Discover and read the best of Twitter Threads about #NephPearls

Most recents (8)

Last week twitter was unexpectedly keen for renal registrar on-call tips, so here’s round 2️⃣ of kidney #tipsfornewdocs covering iv fluids, AKI, “renal screen” bloods, immunosuppression, electrolytes, DKA in ESKD, peritoneal dialysis, proteinuria, meds & ⬆️BP (thread)
Iv fluids; Renal #tipsfornewdocs 2️⃣ 1/15

✅ 1L 5% dextrose 12 hourly = 50g glucose = 55 skittles. Not same as feeding patient.
✅ “iv fluid for AKI plus furosemide to keep it off their chest” isn’t a thing - commit to goal of wetter or drier.
(specialist use only eg. ⬆️Ca, ⬆️K)
AKI; Renal #tipsfornewdocs 2️⃣ 2/15

✅ In AKI anticipate accumulating meds (eg opiates,insulin) & ⬇️dose before complications
✅ Seeing unobstructed AKI pt, BP/K/pH fine but becoming oligoanuric at 1am despite euvolaemia? It’s OK to watch + wait. Trial by drowning not obligatory.
Read 17 tweets
To celebrate 1 yr of taking referrals as the renal registrar on-call, it’s time for some kidney-themed #tipsfornewdocs covering high K, AKI, “nephrotoxins”, medications, iv contrast, hypertension, & caring for kidney transplant & dialysis patients. #nephpearls (thread)
⬆️K - Renal #tipsfornewdocs 1/18

✅ Insulin-dextrose is not benign (⬇️BM risk) & does not get rid of K (only hides it), therefore rather than give round after round do phone us for help!
✅ Repeat ECG, re-bolus calcium gluconate if persistent changes
✅ Salbutamol dose = 10-20mg
⬆️K - Renal #tipsfornewdocs 2/18

✅ Get a bicarb level (correct acidaemia to help ⬇️K)
✅ No one who can’t name 3 side-effects of bicarb should decide to give bicarb (not a bad rule for any drug!)
✅ Review NSAIDs, ACEi, A2RBs, spironactone, beta-blockers, trimethoprim, diet
Read 20 tweets
Hemodialysis 101: Venous Catheter Access #Nephpearls #DialysisDirector
HD Catheters: Nominal flow > 400 mL/min (actual flow 350 mL/min) can rarely be obtained and usually flow is limited to a range closer to 300 mL/min
#Nephpearls #DialysisDirector
HD Catheters: Order of preference for various sites of insertion
📌 Optimal site is R IJ since venous pathway to the RA is relatively short and straight
📌 Avoid SC Vein due to ⬆️ rate of insertion related complications
📌 L IJ is not optimal
#Nephpearls #DialysisDirector
Read 12 tweets
Hemodialysis 101: AVF/ AVG
#Nephpearls #DialysisDirector
Sites for AVF creation in the upper extremity #Nephpearls #NephJC
Various configurations and sites for AVG placement #Nephpearls #DialysisDirector
Read 14 tweets
Hemodialysis 101: Apparatus
📌 From the patient, blood is pumped via the vascular access thru an ARTERIAL blood line (INFLOW) to the dialyzer
📌 Blood is returned to the patient from the dialyzer via a VENOUS blood line (OUTFLOW)
#Nephpearls #DialysisDirector
Redsense sensor is used to detect blood leakage at the site of potential line separation
📌 For those who are at high risk for line separation
#Nephpearls #DialysisDirector
The VENOUS PRESSURE can be used to monitor the state of coagulation.
It is a function of:
📌 Blood viscosity
📌 Downstream access (needle or catheter) resistance
#Nephpearls #DialysisDirector
Read 8 tweets
FRANCIS: Hemolytic Uremic Syndrome
#NKFClinicals 🇺🇸 #Nephpearls
Clinical and laboratory manifestations of atypical HUS (aHUS)
#NKFClinicals 🇺🇸 #Nephpears
Read 9 tweets
💥Why is the #CREDENCE Trial such a big deal for the Nephrologists?
⚡️It is the first ‘positive’ trial in CKD DM pts. in two decades!
The last positive RCTs in CKD-T2DM were RENAAL & IDNT & those were published in 2001....19 years ago!

💥RENAAL Trial: Losartan ⬇️ CKD progression & ⬇️ risk of ESRD by 28% compared to placebo, but it did not lower CV mortality
💥IDNT Trial: Irbesartan ⬇️ CKD progression & risk of ESRD by 23% compared to the Amlodipine and Placebo, but it did not lower CV mortality
Read 17 tweets
💥Tutorial on ‘Dialysis Adequacy’
⚡️Is Urea a good solute to assess Adequacy ?
⚡️Is Kt/V urea a good Adequacy test?
⚡️Should ‘time on dialysis’ be an independent measure of Adequacy?
⚡️Should ‘UF rate’ be a measure of Adequacy?
Urea is not the perfect uremic solute to assess dialysis adequacy, in fact it is far from perfect👇🏽
Kt/V urea is a measure of the dialysis dose
‘K’ is the dialyzer clearance, ‘T’ is the time on dialysis and ‘V’ is the volume of distribution of urea (which = Total Body Water)
Familiarize yourself with spKt/V, eKt/V and stdKt/V 👇🏽
Read 25 tweets

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