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Joel M. Topf, MD FACP Profile picture
@kidney_boy
Jul 26, 2020 • 3 tweets • 1 min read • Read on X
#AskRenal in 2007 KI published this paper showing massive albumin filtration at the glomerulus in norml kidneys shattering decades of dogma regarding the negative charge in the glom. pubmed.ncbi.nlm.nih.gov/17228368/
This was followed by a Pro-Con debate in JASN in 2008
jasn.asnjournals.org/content/19/3/4…
What is the current thought?
A) The classic, glomeruli are impermeable to albumin
B) The rebel, glomeruli leak a lot of albumin that is normally reabsorbed in the proximal tubule

Please reply with the real answer the poll is for fun but won't help me answer my question

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
Sep 21
Next session started by Rovin to talk about IGAN pathophysiology and the selection of therapeutics

4-hit model
1. formation of IGA galactose deficient
2. formation of autoantibodies against these IgA
3. Formation of circulating IgG-IgA1 immune complexes
4. Deposition of the immune complexes in the kidney

#RKDSummit
1st case
Hematuria on U/A
Gross hematuria after covid vaccine
10 RBC/HPF, no casts
Scar 0.9 mg/dl, 24-hr urine 750 mg of protein

#RKDSummit
Image
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A bit “Juicy”
Mesangial expansion (arrows, fig 1)
Mesangial hypercellularity (circle, fig 2)
Biopsy has no chronicity (fig 3)
Lights up with C3 and IgA (fig 4)

#RKDSummit


Image
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Read 35 tweets
Joel M. Topf, MD FACP Profile picture
Sep 21
Honored to be invited to second annual Rare Kidney Disease Scientific Summit. Amazing cast of physicians in attendance. #RKDSummit
Image
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Brad Rovin and John Barratt (IGAN king) defend the focus on IgAN and FSGS. Update and recap of the last year. #RKDSummit Image
Agenda look interesting.
Rovin says he is going to call out people from the audience. #RKDSummit Image
Read 21 tweets
Joel M. Topf, MD FACP Profile picture
Apr 13
When we published our study <> of ODS and hyponatremia we were pummeled for including people at low risk of ODS because we included Na levels between 120 and 130. They said it is well known "that ODS is incredibly rare/non-existent at those levels." 1/4evidence.nejm.org/doi/10.1056/EV…
Of course one of the reasons it was thought to be incredibly rare was that no one looked for CPM in patients with Na from 120-130. We found a fair number (≤5 of 12). 2/4 Image
Our findings are replicated in a study from Australia. The authors took a different approach to investigating ODS. Instead of starting w/ hyponatremia and working forward to ODS, they started with a dx of ODS and worked backwards
3/4ncbi.nlm.nih.gov/pubmed/35717664
Read 4 tweets
Joel M. Topf, MD FACP Profile picture
Sep 17, 2023
Gadolinium in dialysis patients.
What's up with that?
#Tweetorial
1/11
Nephrogenic systemic fibrosis (NSF) is an iatrogenic disease that presents with hardening of the skin and other organs. It is often lethal. I treated 5 people with this condition (including one with AKI). Terrible.
2/11 Image
The etiology of NSF was unknown and there were many theories. In 2006, Thomas Grobner published a small case series showing 5 patients developing NSF within weeks of receiving gadolinium contrast for MRI.
3/11pubmed.ncbi.nlm.nih.gov/16431890/
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
Aug 12, 2023
I just recently recommended the Renal Physiology book by Bruce Koeppen and Bruce Stanton. I thought it was a good medical student level text book: pbfluids.com/2023/08/ouwb-s…
But I came across this question in Chapter 8 Regulation of Acid Base. It is a straight forward question asking the learner to interpret simple acid-base cases. Image
But the question falls apart when you look at the answer... Image
Read 7 tweets
Joel M. Topf, MD FACP Profile picture
Apr 14, 2023
Lab guy from Yale up next Joe El Khoury He is on YouTube. Episode 1 was on pseudohyponatemia
209 subscribers. Clinical Chemistry with Joe El-Khoury Image
Here is the YouTube channel: youtube.com/@ClinChemJoe

https://t.co/LWupt0HWN1 #NKFClinicals
Despite calling it “laboratory error”, a lot of the problem happens long before the sample gets to the lab. #NKFClinicals Image
Read 9 tweets

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