Background: In the US, native kidney biopsies are usually inpatient procedures. We developed an outpatient biopsy protocol for low-risk patients and assessed its safety and efficacy. Methods: Patients with an SBP <140 mm Hg and a BMI ≤35 who were not taking anticoagulants, ASA and NSAIDS in the preceding week were included. Biopsies were performed under ultrasound guidance using a 15-gauge needle that changed to a 14-gauge needle during the study. Patients were discharged after 5 h of observation if there were no signs of bleeding. Complications were carefully recorded. Results: Between November 2008 and April 2011, 105 patients underwent outpatient renal biopsies. A 15-gauge needle was used in 43 patients (group A) while a 14-gauge needle was used in 62 (group B). A median of 25 (range 4–64) glomeruli were obtained in group A versus 39 (range 0–107) in group B (p < 0.001). Complications requiring admission for observation occurred in 7 patients (16%) in group A versus 5 patients (8%) in group B (p = 0.22). One patient in group B had bleeding requiring intervention, while all other complications were minor. Nine complications occurred during the observation period, while 3 patients presented >48 h after biopsy. The mean cost per patient for each outpatient biopsy was USD 976 versus USD 5,489 for inpatients. Conclusions: In a selected low-risk population, outpatient renal biopsy is safe with low complication rates and results in significant cost savings relative to elective inpatient biopsies. The use of a 14-gauge biopsy needle resulted in a greater yield of glomeruli without increased complications.

We report the 2nd patient to have hyperthyroidism while on maintenance hemodialysis. This case is instructive because the diagnosis of hyperthyroidism in uremic patients is difficult due to similar signs and symptoms. This case report describes, for the first time, the unique interaction between hemodialysis and thyrotoxic heart disease. Paroxysmal atrial fibrillation and severe hypotension interfered with all hemodialyses. Only the correction of the hyperthyroid state and withdrawal of all beta-blocking agents allowed resumption of normal hemodialysis. The delayed gastric emptying and hypercalcemia ultimately resolved with return to the euthyroid state and did not recur during 10 months of follow-up.

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Hyperkalemia was commonly observed in successful renal transplant patients treated with cyclosporine and prednisone. At 1, 3 and 6 months after transplantation, 13 of 50, 9 of 50, and 5 of 50 patients, respectively, had serum concentrations of potassium greater than 5 mEq/1. This contrasts with the finding of hyperkalemia in only 1 of 13 comparable patients treated with azathioprine and prednisone. Mean serum concentrations of potassium at these dates were significantly higher in cyclosporine-treated patients than azathioprine-treated patients. The 2 patient groups had similar mean serum concentrations of chloride, bicarbonate and creatinine, and mean creatinine clearances at 1 and 3 months. Exposure to diuretic agents and antihypertensive agents was similar in the 2 groups. Serum concentrations of electrolytes and renal function data in hyperkalemic and normokalemic transplant patients receiving cyclosporine were similar. These observations suggest an association between cyclosporine administration and hyperkalemia in renal transplant recipients.

We present a case of granulomatous interstitial nephritis and renal failure after a jejunoileal bypass for obesity. Improvement of the renal function occurred after reversal of the intestinal bypass. The renal biopsy showed an interstitial nephritis, oxalate crystal deposition and several aggregates of multinucleated giant cells related to the crystal material (granulomatous reaction). By ultrastructural and histochemical studies we demonstrated mitochondrial alterations in the tubular epithelial cells, and we suggested the proximal tubule origin of the giant cells. The association of the oxalate crystals with damaged tubules and giant cells suggests that the oxalate crystals are responsible for these alterations. The possibility of an associated immunological process as the cause of the interstitial nephritis cannot be excluded.