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Triptans are effective as acute abortive therapy for migraine and cluster headaches by targeting the serotonin 5-HT1B/1D receptors located in the cerebral, coronary, and peripheral arteries. This class of medications inhibits the release of vasoactive peptides and promotes vasoconstriction, combating the pathologic vasodilatation contributing to migraine headaches.1 Potential complications of these vasoconstrictive properties include myocardial infarction,2, 3 cerebrovascular accident,4 ischemic colitis,5 and spinal cord infarction.6 We present a case of bilateral renal infarctions associated with sumatriptan use.

Contrast exposure in a population with chronic kidney disease (CKD) requires additional consideration given the risk of contrast-induced nephropathy (CIN) after exposure to iodinated contrast as well as systemic injury with exposure to gadolinium-based contrast agents (GBCA). Strategies to avoid CIN, and manage patients after exposure, including extracorporeal removal of contrast media, may differ among an advanced CKD population as compared to a general population. There is strong evidence to support the use of isotonic volume expansion and the lowest dose of low-osmolar or iso-osmolar contrast media possible to decrease CIN. The current literature on other newer prophylactic strategies such as statins, remote ischemic preconditioning, discontinuation of renin angiotensin aldosterone system (RAAS) blockade, and RenalGuard is limited thus these strategies cannot currently be recommended as routine prophylaxis for CIN. The use of extracorporeal removal of contrast agents as prophylaxis to reduce CIN has been the subject of multiple studies; however, data do not support a beneficial effect in reduction in CIN. Immediate removal of contrast by dialysis in a maintenance dialysis population is also not recommended, unless an individual's cardiopulmonary status is dependent on strict volume management. In patients with reduced renal function, GCBA exposure increases the risk of NSF. In patients with AKI, CKD stage 3 or greater (eGFR

Contrast-induced acute kidney injury (CI-AKI) risk is generally higher with the use of coronary angiography, with an average incidence of CI-AKI of 13.7% and a range between 4.4% and 28%. Long-term effects of acute kidney injury following nephrotoxic exposure include CKD progression and all-cause mortality. Baseline CKD status is the most predictive risk factor for CI-AKI, with increased risk in eGFR

Dietary supplement use is high among US adults, with the intention by users to promote overall health and wellness. Kidney donors, who are selected based on their overall good health and wellness, can have high utilization rates of dietary supplements. We provide a framework for the evaluation of living kidney donors and use of dietary supplements. In this review, dietary supplements will include any orally administered dietary or complementary nutritional products, but excluding micronutrients (vitamins and minerals), food, and cannabis. Use of dietary supplements can influence metabolic parameters that mask future risk for chronic illness such as diabetes and hypertension. Dietary supplements can also alter bleeding risk, anesthesia and analgesic efficacy, and safety in a perioperative period. Finally, postdonation monitoring of kidney function and risk for supplement-related nephrotoxicity should be part of a kidney donor educational process. For practitioners evaluating a potential kidney donor, we provide a list of the most commonly used herbal supplements and the effects on evaluation in a predonation, perioperative donation, and postoperative donation phase. Finally, we provide recommendations for best practices for integration into a comprehensive care plan for kidney donors during all stages of evaluation. We recommend avoidance of dietary supplements in a kidney donor population, although there is a paucity of data that identifies true harm. Rather, associations, known mechanisms of action, and common sense suggest that we avoid use in this population.

With an increasingly aging population and improved mortality in individuals with end-stage kidney disease, more surgeries are being performed on patients with all stages of chronic kidney disease (CKD). This high-risk population carries unique risk factors that have been associated with increased adverse perioperative outcomes, including acute kidney injury, cardiovascular events, and mortality. In this article, we review the literature describing absolute risks associated with common surgeries performed in patients with CKD and patients receiving maintenance dialysis. We also review perioperative optimization with special risk assessment including evaluation of cardiovascular and bleeding risk evaluation, hypertension management, and timing of dialysis. Predictive model scores are reviewed as a method to stratify risk for acute kidney injury, major adverse cardiac events, or other serious complications with elective surgeries. A multidisciplinary approach with individualized counseling is necessary to counsel the patient with advanced CKD or patients treated with maintenance dialysis considering elective surgery.

The manner in which the circulation accommodates each heartbeat may underlie blood pressure (BP) variability. We used the Ambulatory Arterial Stiffness Index (AASI), which reflects this ventricular-vascular interaction, in untreated individuals with prehypertension and Stage 1 hypertension to evaluate two different measures of BP variability using the brachial pulse pressure (PP) obtained over 24 hours. We enrolled 64 untreated adults with systolic BP between 130-159 mm Hg and diastolic values of

Blood pressure variability (BPV) is associated with adverse cardiovascular outcomes. Factors determining BPV are unclear. Arterial stiffness manifested by pulse pressure (PP) may be related to BPV, and is reflected in the pulse wave velocity (PWV), as well as the regression of diastolic on systolic pressure determined by the Ambulatory Arterial Stiffness Index (AASI). We hypothesized that arterial stiffness was associated with PP variability (PPVAR) and determined arterial stiffness using AASI and PWV. Ambulatory blood pressure (BP) data from untreated subjects (n=56, 28 men) with SBP >130 to AASI correlated positively with day PPVAR (r=0.57, p The relationship between AASI and PPVAR was only evident when the blood pressure periods were broken down into day and night. The 24 hour regression relationship of diastolic on systolic blood pressure with PPVAR appears different between day or night compared with the 24 hour aggregate, suggesting circadian differences in factors which modify PPVAR. Poor PWV correlation with PPVAR is likely due to relatively young age of our subjects.