Discover and read the best of Twitter Threads about #nsmc

Most recents (24)

🧵1/ A nephrologist's retrospective
🤔This is the result!
Among talented, dedicated people I was nominated, I somehow won. I felt humble and shocked... So unreal, trying to understand why my name is there
#NephjCkidneys #NSMC

nephjc.com/news/2022/11/5… Image
2/ 🧵Here it starts, in Jan 2022:
Hi, my name is Cristina, and I'm a🇷🇴nephrologist, too shy to stand out in a crowd, lost after finishing my residency. Teaching, the idea of continuing my Phd made me keep my head above the water
Too busy with life, constantly seeking
3/ I got over myself and made courage to pursue the thought I had a few months before -> #NSMC
After waiting impatiently, I got my answer through this mail ✨ Image
Read 12 tweets
1/
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?
#DiureticResistanceMechanisms
#NephMadness #NephTwitter #MedTwitter
2/
#DiureticResistance
Diuretic resistance is the failure to achieve euvolemia despite increasing doses or maximal tolerated diuretic therapy
3/
What will be your first line to use to diurese a patient?
Read 15 tweets
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! https://www.nsmc.blog/
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 ImageImageImageImage
Read 4 tweets
1/
📢Tweetorial alert!
Hey #medtwitter! Have you checked out @TheskeletonKG latest case - a rare cause of hypokalemia?
renalfellow.org/2021/05/22/ske…

Let's go through it together
#NSMC #FOAMed #NephTwitter @NSMCInternship
2/
A 32-year-old woman, presented to the clinic with B/L lower extremity weakness & upper limb cramping for 2 weeks. Motor power 3/5 in lower limbs & 4/5 in upper limbs. B/L ankle & knee jerk reflexes were absent. She had 1 such episode in the past which recovered spontaneously.
3/
She denied using any medications before the onset of symptoms. She had no family history of kidney disease. Her labs showed ⏬K⏬Mg, normal TSH and negative ANA. USG of the abdomen was normal.
Read 20 tweets
1/ I often get asked about the presence of granular casts on the automated UA reported by the lab whether it is equivalent to seeing muddy brown casts.

❓Do you think granular casts can be used to diagnose ATN?

More to see in #NephMadness on #liquidbiopsy
@NSMCInternship
2/ Spin the urine! This is one of the maneuvers that I enjoy doing with residents the most as there is a lot to uncover.

I totally underestimated the power of this test. How many times have you spun the urine yourself before nephrology training?
3/ The clinical properties of urine have long been described by the medical community.

‘Diabetic’ (polyuric) disorders were classified as ‘mellitus’ (honey-sweet) or ‘insipidus (flavorless) based on the urine’s taste!

#NephMadness #liquidbiopsy Image
Read 19 tweets
1/12

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)?
3/

😳 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.

pubmed.ncbi.nlm.nih.gov/18359408/
Read 12 tweets
1/🧵
🔥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?
2/

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:
3/

➡️⬅️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

ajkd.org/article/S0272-…
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
1/ 💥Hello, #Nephtwitter 💥
⚡️Let’s talk a little bit about #ciliopathies today.
⚡️How are Nephronophthisis (NPHP), polycystic kidney disease (PKD), & in fact many cystic diseases (aka #ciliopathies) related?!
Join me in the exploration-
#tweetorial #MedTwitter #ASPNeph #NSMC
2/ 💥Let’s begin with Cilia-
📌Motile cilia- generate flow of mucus & CSF
📌Non-motile/sensory cilia (inner ear, retina, & olfactory epithelium)
- plays a part in important pathways [Hedgehog, Wnt (wingless-Int-1), & PCP (planar cell polarity) signaling]
ncbi.nlm.nih.gov/pmc/articles/P…
3/Now let’s move on to💥Cystoproteins💥
📌These are proteins in cilia when mutated → cystic kidney diseases in humans, mice, or zebrafish
📌expressed in primary cilia, basal bodies or centrosomes
Read 9 tweets
1/ A tweetorial on antigens and antibodies seen in primary membranous nephropathy @NSMCInternship
What’s the latest so far?
2/ Let's start with a poll: which of the following antigens are not associated with primary membranous nephropathy:
3/ Primary MN
⚡️20-30% of nephrotic syndrome in Caucasian adults
⚡️MN reflects GBM thickening with little/no cellular proliferation/infiltration on LM
⚡️Several antigens discovered: PLA2R, THSD7A, NELL-1, Semaphorin 3B
⚡️No antigens identifiable in 15-20% cases
Read 16 tweets
1/ Paraproteinemic kidney disease: Cast nephropathy, myeloma kidney, MGUS, MGRS, LCCN, AL, AH, MIDD, LCPT…)

Lost in the alphabet soup!!!

Time for an #MGRS #tweetorial
#NephTwitter #Hemetwitter #MedTwitter #Onconephrology #NSMC
2/ Let’s start with a poll: which of the following disease states can cause MGRS (monoclonal gammopathy of renal significance):
3/ Before we get to the answer, let’s dissect the term MGRS:

Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis

link.springer.com/referenceworke…
Read 21 tweets
When was the last time you were paged about a serum Cl- level? Probably never.

Despite being the most abundant anion in the body, Cl- is under appreciated

🔥Here’s why it matters (esp in heart failure!)

#tweetorial #medtwitter #nephtwitter #cardiotwitter #NSMC
There is evidence supporting the use of hypertonic saline in patients with decompensated heart failure

See excellent blog post by @aldorodrig
👉 renalfellow.org/2019/04/03/the…

Mechanistically it never made sense to me, until I realized I may be focusing on the wrong ion 🤷🏾‍♂️
Chloride MAY be the 🔑 here. Something that will hopefully be more clear after the completion of ongoing trials

👉🏾 clinicaltrials.gov/ct2/show/NCT03…

In heart failure patients ⬇️ Cl- is associated with

1. Poor Prognosis
2. Neurohumoral activation
3. Diuretic Resistance
Read 10 tweets
📌Visual abstract (VA), seems to be a rising star🌟 in this new #meded & #FOAM era
Many journals are adopting VA
Cool clubs like #NSMC, #NephJC uses VA
How about we discuss creating a VA, shall we!?
#Nephtwitter #medtwitter #podkopiluwak #tweetorial
📌How confident are you in creating a #visualabstract?
📌Don’t worry... if you have a PowerPoint program and interest in making one, you CAN make one.
LET YOUR IMAGINATION FLY!!!
Btw, I am option b http://magicangelworld.blogspot.com/2013/01/being-imaginativ
Read 15 tweets
1/14
Meet Hilda. I was one of her doctors. When she died, she left 2 sons behind. My grief about her situation brought anger and then determination.

A #tweetorial on outcomes, advocacy, and policy in dialysis access for undocumented immigrants.

#medtwitter #nephtwitter #NSMC Image
2/14
Hilda suffered along with the other 80 undocumented immigrants with kidney failure, who in Colorado could only receive dialysis every 6 to 7 days when at the brink of death (=’emergency dialysis’).

journalofhospitalmedicine.com/jhospmed/artic…

Illustration @NathanAGray Image
3/14
An estimated 6000-8000 undocumented immigrants with kidney failure have limited access to care due to exclusion from Medicare, provisions of ACA & some Medicaid programs.

This U.S. map shows where dialysis is covered by Medicaid (green).
cjasn.asnjournals.org/content/14/8/1…
Read 14 tweets
😇Acidosis in DKA: Why the Gap⁉️
Hello, #nephtwitter, hope you enjoyed the latest blog post renalfellow.org/2020/08/13/the…
Let’s talk all about
⚡Diabetic Ketoacidosis⚡………
⚡Are you ready⁉️
💥#Tweetorial #DKA #Acidosis #Aniongap @TheSkeletonKG #NSMC @podkopiluwak💥 Image
2a/💢 Let’s consider a 44 yo M presents with altered mentation🧠. ✨He has a fruity odor on his breath. Glucose was 1000 with serum bicarb of 10.
✨Urine dipstick was negative for ketones. Is this patient in DKA❓
2b/ What is responsible for his fruity fetor?
Read 17 tweets
“What is the role of vasopressin?”

A nephrologist will talk about osmolality and aquaporins.

An intensivist might talk about its use as a pressor.

But, ask an evolutionary or social scientist and you might be surprised by the answer…

#MedTwitter #NephTwitter #NSMC
Arginine vasopressin (AVP), also known as antidiuretic hormone (ADH), is a short peptide hormone coded by ⒸⓎⒻⓆⓃⒸⓅⓇⒼ.

We have a similar peptide, ⒸⓎⒾⓆⓃⒸⓅⓁⒼ, floating around in our bodies.

Is this AVP, too?
Nope: it’s oxytocin.

Oxytocin & vasopressin are evolutionary cousins located side-by-side on human chromosome 20. Invertebrates have one hybrid copy. Tandem duplication in the common jawed vertebrate ancestor gave rise to our two gene copies.

Image from science.sciencemag.org/content/322/59….
Read 9 tweets
Tweetorial alert📢
Hello, #nephtwitter, we hope you enjoyed our latest blog post
renalfellow.org/2020/07/20/ske…
Let’s talk all about Low Salt Diet & Ca handling in kidney stones. Are you ready ⁉️
💥#kidneystones #lowsaltdiet #dietmatters #theskeletonKG #NSMCInternship #podkopiluwak💥
2/ Kidney stones 🪨 💎🔶♦️💠are a worldwide issue with increasing prevalence. Calcium stones (oxalate > phosphate) - most common (75%).
📍Which of the following contribute to stone formation?
3/ All the above.
Nevertheless, dietary factors are modifiable.
Look, now we have some control, eh...🤓🦾
Read 20 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

sciencedirect.com/journal/semina… Image
2/ “Introduction: Social Media and Medical Education Come of Age” by @kidney_boy

#NephTwitter #MedTwitter #NephJC #HCSM

sciencedirect.com/science/articl…
Read 12 tweets
1/15
Let's start with a question: Have you ever overshot your goal for hyponatremia correction ?
2/15
Hyponatremia overcorrection ↗️ is one of the most common dyselectrolytemia which keeps us on our toes.

✅ Let's discuss some strategies to prevent overcorrection ↗️
Read 16 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
👇
1/22
But before we start - I have two words for you!

☝️OSMOLALITY and
✌️TONICITY

Are they the same or are they not?
🤔
Are OSMOLALITY and TONICITY the same thing?
Read 25 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🧵
nejm.org/doi/full/10.10…

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
🌍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
If you're interested to see what infectious disease specialists are saying, here are 300+ of them.
@DrJRMarcelin @GermHunterMD @jdcooperid please let me know if I am missing anyone #IDTwitter
twitter.com/i/lists/123876…
If you're interested to see what emergency medicine professionals are saying, here are 150+ of them.
@darakass @MDaware @SortaUpToDate please let me know if I'm missing anyone
twitter.com/i/lists/124810…
If you're interested to see what hospital medicine professionals are saying, here are 100+ of them.
@CarolMarceloMD @buckeye_sanjay @katiewiskar please let me know if I'm missing anyone
twitter.com/i/lists/124816…
Read 41 tweets
Ever wondered what causes edema in nephrotic syndrome (NS)? #nephtwitter #medtwitter #nsmc #Tweetorial #NephroticSyndrome #edema #albumin😃
Edema in NS is secondary to?
2 major factors thought to contribute to edema in NS. 1. Underfill hypothesis: low s. albumin➡️low plasma oncotic pressure➡️imbalanced starling forces➡️fluid leak into interstitium➡️reduced effective circulating blood volume➡️activation of RAAS, SNS, AVP
researchgate.net/figure/The-Und…
Read 16 tweets

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