265ARE PATIENTS BEING SCREENED APPROPRIATELY FOR MICROALBUMINURIA? Rhoda Lyn Rojas, Pranay Kathuria Department of Internal Medicine, University of Oklahoma, Tulsa Oklahoma Microalbuminuria is not only the earliest clinical manifestation of diabetic nephropathy, but also an important risk factor for development of cardiovascular disease. The National Kidney Foundation has provided recommendations on screening of microalbuminuria. Testing should be performed only when blood pressure is close to goal and hyperglycemia corrected. Our clinical observations suggested the hypothesis that patients are not screened appropriately for microalbuminuria according to the guidelines provided by the National Kidney Foundation. Charts of all diabetic patients with no known kidney disease seen at the University of Oklahoma – Tulsa Internal Medicine and Family Medicine clinics from November 1, 2008 to October 31, 2009 were reviewed. Each chart was checked whether diabetics were screened for microalbuminuria. In those who had microalbuminuria, we checked if this screening was done according to guidelines provided by the National Kidney Foundation. Charts were also reviewed for documentation of the diagnosis and if an angiotensin converting enzyme inhibitor or angiotensin receptor blocker was prescribed. In the scheduled time duration, four hundred ninety-nine diabetic patients were seen in the out patient clinics. Forty-two per cent (210/499) were tested for microalbuminuria. Fifty-five patients (55/210) had microalbuminuria and 5 (5/210) had macroalbuminuria. Of the 55 patients with microalbuminuria, 4 patients had repeat testing, of which 3 were negative, and 1 was positive. Only 1 out of the 5 patients with macroalbuminuria was started on an angiotensin converting enzyme inhibitor. None of the patients with confirmed microalbuminuria had the diagnosis added to their problem list. Patients are not being screened appropriately for the presence of microalbuminuria according to the National Kidney Foundation guidelines.

266PATIENTS’ TRUST IN THEIR PHYSICIAN ASSOCIATED WITH SATISFACTION WITH ESRD PROVIDERS Margaret Rose, T. Alp Ikizler, Kerri Cavanaugh, Vanderbilt University Medical Center, Nashville, TN, USA

Trust is an important part of physician-patient interactions, however empiric measurement and research of trust and its’ related factors is scant. We examined trust using the validated Trust in Physician Scale in prevalent hemodialysis patients from three dialysis units. We also assessed patient demographics, knowledge of kidney disease and satisfaction with other care providers in the dialysis unit to identify factors associated with trust in ESRD patients. Trust scores were divided at the median to create higher and lower trust categories. In 114 patients the average age was 52, 46% male, 79% non-White with the median number of years on dialysis being three. Trust in physician was not significantly affected by any one demographic characteristic although there were more non-White patients with low trust compared to higher trust (87% vs. 70% p=0.04). High trust in physician was associated with high patient satisfaction in ESRD providers: physician (57% vs. 21% p=0.008), dietician (58% vs. 17% p<0.001), and nurses/technicians (46% vs. 21% p=0.008). High trust in physician scores were also associated with patients reporting staff supported them (p<0.001), and were friendly or encouraging (p=0.002 and p=0.005 respectively). Interestingly trust in physician was not related to kidney disease knowledge. Patients with lower trust scores more commonly reported being bothered by their dependence on dialysis staff or their physician (72% vs. 37% p-value 0.001). Patients with lower trust in their physician reported worse scores on diverse patient reported outcomes including sore muscles (p=0.01), anorexia (p=0.01), quality of sleep (p=0.001), problems with dialysis access (p=0.05), poor view of personal appearance (p=0.01) and dissatisfaction with the time they were able to spend with family (p=0.03). Patients who had more trust in their physician were much more likely to rate their physician as excellent even after adjusting for age, gender, race and dialysis vintage (OR 3.31 [1.21-9.00]; p=0.019). Future interventions to build trust between patients and their physicians may improve patient outcomes in the ESRD population.

267STEROID-DEPENDENT ALLERGIC INTERSTITIAL NEPHRITIS-CASE REPORT. Fadi Rzouq1, Hilana Hatoum2, Sneha Rao3, Muhammad Sheikh1, Aniruddha Palya1,2, Yahya Osman-Malik1,2 Sayed Osama1,2. 1: Internal Medicine Department, Michigan State University/Covenant HealthCare. 2: Internal Medicine Department, Michigan State University/McLaren Regional Medical Center. 3: Research Department, Hurley Medical Center. Background: Acute interstitial nephritis (AIN) is a common cause of acute renal failure. The most common cause is drug-induced while the main treatment is to stop the causative agent. Steroids can useful especially early in the course of disease. Aim: To report a case of steroid dependent recurrent AIN. Clinical Vignette: A 76-year old white female developed biopsy proven AIN secondary to Celecoxib. She has received 9 months course of prednisone followed by total histopathological recovery. Few months after withdrawal of steroid therapy, she has experienced recurrent symptoms of anorexia, malaise, chills and nausea as well as worsening in her kidney function. A repeat kidney biopsy showed recurrent AIN. Prednisone therapy was resumed at this point. A steroid sparing regimen with Mycophenolate was introduced to side effects of steroids. The patient has been maintained on 500mg of mycophenolate mofetil twice daily and prednisone of 2.5 mg for almost 3 years with no recurrence. Discussion: Drug induced AIN is a relatively common cause of AKI. The classic triad of AIN includes fever, rash and eosinophilia with renal insufficiency. Histopathology gives a definitive diagnosis. The features include interstitial inflammation, tubulitis, edema and interstitial fibrosis. The main treatment is steroids especially when administered early in the course of disease with discontinuation of the causative agent. Our patient had recurrent AIN and to avoid long term steroid complications she was started on steroid-sparing therapy.

268AN OVER-THE-COUNTER REMEDY FOR CONSTIPATION Fahad Saeed, Nadia Kousar. University of Illinois Urbana Champaign USA Hypocalcaemia is a commonly encountered problem in the hospital settings. Phosphate enemas are widely available over the counter and frequently used by patients for relief of constipation. Severe hyperphosphatemia with resultant hypocalcaemia attributed to phosphate enema use is rarely reported. We describe a case of near fatal electrolyte abnormalities caused by phosphate enemas. A 24 year old Caucasian woman with h/o quadriplegia from a motor vehicle accident, chronic constipation secondary to colonic inertia and outlet dysfunction, type 1 diabetes mellitus with complication of gastroperesis presented to the emergency department with abdominal pain and constipation for three days. She received six phosphate enemas in the past seven days. She also had poor oral intake before admission. Exam was remarkable for quadriplegia, decreased alertness and diffuse abdominal tenderness. Labs were significant for calcium of 5.5 mg/dL, phosphorus 16 mg/dL, BUN 21 mg/dL, creatinine 1.85 mg/dL (baseline around 1. 3 mg/dL) and sodium 159 mEQ/L. She had chronic kidney disease without baseline electrolyte abnormalities in the past. EKG demonstrated prolonged QT interval. She received tap water enemas in the hospital with successful wash out of the retained phosphate enemas. Calcium and phosphorus returned to normal limits with administration of IV Calcium gluconate injections. Her free water deficit was also replaced with IV fluids. This resulted in complete resolution of symptoms, QT prolongation on EKG and electrolyte abnormalities with return of her renal functions close to baseline. Over the counter phosphate enemas are a less recognized cause of hyperphosphatemia. These agents can cause electrolyte disturbances which could be potentially fatal. Phosphate enemas should be avoided in patients with chronic constipation and baseline renal insufficiency. Physicians should be aware of the possible adverse effects of hypertonic phosphate enemas. Patient education should also be provided to avoid these problems

NKF 2011 Spring Clinical Meetings Abstracts

Am J Kidney Dis. 2011;57(4):A1-A108 A83