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Medullary Nephrocalcinosis is caused by diffuse increase in calcium in the kidneys especially the renal pyramids. Normally hypoechoic they become echogenic.

This condition is usually asymptomatic and may present with increased BUN.

Medullary sponge kidney has a very similar appearance and may be difficult to differentiate with Ultrasound alone.

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Are glucose‐lowering medications effective and safe in people with diabetes and chronic kidney disease (CKD)?

Cochrane Review; 44 studies (13,036 people).

Key findings

SGLT2 inhibitors probably reduce glucose levels, blood pressure, heart failure, and high potassium levels but increase genital infections and slightly reduce kidney function. SGLT2 inhibitors may reduce weight. Their effect on the risk of death, hypoglycaemia, acute kidney injury, urinary tract infection, end‐stage kidney disease, low blood volume, bone fractures, diabetic ketoacidosis is uncertain.

DPP‐4 inhibitors may reduce glucose levels. Their effect on the risk of death due to heart attacks and strokes, heart failure, upper respiratory tract infections, liver problems, kidney function, hypoglycaemia, pancreatitis, and pancreatic cancer is uncertain.

GLP‐1 agonists probably reduce glucose levels and may reduce weight. Their effect on kidney function, hypoglycaemia, gastrointestinal symptoms, and pancreatitis is uncertain.

Compared to glipizide, sitagliptin probably has a lower risk of hypoglycaemia.

Conclusions

Evidence concerning the efficacy and safety of glucose‐lowering agents for people with diabetes and CKD is limited.

More studies are required.

Grayscale (image 1) and color Doppler (image 2) ultrasound of the right kidney (arrow) shows medullary nephrocalcinosis (arrowhead). There is considerable twinkle artifact when color Doppler is applied. Medullary nephrocalcinosis can be caused by many different underlying entities including hyperparathyroidism, renal tubular acidosis, medullary sponge kidney, and hypercalcemia. Extensive medullary calcifications are not typically seen with other entities.

Horseshoe kidney on the back table before kidney transplant. The aorta and vena cava are still attached in en bloc fashion. Basically, this recipient gets two kidneys during this transplant.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?