Discover and read the best of Twitter Threads about #NephPEARLS
Most recents (24)
Cardiac #POCUS views - image acquisition pearls from JACC POCUS workbook
#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
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#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
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#POCUS enthusiasts, is this IVC normal, abnormal? (asking about possibilities, not definitive conclusions)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread)
IVC transverse #POCUS
#POCUS answer:
I deliberately avoided clinical context in the original tweet to gather multiple opinions.
Image obtained from a thin, trained athlete with resting HR in 40s-50s.
A dilated IVC is commonly seen in this setting with no right heart pathology. In addition, particulate… twitter.com/i/web/status/1…
I deliberately avoided clinical context in the original tweet to gather multiple opinions.
Image obtained from a thin, trained athlete with resting HR in 40s-50s.
A dilated IVC is commonly seen in this setting with no right heart pathology. In addition, particulate… twitter.com/i/web/status/1…
Some excellent anatomic illustrations for friends who place central lines.
#POCUS #MedTwitter #Nephpearls #FOAMed
Courtesy: pubmed.ncbi.nlm.nih.gov/27521991/
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis)
#POCUS #MedTwitter #Nephpearls #FOAMed
Courtesy: pubmed.ncbi.nlm.nih.gov/27521991/
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis)
#POCUS quiz
1. What tracing did I obtain here?
2. What are some clinical scenarios where doing this would be helpful?
#IMPOCUS #MedEd #Nephpearls
1. What tracing did I obtain here?
2. What are some clinical scenarios where doing this would be helpful?
#IMPOCUS #MedEd #Nephpearls
#POCUS Answer: Pericardial effusion
Cannot comment on tamponade just from this view
Other views in 🧵below. No obvious chamber collapse.
Cannot comment on tamponade just from this view
Other views in 🧵below. No obvious chamber collapse.
Subcostal #POCUS
Some helpful illustrations of cardiac support devices for trainees and non-intensivist consultants like me rounding in the ICU.
🔗ccjm.org/content/84/4/2…
#Nephpearls #MedEd #MedTwitter
Also, good to be aware while performing #POCUS
🔗ccjm.org/content/84/4/2…
#Nephpearls #MedEd #MedTwitter
Also, good to be aware while performing #POCUS
ECMO illustrations #MedEd
Other relevant illustration: Left ventricular circulatory support devices
🔗 nature.com/articles/s4156…
a, The intra-aortic balloon pump uses counterpulsation to provide circulatory support and is commonly inserted via the femoral or axillary artery. b, Microaxial flow devices… twitter.com/i/web/status/1…
🔗 nature.com/articles/s4156…
a, The intra-aortic balloon pump uses counterpulsation to provide circulatory support and is commonly inserted via the femoral or axillary artery. b, Microaxial flow devices… twitter.com/i/web/status/1…
After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Pulsus paradoxus #echofirst
Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis
3⃣ Apical 4-chamber view #POCUS
Hyponatremia in pregnancy has unique multifaceted pathogenesis ⭐✨ ✨⚡
Here is a short 🧵 exploring this intriguing concept
@rabihmgeha @DxRxEdu @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @Sharminzi @rav7ks @RosenelliEM @SatyaPatelMD #MedTwitter #Nephpearls
Here is a short 🧵 exploring this intriguing concept
@rabihmgeha @DxRxEdu @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @Sharminzi @rav7ks @RosenelliEM @SatyaPatelMD #MedTwitter #Nephpearls
1.) Reset Osmostat
- Common in first 2 months of pregnancy
- Due to altered osmolality set point at which ADH is released
- Usually asymptomatic with 4-5 mEQ drop in Na levels.
- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.
#MedTwitter
- Common in first 2 months of pregnancy
- Due to altered osmolality set point at which ADH is released
- Usually asymptomatic with 4-5 mEQ drop in Na levels.
- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.
#MedTwitter
2.) Preeclampsia and SIADH
Proteinuria>> Intravascular volume depletion (akin to Cirrhosis, HF)>> nonosmotic stimulus to release ADH
Abnormal placenta>excess release of Oxytocin
Pregnant patients receive Oxytocin and IV fluids for multiple other reasons as well
#MedTwitter
Proteinuria>> Intravascular volume depletion (akin to Cirrhosis, HF)>> nonosmotic stimulus to release ADH
Abnormal placenta>excess release of Oxytocin
Pregnant patients receive Oxytocin and IV fluids for multiple other reasons as well
#MedTwitter
Basic cardiac #POCUS views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
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Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
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🔥Hello #NephTwitter
💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin
⚡️After ruling out most infective causes👉Look for non-sepsis causes too
Unroll…
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin
⚡️After ruling out most infective causes👉Look for non-sepsis causes too
Unroll…
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥Fever in Inflammation
⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines
⚡️Autoimmune diseases
⚡️Autoinflammatory conditions
👉Periodic fever syndromes
Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines
⚡️Autoimmune diseases
⚡️Autoinflammatory conditions
👉Periodic fever syndromes
Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🔥Drug induced fever
💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever
⚡️Stimulation of non-shivering thermogenesis
Unroll…
doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever
⚡️Stimulation of non-shivering thermogenesis
Unroll…
doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
A 44 year old woman came with abdominal pain & admitted for pancreatitis. After few days, her pain got worse & she became hypotensive, had AKI w/⬆️lactate. What is the physical sign & electrolyte imbalance? #Medtwitter (Video: @miguel_lando)
@miguel_lando Chvostek sign, Hypocalcemia (Video by @IhabFathiSulima)
#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵
#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵
#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])
#2 👆BART holds good unless u invert the scale.
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)
#3
While performing any Doppler study, it's important to keep in mind that the angle between US beam & blood flow determines the accuracy of velocity displayed. Parallel = best, perpendicular = worst
As #VExUS does not rely on absolute velocities, its OK not to have perfect angle
While performing any Doppler study, it's important to keep in mind that the angle between US beam & blood flow determines the accuracy of velocity displayed. Parallel = best, perpendicular = worst
As #VExUS does not rely on absolute velocities, its OK not to have perfect angle
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca and Bayer & is intended for #healthcare providers. See faculty disclosures ckd-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium was first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca, Bayer, & Chiesi & is intended for #healthcare providers. See faculty disclosures cardiometabolic-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls
2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS
3/ Apical 4-chamber view
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS
⁉️How frequently do you diagnose "Treatment Induced Neuropathy" or Insulin Neuritis in your diabetic patient presenting with painful neuropathy ?
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes (TIND)
💡Iatrogenic complication of aggressive glycemic control
🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️
Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
💡Iatrogenic complication of aggressive glycemic control
🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️
Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes
♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA
Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA
Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
Advancing Evidence-Based Care in Diabetes and CKD
#ISNWCN 🇲🇾 #Nephpearls
👉 kdigo.org/wp-content/upl…
#ISNWCN 🇲🇾 #Nephpearls
👉 kdigo.org/wp-content/upl…
Glucose-lowering agents in Type 2 Diabetes (T2D) and CKD: Indications and dose adjustments
#ISNWCN 🇲🇾 #Nephpearls
#ISNWCN 🇲🇾 #Nephpearls
.@goKDIGO Glomerular Diseases Guideline: Reflections on a Decade of Progress with @adrianliew8 @ReichHeather @Dr_KeishaGibson
#ISNWCN 🇲🇾 #Nephpearls
👉 kdigo.org/wp-content/upl…
#ISNWCN 🇲🇾 #Nephpearls
👉 kdigo.org/wp-content/upl…
IgA Nephropathy: A 1st step is in treating IgA Nephropathy is assessing "prognosis" based on data available at the time of biopsy
@goKDIGO suggest using the "prediction tool" that was derived from the largest & most geographically diverse cohort to date
#ISNWCN 🇲🇾 #Nephpearls
@goKDIGO suggest using the "prediction tool" that was derived from the largest & most geographically diverse cohort to date
#ISNWCN 🇲🇾 #Nephpearls
IgA Nephropathy: The @goKDIGO treatment algorithm recommends consideration of use of corticosteroids in patients with "persistent proteinuria >1g/day" if the risk/benefit profile is favorable
📌 A GFR of 30 is considered a threshold for treatment
#ISNWCN 🇲🇾 #Nephpearls
📌 A GFR of 30 is considered a threshold for treatment
#ISNWCN 🇲🇾 #Nephpearls
First clinical-grade porcine 🐖 kidney xenotransplant using a human decedent model ca. 2022 from @amjtransplant #NephJC #Nephpearls
#VisualAbstract by @NamrataYParikh
👉🏼 pubmed.ncbi.nlm.nih.gov/35049121/
#VisualAbstract by @NamrataYParikh
👉🏼 pubmed.ncbi.nlm.nih.gov/35049121/
Attitudes to Clinical Pig Kidney Xenotransplantation among Medical Providers and Patients ca. 2020 from @ASNKidney360 #Nephpearls
kidney360.asnjournals.org/content/1/7/657
kidney360.asnjournals.org/content/1/7/657
Paving the Path toward Porcine Organs for Transplantation ca. 2017 from @NEJM #NephJC #Nephpearls
nejm.org/doi/full/10.10…
nejm.org/doi/full/10.10…
Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.
1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS
1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS
2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗nephropocus.com/2021/07/12/the…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗nephropocus.com/2021/07/12/the…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)
3/ Apical 4-chamber view #POCUS
Note how RV is dilated - bigger than LV and forming the cardiac apex.
Inter-atrial septum is bowing to the left indicating high right atrial pressure (not unexpected).
Note how RV is dilated - bigger than LV and forming the cardiac apex.
Inter-atrial septum is bowing to the left indicating high right atrial pressure (not unexpected).
Nephrolithiasis 101: When to order a 24-hour urine collection #Nephpearls
Multiple or metabolically active stones (stones that increase in size/ number w/in a year)
Children
Demographic groups not typically prone to stone formation
Stones other than those containing calcium
Multiple or metabolically active stones (stones that increase in size/ number w/in a year)
Children
Demographic groups not typically prone to stone formation
Stones other than those containing calcium
Interpretation of urine chemistries to identify lithogenic risk factors and assess the contribution of diet to the formation of kidney stones ca. 2016 from @ravineja #Nephpearls
sciencedirect.com/science/articl…
sciencedirect.com/science/articl…
Neglected analytes in the 24 hour urine: ammonium and sulfate ca. 2021 from @CO_Neph_Hype @ravineja #Nephpearls
👉 pubmed.ncbi.nlm.nih.gov/34798636/
👉 pubmed.ncbi.nlm.nih.gov/34798636/
PREDNOS 2: Evaluation of Daily Low-Dose Prednisolone During URTI to Prevent Relapse in Children w/ Relapsing Steroid-Sensitive Nephrotic Syndrome ca, 2022 from @JAMAPediatrics #NephJC #IPNAJC #Nephpearls
#VisualAbstract by @drM_sudha
jamanetwork.com/journals/jamap…
#VisualAbstract by @drM_sudha
jamanetwork.com/journals/jamap…
Low-dose versus conventional-dose prednisolone for nephrotic syndrome relapses: a randomized controlled non-inferiority trial ca. 2022 from @Ped_Neph #NephJC #IPNAJC #Nephpearls
#VisualAbstract by @md_abdulqader83
link.springer.com/article/10.100…
#VisualAbstract by @md_abdulqader83
link.springer.com/article/10.100…
PREDNOS: Sixteen-week versus standard eight-week prednisolone therapy for childhood nephrotic syndrome ca. 2019 from @bmj_latest #NephJC #IPNAJC #Nephpearls
#VisualAbstract by @jbda19
pubmed.ncbi.nlm.nih.gov/31156083/
#VisualAbstract by @jbda19
pubmed.ncbi.nlm.nih.gov/31156083/
Clinical Practice Guideline for the Management of Glomerular Diseases ca. 2021 from @goKDIGO #NephJC #Nephpearls
#VisualGraphics by @michaelturk6
Executive Summary pubmed.ncbi.nlm.nih.gov/34556300/
Full Guideline pubmed.ncbi.nlm.nih.gov/34556256/
#VisualGraphics by @michaelturk6
Executive Summary pubmed.ncbi.nlm.nih.gov/34556300/
Full Guideline pubmed.ncbi.nlm.nih.gov/34556256/
The spectrum of glomerular diseases from @neilturn #NephJC #Nephpearls
👉 global.oup.com/academic/produ…
👉 global.oup.com/academic/produ…
Nephrotic range proteinuria does "not always" mean nephrotic syndrome #NephJC #Nephpearls
👉 pubmed.ncbi.nlm.nih.gov/34556256/
👉 pubmed.ncbi.nlm.nih.gov/34556256/
