Keyword: Nephrology

ABSTRACT: Post-bariatric surgery patients face higher risk of micronutrient malabsorption and often receive intravenous iron like Ferric carboxymaltose (FCM).  Recent studies associate FCM with severe (serum phosphate levels < 1 mg/dL) and prolonged hypophosphatemia caused by elevated Fibroblast Growth Factor 23 (FGF23) levels, which reduces phosphate reabsorption in the kidneys via α-Klotho co-receptor. FCM, in particular, can therefore lead to notable and sustained FGF23-mediated hypophos-phatemia. We present a case of prolonged and severe hypophosphatemia secondary to fibroblast growth factor 23 (FGF23)-mediated phosphaturia following ferric carboxymaltose (FCM) administration in a post-bariatric surgery patient. This case underscores the complex interplay between intravenous iron therapy, phosphate metabolism, and altered absorption physiology following bariatric surgery. It highlights the need for clinicians to monitor phosphate levels after FCM administration, particularly in high-risk patients such as those with malabsorption.

ABSTRACT: A 41-year old female patient who underwent kidney transplantation as an outcome of chronic glomerulonephritis came to the hospital with the signs of acute upper respiratory tract infection. As the patient further developed oliguria, peripheral edema, fever, and an increased BP, she was further relocated to the University Medical Center (UMC). Upon admission to UMC, signs of septic shock were detected, and acute transplant rejection was suspected, to exclude which kidney biopsy was performed and stage 3 chronic kidney disease (CKD) in allograft kidney was detected. Antibacterial treatment as well as pulse therapy were performed as patient had septic shock and tubulointerstitial nephritis (TIN).

ABSTRACT: A 46-year old male was admitted to the University Medical Center (UMC) hospital with the following symptoms of anuria, abdominal fullness, hypotension, exertional dyspnea, and peripheral edema. The purpose of his visit was the insertion of a peritoneal dialysis catheter. He had chronic kidney disease stage 5 as a consequence of diabetic nephropathy, liver cirrhosis due to hepatitis C infection, and HIV. His disease course was further complicated by the presence of a urinary tract infection. As a result of his multiple comorbidities, he underwent a complex treatment regimen which included renal replacement therapy with ultrafiltration, blood transfusions for his anemia, platelet transfusions for his thrombocytopenia, albumin infusion for his hypoalbuminemia, and antibiotic treatment for his concurrent infection. Additionally, he received diuretic treatment for his hypervolemia and anti-hypertensives to control his blood pressure. After peritoneal dialysis (PD) insertion, the patient successfully underwent PD and was discharged home.