Discover and read the best of Twitter Threads about #nephjc

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Unlike most other animals, humans cannot convert uric acid into a more soluble compound.

Precipitated uric acid can cause a host of problems like gout and kidney stones.

What happened to our uricase?: a brief Tweetorial.

Fig. from…

#NephJC #NephTwitter
Uricase is many animals' golden knight: it protects against the Disease of Kings by converting urate to allantoin.

Great apes (including humans) do not have a functional uricase.

Why would this ever be an evolutionary favored trait, you ask?

Fig. from:…
Kratzer et al. looked at great ape genomes and found:
1) Progressive ↓ in uricase activity due to promoter mutations in the Eocene.
2) Appearance of a stop codon in exon 2, effectively shutting down the gene ~ 15 MYA.

Figs. from… &…
Read 9 tweets
1/ 🔥 Check out this special issue of “Nephrology and Social Media” in Seminars in Nephrology.

Here is a thread of these amazing articles and the VA’s made by the #NSMC team.

#NephTwitter #MedTwitter #NephJC #HCSM… Image
2/ “Introduction: Social Media and Medical Education Come of Age” by @kidney_boy

#NephTwitter #MedTwitter #NephJC #HCSM…
Read 12 tweets
New paper alert

Fitting as we conclude a #NephJC tonight that the latest paper on twitter journal clubs drops

Free link (till Aug 5, email/DM after Aug 5 if needed)

What are twitter journal clubs? How do the fit into the hsitory of journal clubs?

@Stones__ and I try to explain in this review

Here's a TL;DR version in a great graphic created by @stones_
for the evolution
from Osler to Twitter

(also the titlle of our 2018 @AJKDonline paper…)

Read 10 tweets
💥SGLT2 Inhibitors as Diuretics:

⚡️SGLT2i: how is it’s diuretic effect potentially different from the Loop Diuretics?

💥Let’s start with a Poll:

⚡️Loop Diuretics inhibit ❌ the Tubuloglomerular Feedback & ⬆️ Renin secretion
💥Diuretics are used for Heart Failure therapy

⚡️The goal of diuretic therapy in Heart Failure is to achieve:

☄️Negative Na, Cl & Water balance
☄️⬇️ ECF volume
Read 23 tweets
This week at #NephJC we took a break from #COVID19 to discuss the @NEJM ISCHEMIA-CKD trial🧑‍🏫👨‍🏫
⚡️For those of you who missed it, here’s a recap in the form of a🧵…

Thanks @amyaimei and @Vernisartan for being such great mentors and helping me out! #NSMC
But first, lets take a quick poll
👉Do you advise your patients with advanced CKD (GFR<30 mL/min/1.73m2) and moderate myocardial ischemia to go for coronary angiography?👈
<1> Background
First off, let’s appreciate 👏 @SripalBangalore and the ISCHEMIA-CKD group for this Herculean 💪 task.
All previous revascularization trials have neglected ✖️advanced CKD patients (GFR < 30 mL/min/1.73m2).

Perhaps good old ‘Renalism’ was at play? 🤔
Read 23 tweets
Do you manage the renal impact of #covid19 on general wards?

My summarised recommendations on;
✅ Volume status
✅ ACEi
✅ Transplant & dialysis patients

taken from @RenalAssoc, #eraedta, #nephjc & @UpToDate

= lots of relevant info in 8 tweets👇

#medtwitter #covid4mds

✅ Many potential factors;
✔️hypovolaemia due to fever / GI symptoms
✔️sepsis & cytokine release
✔️rhabdo, even without myalgia; check CK!
✔️direct viral tubule invasion?
✅ Low grade proteinuria & haematuria common
✅ Don’t miss ‘usual’ post-renal AKI; bladder scan +- US
Volume status

Assessment not easy at best of times!

Balance of maintaining volume to prevent AKI & avoiding hypervolaemia which impairs oxygenation in ARDS

🟠 UK Renal Assoc - “target euvolaemia”

🟠 Uptodate - “fluid goals conservative as per ARDS criteria” but individualise
Read 10 tweets
1/ Patients who are currently taking ACEi or ARBs are advised not to change their therapy unless directed by their doctor. There is increasing conversation about the interaction of ACE2 and COVID-19. #COVID19 #NephJC #nephtwitter #medtwitter
2/ Let’s talk about current evidence in an effort to decrease confusion about this topic. Check out this amazing post @NephJC for more information by @Nephro_Sparks and @hswapnil
3/ Angiotensin converting enzyme (ACE) is an important regulator of Renin-Angiotensin-System (RAS). ACE2 is a homolog of ACE, which converts angiotensin (Ang) I to Ang 1-9. Image source:…
Read 19 tweets
Happy #WorldKidneyDay!
We had a brilliant #NephJC discussion on ISPD 2020 recommendations yesterday!
To commemorate this day, here's a small compilation of some important PD studies -
On solute and fluid clearance -

CANUSA Re-analysis

CCr = creatinine clearance
pCCr = peritoneal creatinine clearance
CANUSA ⏩ 0.1🔽Kt/V ➡️6%🔼RR of death
5L/wk 🔽 CCr ➡️ 7% 🔼RR of death
◼️ Gave target weekly Kt/V = 2.1 and CCr = 70L/wk
❗ ASSUMED pCCr = Residual kidney CCr
Read 15 tweets
Really interesting study that will certainly find its way into my fluids lecture. But given the centrality of IV fluids to much of what nephrologists do, should we cover it in #NephJC?…
First draft of the new slide
final draft
Read 3 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
Late in 2012 my friend and colleague, Marcel discussed a perplexing case of resistant hypertension - we had even done renal denervation
What do you think we were missing? 1.5/
twitter poll time
Frans Leenen suggested taking a leaf out of TB treatment and doing DOT = direct observed therapy
We were astonished at the result, published here…
The drop in BP was Yuge:
Read 22 tweets
Time for a #tweetorial/#medthread on:


This is a devastating diagnosis often seen in inpatients, so this goes to all the @DermHospitalist & #hospitalists out there!

#FOAMed #MedEd #dermatology #dermatologia #dermtwitter #medtwitter @SHMlive @DermHospitalist
First of all, what is it? The exact mechanism is unknown. What we do know is that there is calcium in the arterioles of the skin, with arterial thrombosis. This interruption of blood flow causes painful ulcers and retiform purpura. Remember this?

That interruption of blood flow causes the clinical picture of calciphylaxis - retiform purpura with a predilection for fatty areas, violaceous borders, necrosis with ulceration, and TERRIBLE PAIN. Without the pain, I really think one needs to reconsider the diagnosis!

Read 17 tweets
Welcome to the @NSMCInternship #tweetorial for this week’s study on a new risk prediction tool for IgA nephropathy, appearing in @JAMAInternalMed. Check out these unhappy glomeruli with mesangial IgA deposits in green from (1/16)
Recent unsuccessful #RCT: STOP-IgA (immunosuppression+supportive care isn’t superior to supportive care alone) & TESTING (corticosteroids reduce risk of #ESRD but cause serious infections) were covered by @NephJC:…
and… … (2/16)
Question for the #NephTwitter: What percentage of patients with IgA nephropathy develop #ESKD by 10 years? (3/16)
Read 16 tweets
Today I gave divisional rounds @UofA_ID on the power of #SoMe and #IDTwitter for ID physicians and microbiologists.

I have gained loads in this space, and here I compile some of the takeaways 🥡 for those who remain unconvinced of the benefits of #MedTwitter

A thread 1/
Whether we like it or not, #SoMe has changed our world. It has changed the way leaders are chosen, the way we communicate & interact with one another, the empowerment & mobilization of societies, & giving us unprecedented access to people and spaces otherwise unimaginable. 2/
#SoMe has also changed the way academic physicians and scientists practice and how we conduct and communicate science. 3/
Read 35 tweets
1/ #Tweetorial #NephJC #Hypernatremia Reviews and guidelines say to correct hypernatremia in adults by no more than 10 mmol/L per day. This is based on little hard data, has little support in literature and may be harmful…
2/ What rate do you target for the correction of chronic (>48 hours or present on admission) hypernatremia #NephJC
3/ The rapid lowering of serum sodium will lower the tonicity of the extracellular compartment. Water will then be osmotically drawn into relatively hypertonic intracellular compartment. This can cause cerebral edema and increased intracranial pressure. #NephJC
Read 19 tweets
The #CREDENCE Trial was discussed @NephJC last night. We were fortunate to have the lead author of the paper @VladoPerkovic join in. He took questions from the participants. Here is the summary of his responses 👇🏽
Q1: Why was the 100 mg dose of Canagliflozin used in #CREDENCE and not the 300 mg dose?
VP: We were anxious about the toxicity as seen in some previous trials, & we wanted to minimize that risk
Q2: Why did centers from Germany have a lower HbA1C cut off for inclusion in the study compared to the centers from other parts of the world - 10.5% vs. 12%?
VP: That was a regulatory request from Germany 🇩🇪
Read 24 tweets
💥How do SGLT2 Inhibitors work?
💥How does an anti-diabetic drug improve Renal & Cardiovascular outcomes?
💥To understand this let’s first review:
⚡️Renal handling of glucose
💥Renal handling of glucose:
⚡️180 g of glucose is filtered thru the glomeruli every day
(180 L x 100mg/dL)
⚡️But all the glucose is completely reabsorbed
⚡️Renal reabsorption of glucose occurs thru transporters in the proximal tubule called SGLT
💥Sodium-Glucose Co-transporters (SGLT)
⚡️There are many 👇🏽
⚡️Not all of them are located in the kidney👇🏽
Read 24 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
Here is my attempt at organizing the massive number of replies to my request for physicians on Twitter to follow for my #MPLSVAGrandRounds talk “Social Media in Medicine”
Here is the original thread, which has lists of people in just about every specialty you could think of, and quickly went beyond my ability to organize.
When going through these lists, @Doctor_V reminded me this important point:
Read 27 tweets
1/ Thread: This morning I gave Dept of Medicine #GrandRounds @OHSUSOM @OHSUNews. In #medtwitter’s spirit of sharing & learning, here is my first #Tweetorial summarizing highlights & crediting #hcsm’s incredible contributors & source material
2/ 4 months ago EBM & cardiology expert Dr. Milton Packer published a blog post detailing how he found Twitter uninformative and emotion/opinion driven
Is this the reality of #medtwitter??…
3/ #SoMe is digitally based mediums that helps us
60% of physicians say their most popular activity on #hcsm = Following what colleagues are sharing and discussing
Channel the “look at me” negative stereotype of #SoMe into “look at THIS” learning etc...
Read 28 tweets
Why does acute tubular necrosis decrease GFR?

There is clearly “acute kidney injury” (the tubules are damaged), but the glomerulus is intact. Why should glomerular filtration decrease if the filtering apparatus is unaffected?

Follow this thread to find out!
Patients with ATN experience a profound decrease in GFR (as evidenced by an increase in creatinine +/- a decrease in urine output).

Which of the following is a major contributor?
Distal sodium delivery is a key factor in ATN. As part of tubular injury, the Na/K-ATPase moves from the basolateral to apical membrane (so cool!). Without the ATPase, sodium reabsorption is limited.

The unabsorbed sodium remains in the lumen.…
Read 18 tweets

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