Has any hospital instituted a reporting requirement that the eGFR cannot be reported if there is a rapid change in creatinine over a short period of time? Feels like it would reduce errors in drug dosing and aid with decision-making
#askrenal
Requiring a test 2-3 weeks after starting an SGLT2i and then dealing with the (expected yet surprising!!) eGFR drop
-> underprescription and unnecessary discontinuation.
Checking should be limited (high risk eg vol issues or if symptoms).
What guidance can we give our trainees? #askrenal
#askrenal @nephjc.bsky.social have a young male with multisystem sarcoid. Eyes, liver, hilar LNs and interstitial nephritis. Granulomas so big you could pick them out without magnification on histo slide! Any experience of anti TNF as steroid sparing for renal involvement?
In a patient suspected to have PA, with high aldosterone, could discrepancy between direct renin measurement (increased) and PRA (lower norm) be caused by a beta-blocker? Re RAS inhibition, no direct renin inhibitor, only ARB in the medication. Thank you! #askrenal
Conceptual framework of effect of intradialytic exercise on patient-important outcomes.
#Cardioprotective intradialytic exercise training may protect against hemodialysis-induced myocardial stunning, and improve patient-important outcomes #patientcare #AskRenal @umanitoba.bsky.social @csnscn.bsky.social
doi.org/10.1177/2054...
What type of fish oil commercially available in the US most closely approximates the PISCES study formulation? Not an expert but I think not every fish oil being sold is equivalent.
#askrenal #nephjc #nephsky
Apart from myeloma and MGRS , what other diseases should we think of in case of increased UPCR with no albumunuria in urine analysis.
Urine alb- trace
UPCR-5.2
SIFE,SFLC - normal
@askrenal.bsky.social #askrenal
#Nephsky
My initial thoughts about aldosterone synthase inhibitors: why spend $$$$ to achieve what $4 of spironolactone can also achieve? Am I missing something?
#askrenal
Curious to know what North American folks think about whether a drop in BP will be enough to get Baxdrostat licensed? In UK suspect NICE will want to see MACE data first to do cost-effectiveness analysis. #medsky #askrenal #nephjc
Is calling “I-G-A nephropathy” “Eye-GAN” mainstream now? I am really struggling to accept that.
#askrenal
If a patient is overloaded and their potassium is not an issue, do you usually do a isolated UF in the beginning or at the end of the dialysis session? Why?
#AskRenal
In patients with antiHBc total positivity with negative DNA, do you use rituximab (eg AAV) with HBV prophylaxis as a safe alternative? Thank you #askrenal
Has anyone studied the use of K supplementation to increase daily solute load and subsequently free water excretion in SIADH?
#AskRenal
Curious if folks ever use this in setting of rapidly rising creatinine to make med dosing decisions - why or why not?
#AskRenal @askrenal.bsky.social
www.mdcalc.com/calc/10191/k...
Looking for a PhD/Md-PhD candidate for a fully funded project at University Hospital Bern Switzerland to work at the intersection of kidney and bone biology. Please share, DM or comment. #NephSky #AskRenal
Question for #nephsky #askrenal. Friend found these casts in a patient with multiple myeloma- Cr 0.8 and UPCR 0.1 g/g. They don’t look like typical hyaline casts. Any thoughts? @juancarlosqvelez.bsky.social @jrseltzer.bsky.social
Do u have a local policy for picc- and mid-lines for pts with renal impairment?
🧭 Any simple algorithm that can be shared with other specialties?
⛔️ “Has to be discussed with nephrology” is a battle- we r the bad people who r inconsiderate of realities of the pt’s (immediate) care!
#askrenal
#askrenal any preferences in diagnosis of pleuro/peritoneal leak in the hospital. NM scintigraphy versus ct peritonograohy? Trying to set up some inpatient order sets for the group. I saw @juancarlosqvelez.bsky.social had some good scintography pictures.
Any good refs for recovery from AKI-D post liver transplant?
#AskRenal
⚠️ Calciphylaxis is a debilitating and painful condition that is hard to treat.
▶️ Do you use daily dialysis as part of treatment? If so, what criteria do you use?
#askrenal
pubmed.ncbi.nlm.nih.gov/21872378/
doi.org/10.1093/ndt/...
Using 3% saline for severe asymptomatic hyponatremia.
Yay or nay?
#askrenal
What’s your treatment for idiopathic pericarditis in PD?
NSAIDs will cause loss of RRF and risk of UGIB. Colchicine at even low doses=diarrhea (and myopathy/cytopenias). Prednisone or try colchicine 0.3-0.6mg po daily to see if tolerated? Defer to cardiology? @askrenal.bsky.social #askrenal
#askrenal is there here a nephrologist from Burundi ? We have a kidney donor from Burundi who is interested in donating to a family member in Canada and we are looking if in Burundi there is possibility of doing a HLA typage ?
Congratulations CCCTG
Ringers and normal bicarb (3 amps per L 5% dextrose) have their place, especially in nephro practice, but for routine fluids, normal saline is cheaper and just as good
#askrenal #nephsky #medsky
Remember Ringer's is hypotonic - not for head injury
www.nejm.org/doi/10....
Figure 9. Example of a run chart identifying change in practice over time. Outliers, or astronomical data points are highlighted. A run chart can be interpreted by counting the number of times the line connecting the data points crosses the median which indicates change in practice over time.
At What #eGFR Should We Start #Dialysis? An Interactive Quality Improvement Teaching Case for Healthcare Providers #AskRenal #NephSky
@csnscn.bsky.social @cjkhd.bsky.social @ottawahospital.on.ca
doi.org/10.1177/2054...
#askrenal billing question- does any group actively collect a consent to bill from there patients for monthly capitation billing? My hospital wants to require this but I have never heard of any group routinely doing this and they want one signed annually.
