Discover and read the best of Twitter Threads about #ckd

Most recents (7)

Why #kidney function does not equal #GFR (and certainly not Cr), making it an elusive target in clinical practice & the latter a poor surrogate outcome, despite its robust correlation with prognosis. Caring for kidneys versus improving Cr/GFR. A thread below:
The kidneys in essence have 3 functions:
1. Glomerular function = Clearance
2. Tubular function = Homeostasis
3. Neurohumoral function

GFR mainly reflects 1. So why do we take GFR (or its estimate Cr) as a surrogate for renal function?
Look at GFR determinants (=N x snGFR).

In stable circumstances, GFR mainly reflects the number of functional nephrons.

Starting from 1 million per kidney at birth, one loses 5,000-10,000 per year with aging: age-related GFR decline <1 mL/min/1.73m²/y…
Read 9 tweets
The new @RenalAssoc Pregnancy and Renal Disease Guideline (chaired by @DrKateWiles) is a veritable goldmine of practical pearls and clinical wisdoms, as well as some new or updated practice-changing recommendations. Here come a few of my take-homes... #renalSCE #meded #CKD
@RenalAssoc @DrKateWiles First the pre-conception ACEi/ARB advice has been clarified. Quite clear now that continuing ACEi up until the point of missed-period or positive test in strong-indication patient (eg IgA disease) is sound strategy. Lack of data means @renalassoc advise avoiding ARB #meded
@RenalAssoc @DrKateWiles This guideline clears up the slightly wishy-washy advice about breastfeeding on immunosuppressant drugs in the @RenalAssoc transplant guideline. Prednisolone, Tacrolimus, cyclosporin, azathioprine = all recommended safe to breastfeed. #meded
Read 19 tweets
@UCIkidney @kamkalantar hosted dinner discussion last night: #AdvancingAmericanKidneyHealth Executive Order
@MSchreiber_MD and @DrBobPro @DaVita | Mark Shapiro (Balboa Nephrology Medical Group)
Big changes happening and #nephrologists need to step up… #nephtwitter
Starting Jan 2020 half of #nephrology groups in the US will be assigned to the CMS Kidney Care First (KCF) accountable care model.
If you’re picked you HAVE TO participate, but can opt to switch to one of the other #KCC (Kidney Care Choices) models:…
The other payment models (Comprehensive Kidney Care Contracting #CKCC options) vary in amount of risk the neph practice is willing to take on for care of the #CKD patient.
This is at the level of the #nephrology practice NOT at the dialysis unit.
Read 12 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
#NationalDiabetesWeek we heard from @DiannaMagliano during 2002-2013, there was 6 times more likely progression of diabetes to kidney failure in Aboriginal and Torres Strait Islander people.
We know from #eGFRstudy led by Maple-Brown @MenziesResearch, the annual decline in kidney function is 3 times than expected for healthy aging. Having diabetes was a strong indicator of loss of kidney function #NationalDiabetesWeek
We know acute kidney injury is a potentially modifiable risk of loss of kidney function. In the NT, infections and heart disease were key contributors to AKI and needing to start dialysis #NationalDiabetesWeek
Read 12 tweets
Question....Who holds decision rights in planning, offering, limiting end stage kidney disease care? #ESKDethics #ISNWCN
Ethical issues in resource rich western countries and resource limited non-western countries... 76female and 46male #ESKDethics #ISNWCN
Choice! Choice dependent on options available in your area| #ESKDethics #ISNWCN- but..... who determines resource provision. NIXON affirmed that it was a measure of society that care is afforded for people with care needs
Read 14 tweets
It’s #PiDay… but it’s also #worldkidneyday! Critically important issue to me personally and so many Americans. 1/8
Many people with #chronickidneydisease don’t know it and it is major and rising cause of morbidity and mortality in the US and globally – we must do better! #heartyourkidneys #worldkidneyday 2/8
Today is also great opportunity to pay tribute to all of those courageous and generous people who have donated kidneys. Living donors should be better supported and we are working to make this happen. #worldkidneyday 3/8
Read 8 tweets

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