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Michel Vallée,1 Jordan Weinstein,2 Marisa Battistella,3 Roxanne Papineau,4 Dianne Moseley,5 Gordon Wong6 1Université de Montréal - Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada; 2Division of Nephrology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada; 3University Health Network- Toronto General Hospital, Toronto, Ontario, Canada; 4Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; 5Trillium Health Partners, Mississauga, Ontario, Canada; 6Trillium Health Partners, Credit Valley Nephrology, Mississauga, Ontario, CanadaCorrespondence: Gordon WongTrillium Health Partners, Credit Valley Nephrology, 2300 Eglinton Ave. West Suite #501, Mississauga, Ontario, L5M 2V8, CanadaEmail gwong1030@gmail.comAbstract: Population-based studies have shown that most patients with advanced chronic kidney disease (CKD) do not have optimal phosphate levels. Meta-analyses suggest that there is a morbidity and mortality benefit associated with the lowering of serum phosphate levels. However, to date there is no conclusive evidence from randomized controlled trials (RCTs) that lowering serum phosphate levels reduces the risk of morbidity and mortality. However, hyperphosphatemia may pose a risk to patients and treatment should be considered. We therefore sought to conduct a multidisciplinary review to help guide clinical decision-making pending results of ongoing RCTs. Restricting dietary phosphate intake is frequently the first step in the management of hyperphosphatemia. Important considerations when proposing dietary restriction include the patient’s socioeconomic status, lifestyle, dietary preferences, comorbidities, and nutritional status. While dietary phosphate restriction may be a valid strategy in certain patients, serum phosphate reductions achieved solely by limiting dietary intake are modest and should be considered in conjunction with other interventions. Conventional dialysis is also typically insufficient; however phosphate removal may be augmented by increased frequency or duration of dialysis, or through enhanced methods such as hemodiafiltration. Phosphate binders have been shown to reduce absorption of dietary phosphate and lower serum phosphate levels. There are several phosphate binders available, and while they all lower phosphate levels to variable degrees, they differ with respect to their pill burden, potential to induce or exacerbate vascular calcification or ectopic calcification, tissue accumulation, safety, and tolerability. The widespread treatment of hyperphosphatemia requires convincing data from RCTs to ascertain whether lowering serum phosphate levels improves patient-important outcomes, as well as the optimal method and degree of phosphate control. In the interim, the decision and approach used to treat hyperphosphatemia should be based on the best available data, as well as patient needs and clinical judgment.Keywords: chronic kidney disease, nutrition, phosphate, phosphate binders

Ann-Sophie Laroche,1 Robert Z Bell,1 Sarah Bezzaoucha,1 Eva Földes,2 Caroline Lamarche,1 Michel Vallée11Section of Nephrology, 2Section of Internal Medicine, Department of Medicine, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada Introduction: Retroperitoneal fibrosis (RPF) is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs. This study describes the clinical characteristics, diagnostic methods, and treatments and their effects on renal function.Methods: We conducted a retrospective analysis of patients diagnosed with RPF at Maisonneuve-Rosemont Hospital.Results: We identified 17 patients with RPF between 1998 and 2013. Eight patients were females (47%), and the mean age was 62±18 years. Eleven patients were idiopathic. Back pain was the most common symptom. All diagnoses were made based on the finding of a retroperitoneal mass on the computed tomography scan. Three patients had histological diagnosis of RPF and seven patients had unspecific changes on their biopsy. Twelve patients needed double-J stents, three patients had a temporary percutaneous nephrostomy, two patients had to have a nephrectomy for refractory ureteral obstruction, and one patient required hemodialysis. Ten patients with idiopathic RPF received medical treatment. In the treated group, only two patients had complete remission of the disease and five patients had improvement of their lesions. There were no deteriorations and only one relapse. Seven patients did not receive any treatment; two of them achieved complete remission, one of them deteriorated, and two of them had no changes.Conclusion: Most of our cases of RPF were idiopathic. Almost all treated patients received prednisone and seemed to respond, at least partially. There was a lot of heterogeneity in patient management, which makes it difficult to compare treatment effects. However, treated patients seemed to have more favorable outcomes than those who were not. Keywords: retroperitoneal fibrosis, hydronephrosis, renal failure

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Catherine Langevin, Caroline Lamarche, Robert Z Bell, Michel Vallée Department of Nephrology, Maisonneuve-Rosement Hospital, Montreal, QC, CanadaAbstract: Thrombotic complications figure among the most frequent causes of mortality in diabetic ketoacidosis (DKA) and hyperosmolar state. We report the case of a 55-year-old woman presenting with DKA whereby a newly discovered patent foramen ovale was found due in part to the observation of bilateral deep vein thrombosis in legs, bilateral multiple pulmonary embolisms, and left subclavian acute artery thrombosis. Diabetes is known as a hypercoagulability state, and DKA is rising as a risk factor for vascular events. The importance of prophylactic anticoagulation should be emphasized in this setting.Keywords: thrombosis, hypercoagulability, prophylactic anticoagulation, pulmonary embolism