Discover and read the best of Twitter Threads about #Nephpearls

Most recents (19)

@VijayanMD @Charbel_Khoury @GMatzumura #Tweetorial Reveal of this week's pathology case from @WUNephrology consults #FOAMed
@VijayanMD @Charbel_Khoury @GMatzumura The cortical tubulointerstitial tissue had an expansile interstitial fibrosis without significant tubular atrophy.  With diffuse mixed interstitial inflammatory infiltrate composed of eosinophils, plasma cells and mononuclear cells. ImageImage
@VijayanMD @Charbel_Khoury @GMatzumura Immunohistochemical stain for IgG4 highlights numerous positive cells within the interstitium

The patient's serum IgG4 was elevated 185.0 (2.4 - 121.0) mg/dL Image
Read 14 tweets
🔥Horseshoe Kidney for Nephrologist (1/n)

⚡Most common renal fusion
⚡Ectopia+Malrotation+Vascular changes
⚡Prevalence 0.25%
⚡1522: da Carpi described 1st
⚡70% Lt dominant
⚡90%: Lower pole fusion

Pics-Surg Radiol Anat;J Ped Urol
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (2/n)

⚡Anatomical variations associated with HSK

Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (3/n)

⚡Congenital anomalies associated with HSK
👉Edward syndrome 67%
👉Turner syndrome 14%-20%
👉Down syndrome ~1%

Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
Read 5 tweets
Is being pregnant magical🌟?
I’m not so sure, but let’s give OB a Nephrology twist. 🍼🐣

#nephtwitter #obtwitter #endotwitter #reallythekidneysarethecoolest #medtwitter #tweetorial

Why do you gain weight when you are pregnant?
The average woman ⬆️gains a plasma volume of 1250 mL (an increase of 45-55%).

Significant lab values changes include
- Plasma Na ⬇️reduced by ~ 5 mmol/L
- Plasma osmolality ⬇️reduces by ~10 mOsm/kg
- Cr ⬇️decreases by 0.3 mg/dL due to increased GFR among other changes ImageImage
There is an entire milieu of hormone changes during pregnancy🤰. Some are natriuretic and some are anti-natriuretic.

Sources: Comprehensive Clinical Nephrology Chapter 42, ImageImage
Read 18 tweets
Touch contamination: The overall rate of peritonitis was low after contamination (2012)

📌 Wet contamination was asso. w/ ⬆️ risk of peritonitis

📌 Prophylactic antibiotics after wet contamination were effective in preventing peritonitis #Nephpearls

Touch contamination: Prophylactic antibiotics are usually recommended after wet contamination (if dialysis solution is infused after contamination, or if catheter administration set was open for an extended period) ca. 2016 from @ISPD1 #Nephpearls
Touch contamination: Algorithm ca. 2006 from @Kidney_Int #Nephpearls
Read 5 tweets
Lupus nephritis: To re-biopsy or not ...
#NKFClinicals #Nephpearls
Lupus nephritis: On “For Cause” repeat renal biopsy
#NKFClinicals #Nephpearls
Read 11 tweets
FSGS: The Basics
#NKFClinicals #Nephpearls
Proposed diagram to differentiate between Primary vs Secondary FSGS based on clinical presentation and EM 🔬 examination ca. 2015 from @NDTsocial @SethiRenalPath @GlassockJ @fervenzafernan1
#NKFClinicals #Nephpearls
FSGS: Histologic variants and its implications
#NKFClinicals #Nephpearls
Read 10 tweets
Thanks #medtwitter #meded #nephpearls for answering this question! As suggested by the wisdom of the crowd, the correct answer is cyanide poisoning due to "vitamin B17." (Shout-out to @J_Corky who guessed early on). See tweetorial for discussion!
@J_Corky Wait, they didn't cover that in training? Vitamin B17 is not a vitamin - it's marketed as one, though, and used as alternative therapy for cancer and "general health." Some alternative rx is innocuous - vitamin B17 is not.
@J_Corky Let's call vitamin B17 what it is - amygdalin. Amygdalin is a compound found in Prunus species seeds - peach pits, apricot seeds, bitter almonds. See that -CN (cyano) moiety at the bottom of the structure? That's right - it is hydrolyzed by gastric acid to cyanide. 2/
Read 20 tweets
#medtwitter is fairly comfortable managing “normal” DKA right? But how about in the anuric dialysis patient? The cookbook protocol can be deadly.

Read this #tweetorial to learn about how their DKA pathophysiology is fascinatingly different.

#meded #nephpearls #endotwitter
Quick recap of normal DKA pathophysiology;

🔑 insulin requirement > insulin supply

✅ “stress hormones” rise
✅ blood glucose rises & because glucose is an osmotic diuretic, there is a huge, inappropriate urine output
✅ body makes ketones as alternative fuel, so pH falls
Recap of normal DKA;

✅ patient symptomatic,extracellularly dry, 6 litres down & counting
✅ whole body K low due to osmotic diuresis, but often ⬆️K at first due to hypertonicity/ low insulin/ acidosis
- serum K then rapidly falls as INsulin drives K & glucose INtracellularly
Read 18 tweets
Hyperkalaemia treatment

KDIGO have just published their conference conclusions on managing acute #hyperkalaemia so I run through some learning points, some criticisms and the bits I’m not sure about as a renal reg.

#medtwitter #nephpearls #meded
Before we start - why do we care?

Because hyperkalaemia associates with a large increase in risk of death in the next 24 hours.

☠️ mortality not necessarily caused by the hyperkalaemia itself, but can indicate that something bad is happening…
So, the KDIGO conference paper.

Firstly, no one can even agree on the definition of hyperK. What’s up with the Swiss? 4.5mmol/l as the upper limit of normal? Compare this with some values used in research papers.....!
Read 14 tweets
Preparing for a 45-minute lecture on Review of Nephrology Literature 2019
📌 Please recommend noteworthy publications
🔲 Fluids & Electrolytes, Acid-Base
🔲 Hypertension
🔲 Glomerular Diseases
🔲 Cystic Disorders
🔲 Kidney Transplant
#Nephpearls #AskRenal
CREDENCE: Canagliflozin reduces the risk of kidney failure or death due to CV or kidney disease by 30% compared to current standard of care ca. 2019 from @NEJM
#VisualAbstract by @brendonneuen
Randomized Controlled Trial of Long-Term Safety and Efficacy of Veverimer for Treatment of Metabolic Acidosis
Read 18 tweets
Did my fellows' curriculum lecture today, "Images in #Nephrology"
Thought of sharing the slides as a tweetorial. Goal is to present some 'classic' images that aid in kidney-related diagnoses. Not exhaustive; plan to make 2nd part as well.
#MedEd #FOAMed Not much POCUS involved!
1st question. Classic image but rarely encountered. Note the super high blood urea nitrogen and serum creatinine.
Here is the answer.....
Read 61 tweets
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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