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Joel Topf, MD FACP
@kidney_boy
, 5 tweets, 2 min read Read on Twitter
A med student answered a question and was very nervous to say he learned it from UpToDate. He wasn't sure how I felt about UpToDate. He then pointed to this exchange from @OnlineMedEd where one of the teachers disparages UpToDate onlinemeded.org/spa/surgery-tr…
I hold UpToDate in high esteem. I think the authors tend to be top people in their field. I think it answers questions as good as any medical source.
An what is that about getting authors that couldn't get chapters in real text books. What the hell is a real text book?
One of the amazing things is that this exchange is over two years old but the med student remembered it and it still shaded his view of UpToDate as a taboo source to be referenced carefully.
What are your thoughts on UpToDate?
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Joel Topf, MD FACP
@kidney_boy
Internists know that eGFRs can not be used in AKI, that the formula requires the patient’s being in steady state. But fewer internists (and fellows) know that also applies to the protein to creatinine ratio (PCR). (1/10)
Over and over again, I see protein to creatinine ratios ordered in the midst of AKI to “quantify the proteinuria”

The protein to creatinine ratio depends on the patient excreting their daily creatinine load and patients in the midst of AKI (either worsening or improving) do not.
When the creatinine is worsening, the urinary creatinine is less than the daily creatinine load. This decreases the denominator and can inflate the PCR. In my experience this is particularly evident in cardiorenal syndrome type 1. (3/10)
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Joel Topf, MD FACP
@kidney_boy
One thing I love about #KidneyWk in a brief tweetorial #AskASN
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So much of medicine is permission based, but there is no one to ask permission of off you want to tweet about #KidneyWk. There are no social media credentials or badge needed to complain about a speaker, a #manel, or Comic Sans on a slide #AskASN
Read 7 tweets
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Joel Topf, MD FACP
@kidney_boy
Interesting basic metabolic. Don’t you think?
The hyponatremia is due to the hyperglycemia. #ProblemSolved
Don’t be deceived by the normal bicarbonate, there is an anion gap big enough to drive a truck.
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