Discover and read the best of Twitter Threads about #Nephmadness

Most recents (24)

Oh no! This patient is coming with heart failure exacerbation again. He is taking his diuretics but it seems they do not work. What can we do?
#NephMadness #NephTwitter #MedTwitter
Diuretic resistance is the failure to achieve euvolemia despite increasing doses or maximal tolerated diuretic therapy
What will be your first line to use to diurese a patient?
Read 15 tweets
We don’t talk about Bruno 🤫, but we can talk about pregnancy and lupus nephritis (LN)!

Time for a tweetorial! 🚨

#Nephmadness2022 Lupus Region: Tweetorial 🧵
@jkidd03 @Dr_KeishaGibson @anna_burgner @maximal_change…

The information presented in this tweetorial is for informational purposes only and does NOT constitute or substitute medical advice.Medical decisions should be made according to the latest guidelines and medical literature and after consulting with your doctor. 2/19
⦿ SLEs disproportionately affects 👩🏻‍🦰 of child-bearing age

⦿ Patients are at risk of unplanned pregnancies

⦿ Family planning is 🔑 to prevent poor maternal and fetal outcomes due to lupus flares 🔥 3/19
Read 19 tweets
1/16 Inspired by #NephMadness, let’s briefly touch on:

💢Role of kidney biomarkers in patients with CHF
💢‘Worsening kidney function’ in heart failure
💢Permissive hypercreatininemia
💢Handling RAASi and SGLT2i in heart failure
#NephTwitter #MedTwitter…
2/16 Let’s have a poll.
Forward failure, characterized by decreased kidney perfusion, is the main determinant of kidney dysfunction in acute decompensated heart failure. Is this true or false?
3/16 That’s false!
◀️“Backward failure” (Kidney congestion, interstitial edema and tubular dysfunction) is believed to play a more vital role compared to “Forward failure”▶️ (decreased kidney perfusion)
Neurohumoral and inflammatory mechanisms also operate
Read 17 tweets
1/ 🧵Hello #medtwitter Ready for some NephMadness? 🤯
Not just any madness, but beware your mosquito bites 🦟, because today’s topic is #Malaria and kidney involvement.

#NephTwitter #NephMadness
2/ 🧵 Where does the word malaria originate from?

PMID: 11053494
3/🧵 Malaria is an Italian word composed of “mala” and “aria,” meaning bad (malus) air (aeris). It was first used to describe a fever (miasma) mistakenly attributed to exposure to poisonous air.
PMID: 11053494, 9641206
Read 19 tweets
Let's be honest...
#Nephropath #NephMadness

This region features:
🔎PLA2R 🆚Other Membranous Antigens

🔎DNAJB9 🆚IgG4 Disease

Matchup 1⃣: PLA2R 🆚Other MN Antigens

PLA2R facts
✅Present in healthy human podocytes
✅70-80% 👥with 1ry MN & ~ 60% of ALL MN
✅Serum Ab are measured via ELISA & IF
🧪ELISA > 14 RU/mL or
🧪ELISA 2 - 14 RU/mL WITH a positive IFA
Check this beautiful Visual Abstract by @Vernisartan on the serology based approach to MN

A few more words on Anti-PLA2R titers:
✅>150 RU/mL- ⏫ risk of progression
✅> 45 RU/mL- ⏫risk of recurrence post transplant

💡 Titers are part of the risk stratification algorithm💡
Read 8 tweets
1/ Nephrologists & cardiologists might agree on 1 #NephMadness region: #CardioRenal

Matchup 1:
Diuretic resistance mechanisms vs treatment…

So many diuresis roadblocks, summarized below by @hellokidneyMD

@DrFlashHeart @NishaKidneyDoc @HeartDocSadiya Image

Loop diuretics have an S-shaped dose-response curve…

#NephMadness #CardioRenal @kidney_boy Image

#CardioRenal Matchup 2:
♥️ biomarkers in #CKD vs 🥔 biomarkers in ♥️ disease

NT-proBNP, BNP, & troponin degradation products are filtered through the glomerulus…

#NephMadness @DrFlashHeart Image
Read 5 tweets

🎤“Don’t make a change too complicated, just begin.”

🔊 We have a chance to make a ‘change for good’ in anemia Rx in CKD.

👥Let’s discuss hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), the probable champions🏆 of NephMadness 2021. #AnemiaRegion
2/ 📖Hypoxia Inducible Factor (HIF) - Physiology

- Present in all tissues.
- Has O2 regulated 𝞪 (3 isoforms) and constitutively expressed 𝛃 subunits.
- HIF-2𝞪 is expressed in the peritubular fibroblasts, mainly involved in the upregulation of EPO gene.

🗝️↓ Hypoxia, HIF 𝞪 heterodimerizes with 𝛃 subunit in the nucleus → the complex binds with DNA sequences called hypoxia response elements → Gene activation → ↑ RBC production by ↑ essential protein synthesis linked with iron and EPO pathways.…
Read 14 tweets
1/ When bubbles settle on the surface of the urine it indicates disease of the kidneys-Hippocrates

In the day, urinary exam was so crucial, the urine flask was as much a symbol of a physician as today's white🥼!

🧵Is proteinuria a worthy rival to GFR?
#Nephmadness #primarycare
*⃣Normal urinary protein excretion is <150mg/d and comprises mainly Tamm-Horsfall proteins, with very little albumin (5-10mg/d)

*⃣ We don't understand what happens to albumin in the kidney 💯

*⃣ But overall the degree of albuminuria is a ⚖️of filtration + reabsorption 👇
3/Albuminuria is common in injury to the GBM (GLOMERULAR proteinuria)

But non-albumin proteins sometimes dominate the filtrate.
The classic case is OVERFLOW proteinuria in paraproteinemia
CLUE: Neg dipstick, with⬆️Urine PCR

💡Urine dip +=Albuminuria #renalrules
Read 15 tweets
1/ Monitoring eGFR in CKD is almost a reflex🦵!

But how did we get here?
What are we trying to assess?
And how does eGFR help?

#NephMadness #primarycare pits GFR vs proteinuria in CKD

In this tweetorial let's take a closer look at GFR

But first, who has your vote?#NephTwitter
2/ The concept of GFR as a marker of kidney function dates way back to the 1950s. (Apologies to the tubules, we do❤️you!)

But how could we measure GFR??

It was suggested that if a solute had certain characteristics its plasma clearance would = GFR

Let's briefly recap🤓
3/ The solution, INULIN, a non-toxic exogenous molecule, came through studies on aglomerular fish! #AnimalHouse

INULIN renal clearance= measured GFR
It is considered the GOLD standard🏆

But it comes with baggage
🧳It's expensive
🧳It's tedious
🧳It's hardly available anymore
Read 16 tweets

It has been more than a century tackling Anemia in CKD since its first description by Richard Bright in 1835.

👉 #NephMadness 2021 is featuring strong contenders from the #AnemiaRegion.

🤔 Let's find out why Anemia in CKD is an important consideration. #NSMCInternship
2/📊 What % of patients with CKD stage 4 have anemia based on KDOQI (Hb <13.5 g/dL for men and <12.0 g/dL for women) and WHO (<13.0 g/dL for men & <12.0 g/dL for women)?

😳 Around 60% of the patients with stage 4 CKD not on dialysis have anemia based on KDOQI/WHO.

😟 Anemia contributes to significant morbidity in patients with CKD.
Read 12 tweets
🔥PART 2/2 on #PD catheter complications

#NephTwitter #NSMC #medtweetorials #medtwitter #Nephmadness
You see a patient w/ a past history of C-section for poor inflow/outflow 1️⃣ week post laparoscopic PD catheter insertion
📊What are the possible causes of flow problems?

What’s your approach to flow?

1️⃣ Catheter irrigation → 1L of solution (dialysate/saline)
2️⃣ If slow fill → Flush/aspirate with syringe (aseptic technique! 🧤 😷)
3️⃣ If resistance both ways → Likely two-way obstruction

👇 Use an approach to catheter flow problems:

➡️⬅️obstructions due to intraluminal/extraluminal process

👉Fibrin → most common cause of intraluminal obstruction

👉Fibrin → arises with inflammation (e.g. peritonitis)/embedded catheters too!

👉 Diagnose by clinical suspicion (🔎 for fibrin traces in drain bag)
Read 14 tweets
1/ What causes #AKI with extracorporeal membrane oxygenation (ECMO)?

🗣️🗣️Let’s explore this 🔥topic from #NephMadness 2021

🧵#tweetorial #CriticalCare #NephTwitter @NSMCinternship @ASPNeph

Poll: How common is AKI in patients receiving ECMO?
2/ Basics first:
⚡️ECMO: temporary mechanical assistance device that provides prolonged cardiopulmonary support

⚡️Venovenous (VV) ECMO→ full respiratory support
⚡️Venoarterial (VA) ECMO→ both respiratory and hemodynamic support…
3/ Why are we talking about #ECMO?🤔🤔

⭐️Data from @ELSOOrg (Extracorporeal Life Support Organization): ⬆️📈⬆️in number of centers performing ECMO, and the number of runs (courses) per year
Read 18 tweets
⚡ Protocol Biopsies in Lupus Nephritis (LN)⚡
1/ Let's take another stab at (pun intended?) protocol biopsies in LN!

💡 The idea is certainly not new - it has been successfully implemented in kidney transplant recipients #NephTwitter #Tweetorial #FOAMed @NSMCInternship
2/ Out of curiosity - have you asked for repeat biopsies in these patients? When & why? Does your hospital have a protocol for it? Share your experience in the comments too! 👇
3/ I mean, you nailed the diagnosis the first time around, right? So why would you ask for a repeat kidney biopsy in a patient with LN? 🤔
Read 18 tweets
Did you check out the latest SKG case? Read all about it in this awesome and fun thread by @nepherson

⚡️Taking inspiration, here’s a 🧵on the complications of hyponatremia

#NSMC #Tweetorial @TheSkeletonKG
But before we start - I have two words for you!


Are they the same or are they not?
Are OSMOLALITY and TONICITY the same thing?
Read 25 tweets
Association of Opioids and NSAIDs With Outcomes in CKD: Findings From the @CRICStudy ca. 2020 from @AJKDonline #Nephpearls #NephJC
#VisualAbstract by @AliMehdiMD
👉🏼… ImageImage
Pharmacological management of pain in patients with CKD ca. 2019 from @CJASN #Nephpearls #NephJC
👉🏼… ImageImage
Association of NSAID Prescriptions
With Kidney Disease Among Active Young and Middle-aged Adults ca. 2019 from @JAMA_current @JAMAInternalMed #Nephpearls #NephJC
#VisualAbstract by @Stones__
👉🏼… ImageImage
Read 12 tweets
🌍Earth's temp🌡️ has ⬆️ 0.8°C in the past decades🤨

Is this changing pattern of climate threatening 👀 kidney health❓

Let's find out why this global rise in temp concerns nephrologists so much❓


💥Tweetorial alert 💥

#NephMadness #NephTweetorial #NSMC
What makes the kidneys more susceptible to acute injury from climate change?
Kidney is an amazing organ🙃🙂

⚡️It excretes concentrated waste ( To minimize fluid loss)
⚡️It is highly metabolic work🥵🥶
Read 11 tweets
SGLT2i Pearls:

1. SGLT2 inhibitors have significant long-term protection of GFR. However, because they cause afferent arteriolar vasoconstriction, expect to see an acute drop in GFR after initiating.
2. SGLT2 inhibitors work w/ ACEi/ARBs & can still provide improvement in renal outcomes for pts w/ diabetic kidney disease on max dose ACEi/ARB.

3. Patients already on thiazide can experience significant volume loss with SGLT2i initiation. Consider reducing or stopping thiazides
Read 18 tweets
Speaking of staying at home 🏠... let’s not forget that #AdvancingAmericanKidneyHealth (AAKH) aims to have 80% of people with kidney failure use a home dialysis modality or obtain a transplant by 2025. Do you know how close we are to that goal?
#NephMadness #EthicsRegion
As of December 2017, the USRDS reported 38% of people with kidney failure (or end stage renal disease/ESRD) in the United States were either on peritoneal dialysis (PD), home hemodialysis (HD), or had a functioning kidney transplant. What’s the breakdown of each modality?
By and large, that 38% is made up of transplant - 30% of all ESRD patients have a functioning kidney transplant. Only 7% are on PD, and 1.3% are on home HD. The rest of our patients (~ 61%) receive in-center HD.
Read 23 tweets
Have you ever wondered when we should pursue genetic testing in paediatric patients with cystic kidneys?#nephtwitter #medtwitter #NephMadness #Genetics. But first a quick primer on paediatric genetic kidney cystic diseases😃😃
Paediatric genetic cystic kidneys are heterogenous group of disorders. The age of presentation, clinical features and family history are often useful for coming to a diagnosis.…
But first let's talk about 4 common genetic causes of cystic kidney disease in children:
🌟 HNF-Beta related disease
Read 20 tweets
SGLT2i 💊 are emerging as a promising agent to prevent and ⤵️the progression of DKD
Ever wondered
What do they do to electrolytes❓
Why r these diuretics not associated with electrolyte depletion❓

Let's dive deeper🔓
#medtwitter #NephMadness #SGLT2iRegion
What is the impact of SGLT2i on Na and water hemostasis?
First, let’s revisit, how Na and glucose are handled in the nephron 📜
💥100% of the filtered glucose is reabsorbed along the nephron (90%, via SGLT2 in PCT)
💥1 Na+ ion for every glucose molecule gets absorbed from the lumen
💥In PCT 60 - 80% of sodium is reabsorbed
Read 19 tweets
I’ve been working on my #medtwitter elevator pitch. Mostly because lately I seem to have lots of fleeting conversations about it.

And I know I’m not alone.

Here's what I find:

Some are sold but nervous.
Some are intrigued but don’t get it.

And a lot are precontemplative.
I think it’s because it can seem like all #medtwitter users look the same.

Them: “I would get on Twitter but I’m not a social media person.”
Me: “Twitter is different! Even if you don’t do social media!”
Them: 😐“Nah. Can’t see it.”


Them: ✌️🏾

Elevator ride over.
But I’ve been thinking about the many different #medtwitter identities there are. Most can find a fit nestled somewhere in 1 or a few of them.

What works for each person depends on a few things:

Who you are
What you hope to get from it
What’s going on in your life

Read 22 tweets
PRESERVE Trial: NaHCO3 ➕ Acetylcysteine ~ NO significant difference across groups in death, need for dialysis or >/= 50% increase in creatinine at 90 days
#KidneyWk #Nephpearls
👉🏼… ImageImage
.@stevenweisbord breaks down what he thinks about AMACING
#KidneyWk #Nephpearls ImageImageImageImage
Renalism: Coronary angiography and mortality in patients with CKD ca. 2004 from @gchertow @JASN_News
#KidneyWk #Nephpearls
👉🏼… ImageImageImage
Read 5 tweets
#NephMadness water bottle in action in the North Cascades
another action shot of #NephMadness Swag
hang'in with the wildflowers
Read 4 tweets

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