Gates B. Colbert M.D.

Gill, J., C. A. Hebert and G. B. Colbert (2021). “COVID-19-associated atypical hemolytic uremic syndrome and use of Eculizumab therapy.” J Nephrol Aug 24;1-5. [Epub ahead of print].

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There is a high incidence of acute kidney injury with COVID-19 infections. The etiologies of acute kidney injury could be ischemic acute tubular necrosis or a complex process of complement activation leading to thrombotic microangiopathy. We present a case of 32-year-old Hispanic male with a history of heart transplant, admitted with COVID-19 and atypical hemolytic uremic syndrome, which was successfully treated with Eculizumab.

Palmer, B.F., Carrero, J.J., Clegg, D.J., Colbert, G.B., Emmett, M., Fishbane, S., Hain, D.J., Lerma, E., Onuigbo, M., Rastogi, A., Roger, S.D., Spinowitz, B.S. and Weir, M.R. (2021). “Clinical Management of Hyperkalemia.” Mayo Clin Proc 96(3): 744-762.

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Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K(+)) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting. There is a need to improve effective management of hyperkalemia, including classification and K(+) monitoring, when to reinitiate previously discontinued renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, and when to use oral K(+)-binding agents. Monitoring serum K(+) should be individualized; however, increased frequency of monitoring should be considered for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia and for those receiving RAASi therapy. Recent clinical studies suggest that the newer K(+) binders (patiromer sorbitex calcium and sodium zirconium cyclosilicate) may facilitate optimization of RAASi therapy. Enhancing the knowledge of primary care physicians and internists with respect to the safety profiles of these newer K(+) binders may increase confidence in managing patients with hyperkalemia. Lastly, the availability of newer K(+)-binding agents requires further study to establish whether stringent dietary K(+) restrictions are needed in patients receiving K(+)-binder therapy. Individualized monitoring of serum K(+) among patients with an increased risk of hyperkalemia and the use of newer K(+)-binding agents may allow for optimization of RAASi therapy and more effective management of hyperkalemia.

Colbert, G.B., Abra, G. and Lerma, E.V. (2020). “Update and review of renal artery stenosis.” Dis Mon Dec 7;101118. [Epub ahead of print].

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According to Carey et al., “resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (RAAS) (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic”.1 The causes of RH are: non-adherence with dietary salt restriction, drugs (prescription and non-prescription), obstructive sleep apnea, and secondary hypertension.[No abstract; excerpt from article].

Colbert, G. B., M. E. Elrggal, L. Gaur and E. V. Lerma (2020). “Update and review of adult polycystic kidney disease.” Dis Mon 66(5): 100887.

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Autosomal dominant polycystic kidney disease is a common cause of end stage kidney disease. It is a progressive and unfortunately incurable condition that can lead to significant morbidity and kidney failure. Many more patients are diagnosed with this disease without any symptoms as the population is increasingly undergoing imaging for other problems and diagnostic workup. Our understanding of the genetic variants has increased in recent years as research continues to improve. As well, therapeutic options have developed with the FDA approval of a new treatment medication, with many others underway. This review updates the clinician on the pathophysiology, clinical aspects, and therapeutic options for patients the is form of kidney disease.

Colbert, G. B., M. E. Elrggal, L. Gaur and E. V. Lerma (2019). “Update and Review of Adult Polycystic Kidney Disease.” Dis Mon Sep 30. [Epub ahead of print].

Full text of this article.

Autosomal dominant polycystic kidney disease is a common cause of end stage kidney disease. It is a progressive and unfortunately incurable condition that can lead to significant morbidity and kidney failure. Many more patients are diagnosed with this disease without any symptoms as the population is increasingly undergoing imaging for other problems and diagnostic workup. Our understanding of the genetic variants has increased in recent years as research continues to improve. As well, therapeutic options have developed with the FDA approval of a new treatment medication, with many others underway. This review updates the clinician on the pathophysiology, clinical aspects, and therapeutic options for patients with this form of kidney disease.