@cardiomet_CE

@cardiomet_CE

@ChristosArgyrop

@kdjhaveri

@dguerrot

NephroPOCUS

@NephroP

#POCUS puzzle 🧩of the day. Can you put together the pieces and arrive at an unifying diagnosis? Go through the thread 🧵below.
Context: #dialysis patient, physical examination #FOAMed #Nephrology #MedEd

Image No. 1 👇

Color #POCUS

Transverse #POCUS , IVC trace down

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NephroPOCUS

@NephroP

#POCUS quiz
You are performing physical examination in a patient with suspected fluid overload (plethoric IVC).
Parasternal short axis view demonstrates D-sign. But what's in the RV?
Apical view in thread.
#Nephrology #MedEd #FOAMcc
🔗 to source will be posted in a few hours.

Apical #POCUS

As our friends said, it's prominent moderator band in a patient with RV hypertrophy + prominent trabeculae.
Source article 🔗cvcasejournal.com/action/showPdf…

Read 4 tweets

Antonio Guerrero

@guerreroespejo

A 63-year old man, kidney transplantation: fever and a painful ulcer on the lateral side of the tongue.

🔬: showed invasion of X?
1/8

doi.org/10.1016/j.idcr…
#OralPath #maxillofacial #nephrology

🔬 showed invasion of Cryptococcus neoformans.

A tongue swab:➕for HSV-1.

The cryptococcal antigen test on serum: ➕

CRYPTOCOCCOSIS TONGUE ULCER IN A RENAL TRANSPLANT PATIENT
2/8

#mycology #Pathologists #microbiology

A CT-scan of the lungs showed extensive ground glass lesions & a lesion of 4.7 cm in the left upper lobe.

Bronchoalveolar lavage:➕for Cryptococcus neoformans & Pneumocystis jirovecii.

LUNG COINFECTION OF C. NEOFOMANS & P. JIROVECII
3/8

#IDtwitter #MedTwitter

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Beverly G. Tchang, MD

@BevTchangMD

Empagliflozin is now my go-to SGLT2i for pts with #diabetes and #CKD or #CHF, over cana or dapa or ertu.

Why?

A: EMPA-KIDNEY: nejm.org/doi/full/10.10…
and EMPEROR-Reduced and EMPEROR-Preserved
1/

EMPA-KIDNEY is unique because it enrolled GFR 20-45 *without* proteinuria whereas others (DAPA CKD, CANVAS) enrolled pts with CKD+proteinuria, though DAPA-CKD conducted a subgroup analysis for UACR < and > 1000

The primary outcome was a composite of progression of #kidney disease (defined as #ESRD, a sustained decrease in eGFR to <10, a sustained decrease in eGFR of ≥40% from baseline, or death
from #renal causes) or death from #cardiovascular causes

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NephroPOCUS

@NephroP

RV enlargement for #POCUS purposes: In the apical 4-chamber view, if the RV is slightly bigger than the normal configuration of 1/3 - 2/3, its mild enlargement, RV = LV is moderate, RV > LV is severe.
#IMPOCUS #MedEd #Nephrology

Also, observe the RVOT in the parasternal long axis view: the three musketeers rule!
#POCUS

#POCUS #echofirst

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NephroPOCUS

@NephroP

A short 🧵 on hepatic vein #VExUS and key pathologies
From: jacc.org/doi/10.1016/j.…

1/ HV Anatomy & Normal Flow Profile, respiratory variation (forward flow [S,D] ⬆️ during inspiration)

Click ‘ALT’ for normal waveform description

#POCUS #MedEd #Nephrology #IMPOCUS #FOAMed

2/ A. Tricuspid regurgitation: Systolic flow reversal
B. Tricuspid stenosis: prolonged deceleration time of the D-wave + prominent A-wave

Click ‘ALT’ for further description

#POCUS #VExUS

A. Constrictive pericarditis: expiratory ⬇️ in tricuspid flow & RV filling with associated flow reversals on HVD
B. Restrictive cardiomyopathy: prominent D reversals during inspiration
C. ⬆️RVEDP: prominent A-wave
D. RV systolic dysfunction: ⬇️ S-wave

‘ALT’ for description (A&B)

Read 6 tweets

NephroPOCUS

@NephroP

#POCUS quiz for #VExUS enthusiasts.
Image obtained from a patient with heart failure with preserved EF. IVC 1.9 cm with 30% inspiratory collapse.
Here is the intra-renal image. Interpretation of the venous waveform?
POLL in thread 👇
#MedEd #Nephrology

👆#POCUS
S = systolic venous wave
D = diastolic venous wave

@khaycock2

@khaycock2 @ArgaizR @msenussiMD You'll like it (I know u know the answer 🤫)

Read 4 tweets

NephroPOCUS

@NephroP

Cardiac tamponade on #POCUS #echofirst
Click on 'ALT' for description
#MedEd #IMPOCUS #Nephrology
From 🔗pubmed.ncbi.nlm.nih.gov/32572594/

Mitral inflow Doppler and LVOT VTI in tamponade.
'ALT' for description
#POCUS #echofirst #MedEd

Pulsus paradoxus: during inspiration, right heart filling occurs at the expense of the left, so that its transmural pressure transiently improves & then reverts during expiration (Ventricular interdependence). Seen as 👆on #POCUS

Read 5 tweets

Pediatric on Squares

@OnSquares

Welcome everyone to our 2nd Pediatric on Squares Board Review Course
We are starting today until the coming 8 days
Hope it’ll be helpful and enjoyable course
✏️ Note that you still can join and register on the course with accessibility to all recorded session until 27th of August

@Bassemkurdi

Day 1
1st session: Pulmonology Review
By Dr. Bassem Kurdi @Bassemkurdi

#Pediatric #Pulmonology #MCQ

@aalnemri

Day 1
2nd session: Keys to Answer MCQs
3rd session: Neonatology review
By: Prof. Abdulrahman Alnemari @aalnemri
#Pediatric #Neonatology #NICU #MCQ

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@CKD_ce

@ckd_ce

@ERAkidney

1) Welcome to our new #accredited #tweetorial which is Part 2 of a 2-part "highlights" program on new #SGLT2i & #DKD data presented at @ERAkidney #ERA22. #Physicians #nurses #pharmacists #PAs and #NPs can all earn 0.5h CE/#CME by following this 🧵!

@ERAkidney

2a) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. Our expert author is Dr. Clara García Carro (@ClaraGCarro) from San Carlos Clinical Hospital (Madrid, Spain).

@shbermejo

2b) Be sure to check out the first half of this #ERA22 recap from my colleague @shbermejo, and get MORE 🆓CE/#CME at ckd-ce.com/dkd12_ERA22a/. Join me in following @ckd_ce for the BEST in #cardiorenal education delivered entirely by #tweetorial!

Read 48 tweets

@CKD_ce

@ckd_ce

@ERAkidney

1) Welcome to our new #accredited #tweetorial which is Part 1 of a 2-part "highlights" program on new #SGLT2i & #DKD data presented at @ERAkidney #ERA22. #Physicians #nurses #pharmacists #PAs and #NPs can all earn 0.5h CE/#CME by following this thread!

@ERAkidney

2) @ERAkidney #ERA22 is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #Nephrology. It was held in May. Our expert author is Dr. Sheila Bermejo (@shbermejo) from @vallhebron in Barcelona, Spain.

3) This program is #accredited for CE/#CME & is supported by an independent educational grant from the Boehringer Ingelheim/Lilly Alliance. It is not intended for US- or UK-based based HCPs. Accreditation statement & faculty disclosures at ckd-ce.com/disclosures/.

Read 43 tweets

Wilfried Mullens

@WilfriedMullens

Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9).

Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines (2/9).
academic.oup.com/eurheartj/arti…
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC

Only 15% of AHF included in DOSE trial were decongested after 72 hours of high-dose loop diuretic (LD) therapy (3/9).
nejm.org/doi/full/10.10…

Read 9 tweets

NephroPOCUS

@NephroP

One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls

2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS

3/ Apical 4-chamber view
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS

Read 22 tweets

Wilfried Mullens

@WilfriedMullens

What to do if the eGFR drops from 50 to 42 ml/min/m2 during decongestive therapy in acute #HeartFailure ?
Short #Tweetorial on worsening renal function (WRF) (1/9).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC

@MarcoMetra

There is an underappreciated risk of poor outcome in heart failure patients discharged with ongoing congestion and WRF (2/9).
Pivotal paper of @MarcoMetra ahajournals.org/doi/10.1161/ci…

Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines so DON'T stop decongestive efforts during WRF (3/9).
academic.oup.com/eurheartj/arti…

Read 9 tweets

Wilfried Mullens

@WilfriedMullens

Which statement is correct with regards to the use of diuretics in #HeartFailure with congestion?

Short #Tweetorial on how to use diuretics in heart failure (1/9).

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC

Door to ‘diuretic’ time: earlier administration of loop diuretics is associated with improved outcomes independent of HF severity (2/9).
jacc.org/doi/abs/10.101…

The first dose of the loop diuretic should be 40 mg furosemide (=1 mg bumetanide) in diuretic naïve and twice the home dose in patients on loop diuretic (3/9).

Read 9 tweets

Wilfried Mullens

@WilfriedMullens

1/10. Wat is the most important driver of worsening renal function in #HeartFailure ?

Look at #Tweetorial on central hemodynamic derangements in heart failure

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR

2/10. The kidney is a remarkable vascular organ. Renal blood flow = 1000 ml/min, renal plasma flow = 600 ml/min.

3/10. Elevated central venous pressure affects renal function significantly more than reduced cardiac output in heart failure. jacc.org/doi/10.1016/j.…

Read 10 tweets

@CKD_ce

@ckd_ce

@IgAN_JBarratt

Join us tomorrow for the launch of a new accredited tweetorial – a case-based program on the assessment and management of patients with IgA #nephropathy (#IgAN). Free CE/#CME for #physicians, #nurses, #pharmacists! Expert author none other than @IgAN_JBarratt. FOLLOW US . . .

@ckd_ce

. . . and tell your colleagues to join you here on @ckd_ce, your ONLY source for accredited #tweetorials in the #CKD space! #nephtwitter #nephjc @nephondemand @Nephro_Sparks @edgarvlermamd @ChristosArgyrop @goKDIGO @nicklimd @CKJsocial @ERAkidney @kidney_boy @kidneypathology

@IgAN_JBarratt

1) Welcome to our accredited #tweetorial on optimal contemporary mgt of #IgAN. Earn 0.5h CME/CE credit #physicians #nurses #nursepractitioners #physicianassistants by following this thread. I am @IgAN_JBarratt. @MedTweetorials #nephtwitter #nephjc #FOAMed #MedEd

Read 56 tweets

Wilfried Mullens

@WilfriedMullens

Tweet: renal sodium avidity in #HeartFailure

Do you ever wonder what is happening in the kidney in Heart Failure patients? Here’s a short #Tweetorial on renal physiology in HF (1/6).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR

Glomerulus: renal blood flow ↓ in HF, but the kidney tries to maintain GFR by afferent arteriolar vasodilation and efferent arteriolar vasoconstriction. This leads to single-nephron hyperfiltration initially preserving total GFR, but further damaging the glomerulus. (2/6)

Proximal tubules: hyperfiltration leads to ↑ water and solutes filtered, but ↓ remaining in the peritubular capillaries. Due to ↑ peritubular capillary oncotic pressure + ↑ renal lymph flow -> ↑ water and Na+ reabsorption in the proximal tubules (3/6)

Read 6 tweets

Jade Teakell, MD PhD

@JMTeakell

@NSMCInternship

I cannot believe a year has gone by 🗓️🏃‍♀️
What an absolutely incredible experience the w/ @NSMCInternship. Thank you so much to all #NSMC faculty mentors, but especially to @docanjuyadav @kidney_boy @hswapnil & @Nephro_Sparks.
Wish this graduation night could have been in-person!

@NSMCInternship

For anyone interested in #nephrology education and/or sharpening your social medial skills, the @NSMCInternship is the absolute best! 🏆
I cannot recommend this highly enough!
👉 nsmc.blog/about
#FOAMed #MedEd #NephForward

@TheBeaniac

Shout out to #NSMC2021 👉 #TeamTwobules
Thank you so much! Amazing group!
👊
@TheBeaniac @bourneauguste @Dilushiwijay @katierizzolo @menonshina @janewitwong @varunnephro @docanjuyadav @ssfarouk @vandyniyyar @divyaa24 @DrFlashHeart @drM_sudha @PabloGarciaMD @DiMiRenalMD
👊

Read 4 tweets

@CKD_ce

@ckd_ce

@ckd_ce

Be sure to join us TOMORROW here on @ckd_ce for our first ORIGINAL accredited content . . . from none other than @edgarvlermamd . . . whom you #kidney-oriented clinicians will know as a comforting and familiar presence and as an AWESOME teacher. He'll be talking about ...