphoma. Possible 71mechanisms An Unusual Case of Negative Anion Gap inWBC a Patient with for this phenomenon include chemical disruption Hypercalcemia from heparin or mechanical WBC damage from pneumatic transport tubes. The ability to distinguish between trueThodima, hyperkalemia, PHK and Avantika Chenna, Pradeep Reddy Rasib Raja. reverse PHK is crucial in order to determine appropriate therapy. Albert Einstein, Philadelphia, PA, USA 74 Atypical Presentation of Metastatic Esthesioneuroblastoma with Ectopic ACTH Syndrome After 7 Years 162Vamsi Chilluru, Jay Hawkins. University of Nebraska Medical Center, NE, USA DEVELOPMENT OF AOmaha, NEPHROLOGY TEAM-BASED LEARNING FOR MEDICAL STUDENTS: ASSESSMENT OF THE 86 ACTIVITY Prosthetic Valve Endocarditis from Mycobacterium LEARNERS’ ChimaeraPERCEPTION Infection Causing Granulomatous Interstitial Amir Kazory, Zareen Zaidi Nephritis Department of Medicine, University of Florida, Gainesville, Florida, USA Jonathan Dabeen Costa, Ivan Porter, Peter Objective: It has shownAhmed that careerAbdalrhim, choice decisions can be made very early by the trainees, and suboptimal exposure to nephrology has beenClinic, identified Fitzpatrick, Cherise Cortese, Nabeel Aslam. Mayo as Jacksonville, a major reason forFL, the declining USA interest in this subspecialty. Team-based learning (TBL) is an active learning strategy that is increasingly used in medical 87 education Healthtoor Beauty: A thinking, Case ofknowledge an Unusual Cause Severe promote critical application, andof teamwork. WeHypercalcemia performed this study to assess the students’ perspective of the utility of TBL activity compared to conventional lectures within their renal course. Gulshan Dangol, Sashi Ariyaratne, Hilmer Negrete. St. Methods: A TBL activity on hyponatremia was developed including multiple Elizabeth Youngstown, OH, USA choice questionsYoungstown according to theHospital, item-writing recommendations of the National of MedicalDense Examiners. We usedAa validated TBLCases Student with 88 Board Recurrent Disease: Report 34-item of Two Assessment comprisingPathologic of 3 subscales Findings evaluating accountability, VaryingInstrument Presentations, and Patient preference for lecture or TBL, and students’ satisfaction. First-year medical Outcomes students enrolled at the University of Florida College of Medicine were asked to DilinitheDaswatta, Carla complete questionnaire. Sharon The scores Graves, were considered first Ellis. separatelyEmory for each subscale, and thenAtlanta, the total scores University, GA, were USAcalculated. Results: A total of 138 students were enrolled in the renal course, of whom 70 90 (50%) Crystalglobulin-Induced Nephropathy and Keratopathy participated in this voluntary and anonymous web-based study. Although Matthew D’Costa, Sandhya Grande, 81% of students reported that they had toManohar, prepare priorJoe to the TBL and Samih stated thatNasr, they had to contribute to the Mayo learningClinic, of their team, only 52%MN, thought that Marie C. Hogan. Rochester, USA they were accountable for team learning. The majority felt that TBL activities 91 areVitamin C Induced Oxalate Nephropathy an effective approach to learning (74%) with 78 % agreeing that TBL activities helped D’Costa, them recall past information. However, less than halfSandra (45%) felt Matthew Loren Herrera Hernandez, thatHerrmann. TBL helped improve their grades. Mayo Clinic, Rochester, MN, USA Conclusion: Students reported a general preference and satisfaction with TBL 92 over A traditional Case of lectures SeverebutHyponatremia AcuteonKidney Injury a mixed responseand was noted the questions pertaining accountability for team learning. Based onLebanon these findings, future Eddy toDeJesus, Nasr, Rabih. Bronx Hospital studies are warranted focusUSA on identifying the factors that could potentially Center, Bronx, toNY, improve the students’ accountability during TBL activities, and also to explore 103 theAcute Glomerulonephritis Post Administration of impact on their interest in nephrology and future career choices. Pegfilgrastim Hatem Elabd, Naheed Ansari, Belinda Jim. Jacobi Medical Center, New York, NY, USA

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

108 Refractory Hypomagnesemia During Pregnancy in a Patient with Gitelman Syndrome RESISTIVE INDEX BY RENAL DOPPLER IN PREDICTING CHRONIC KIDNEY Thomas Frohwein, Susan Kim, Singh, Isaiarasi Gnanasekaran. DISEASE: Sai Ram Keithi-Reddy, Chhaminder Dhanalaxmi V, Lincoln and Mental HealthIndia Center, Bronx, NY, Anusha Patrick,Medical Yashoda Hospitals, Hyderabad, USA Renal biopsy is quintessential for diagnosis and therapy in renal diseases. Anecdotal suggest correlates with chronic(RVT) 110 Diagnosis andreports Treatment ofRIRenal Veinwell Thrombosis interstitial – anof indicator chronic kidney We in thefibrosis Setting Lupusof Nephritis anddisease. Antiphospholipid conducted a prospective blinded study to assess relation between RI Syndrome (APS) and significant interstitial fibrosis, so a biopsy could be avoided for Pablo purposes. Garcia, Felix Renneberg, Maanit Kohli, Steve Bibu, prognostic Navya Kuchipudi, Van Hoven, Shaunak Dwivedi. In this prospective blindedAnne study (kidney biopsy report was not SaintatPeter’s Hospital, Newunderwent Brunswick, NJ, USA available the timeUniversity of renal doppler), patients Ultrasound testing just before renal biopsy with a real time ultrasound with 111 Scleroderma Renal Crisis (SRC) in the Setting device of Systemic 3.5 MHz convex probe and color doppler capacity. Clinical data, Sclerosis Sine Scleroderma (ssSSc) in Pregnancy including sex, age, serum creatinine level, creatinine clearance, urinary Pabloof protein, Garcia, presence Shaylika Chauhan, Maanit Kohli, excretion of hypertension and diabetes, wereNavya Kuchipudi, Peter’s University recorded. Here we Shaunak explored theDwivedi. relationshipSaint between pre-biopsy Hospital, New USAto predict interstitial resistive index by renalBrunswick, Doppler andNJ, its ability fibrosis in kidney biopsy specimen. Independent sample 121 Red Eyes and Renal Insufficiency in A t-test, Middle Age χ2statistic, Spearman’s correlation coefficients were calculated for Gentleman pairs of continuous variables. Receiver Operator Characteristic curve Heidi Turner. Yale (ROCMaryam curve; NullGondal, hypothesis; trueMae area =Timbol, 0.05) wasJeffery drawn with University, Newsensitivity Haven, and CT,specificity. USA coordinates to assess of 38 patients analysed;24Disease were males; 15 were to IGA 125 A total Atypical Case were of Behcet’s Leading diabetic; 25 had hypertension. Mean age of study population was Nephropathy 45±2.4 yrs ; mean serum creatinine level was 3.63±0.6 mg/dl; eGFR Anastasios Papanagnou, Yorg Al-Azzi. was Sanjeev 46.02±6.37Gupta, ml/min; and mean RI was 0.63±0.01. We observed Westchester Westchester, NY, USA p positive correlationMedical between Center, RI and interstitial atrophy (rs =0.787; p value<0.05). ROC in a value<0.05), and Toxicity glomerulosclerosis (rs =0.728; 126 Cefepime Presenting as Status Epilepticus analysis showed bestStage cut-offRenal RI value to predict moderate to Patient withtheEnd Disease severe interstitial fibrosis was 0.64 (AUC = 0.90; 93.3% sensitivity and Mohit Gupta1, Jayaprakash Dasari1, Aziz Bakhous1, Raed 87% specificity) 1 1 1 AzzemIndex , Donald Dumford , Patrick Gallegos Resistive is an excellent measure in predicting fibrosis ,in Rupesh 1 1 Raina . specimen Cleveland Clinic OH, USA kidney biopsy and can beAkron used inGeneral, place of aAkron, kidney biopsy, especially when done for prognostication purposes. 129 Tenofovir Causing Hospitalization Due to Severe Symptomatic Hypophosphatemia Sanjeev Gupta, Anastasios Papanagnau, Savneek Chugh. 164 Westchester Medical Center, Valhalla, NY, USA HIGH ANION GAP METABOLIC ACIDOSIS DUE TO 5130 The Significance of Anti-Phospholipase Antibodies in a OXOPROLINE WITH LOW DOSE ACETAMINOPHEN: Patient with Membranous Nephropathy Sobia N Khan, Arun Kottarathara, Opeyemi Oladele, Sandeep Mohit Gupta, Jayaprakash Dasari, Rupesh Raina, Pallavi Mallipattu, Nand K Wadhwa, Stony Brook Medicine, Stony Brook, NY, Reddy. USA. Cleveland Clinic Akron General, Akron, OH, USA 132Pyroglutamic A Mysteryacidosis Case oforBlood Leak Alarm Onrecognized 5-oxoprolinemia is Going an under causeSeifeldin for high anion gap Maditz, metabolic acidosis Lohani, (HAGMA). Hakim, Rhyan Sadichhya Sami Acetaminophen disrupts the gamma glutamyl causing depletion Zarouk. Oakland University Williamcycle Beaumont Hospital, of glutathione stores leading to 5-oxoproline accumulation. We report a MI, USA woman who received low doses of case Royal of a Oak, malnourished 133 Previouslyresulting Undiagnosed Associated Vasculitis Preacetaminophen in severeANCA metabolic acidosis and was treated successfully N-acetyl cysteine (NAC). sentingwith Oneoral Month After Kidney Transplantation A 57-year-old woman with schizoaffective disorder, seizures, status Ayman Hallab, Karthik Kannegolla, Mohammad S. Yaqub. post tracheostomy following COPD exacerbation, presented with Indiana Schoolinjury of Medicine, Indianapolis, IN, severe anemiaUniversity and acute kidney with a BUN of 70 mg/dL, USA (Cr) 1.26 mg/dL, bicarbonate (HCO) 15 mmol/L and anion creatinine gap Case (AG) Report 18. She ofreceived PRBC, Dependent volume resuscitation with 149 a Dialysis Immunotactoid bicarbonate solution. She was also treated with antibiotics for Glomerulopathy with Favorable Response to Rituximab tracheobronchitis. On day 5 of admission, 2her BUN and Cr improved to 1 3 , Rohan Markowitz Aaron Mehak 20 mg/dL andIdrees 0.9 mg/dL, HCOBhojwani 22 mmol/L, Glen and AG 15. By day, 9, she 4 1 2 developed worsening HAGMA with HCO of 13 mmol/L AG 25. Dommu . Griffin Hospital, Derby, CT, USA;andFairview 3 day 6 to day 11 with a total She received mg to 650 OH, mg a USA; day from Columbia University, New Hospital,325 Cleveland, of 1625 mg of acetaminophen. She received a total of 2100 mmol of CT, IV York, NY, USA; 4Nephrology Associates, Bridgeport, sodium bicarbonate from day 7 to 21 but acidosis persisted. This USA prompted to check 5-oxoproline level in urines on day 12 which was 150 De Novo Atypical Hemolytic Uremic reported as >10,000 mmol/mol creatinine with Syndrome concurrent Fourteen negative serum acetaminophen level. Transplant On day 21, she was started on oral NAC Months After Renal 1200 mg twice daily with complete resolution of metabolic acidosis Olusola Isikalu, Jennifer Thompson, Maria Aurora Posadas requiring no further bicarbonate infusion. Since then, She maintained Salas. normal HCOMedical and AG. University of South Carolina, Charleston, SC,case USA This illustrates acute severe HAGMA due to pyroglutamic acidosis on Lupus very low doses ofA acetaminophen, particularly in a 151 “Lone” Nephritis: Seronegative, Histopathological malnourished woman with multiple comorbidities. 5-oxoproline levels Diagnosis should be checked routinely in an unexplained HAGMA in a Jamal Janjua, Pratima Kamada, Aiman deficiency Riaz. Gundersen hospitalized patient as the acquired glutathione can be Health System,byLa Crosse, corrected effectively oral NAC. WI, USA

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