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Aisha Shaikh Profile picture
@aishaikh
Aug 22, 2020 • 5 tweets • 1 min read • Read on X
💥Interesting case of Hypokalemia - what do you think is going on?
#askrenal Image
-BP is normal (110/60)
-Orthostatic BP not checked
-H/o chronic diarrhea , diagnosed with Irritable Bowel Syndrome 1 year ago
-15 lbs weight loss in 6 months
-Denies use of laxatives, PPIs or diuretics
-No h/o vomiting
Image
Serum folate level came back low, perhaps pointing towards GI causes - diarrhea/malabsorption/poor nutritional intake
Would avoid folate acid replacement till the hypokalemia improves as folic acid replacement would worsen hypokalemia by causing transcellular shift

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More from @aishaikh

Aisha Shaikh Profile picture
May 2, 2023
An interesting case of new onset HTN and hypokalemia in a patient with leiomyosarcoma

Serum K 2.9
BP 150/90
No accompanying acidosis or alkalosis👇🏽
1/
#onconephrology Image
Step 1: Is the hypokalemia due to renal K losses or extra-renal K losses?

24 hour urine K was 46 mEq/L so renal K losses were contributing to hypokalemia

Serum magnesium was normal

Patient was not on diuretics👇🏽
2/ Image
In the setting of new onset hypokalemia and new onset HTN, there was high suspicion for mineralocorticoid excess or AME

So, plasma renin activity (PRA) and plasma aldosterone were checked

‼️Both PRA and aldosterone were elevated👇🏽
3/ Image
Read 7 tweets
Aisha Shaikh Profile picture
Nov 4, 2022
The most anticipated nephrology trial of the year has been published!
“Empagliflozin in Patients with Chronic Kidney Disease” #Kidneywk
⁦@NEJM⁩ nejm.org/doi/full/10.10…
EMPA-KIDNEY trial is a randomized, parallel-group, double-blind, placebo-controlled trial designed to assess the effect of empagliflozin on progression of kidney disease & CV disease, & to examine safety profile of the drug in a wide range of pts. w/ CKD
The trial included patients without diabetes, patients with an eGFR of less than 30 ml per minute per 1.73 m2, and patients with low levels of proteinuria
Read 18 tweets
Aisha Shaikh Profile picture
Jul 21, 2022
📌 Tweetorial on “IgA Nephropathy: Approach to treatment” based on @goKDIGO webinar by Dr. Richard Lafayette

🔸First step in management of IgAN: Determine the risk of disease progression based on GFR, proteinuria, BP & kidney biopsy findings👇🏽
1/ Image
📌 Approach to treatment of IgAN based on @goKDIGO guidelines👇🏽

🔸This Rx algorithm is NOT applicable to IgA deposition with minimal change disease, IgAN with AKI, IgAN with RPGN, IgA vasculitis, IgA-dominant post-infections GN & secondary forms of IgAN👇🏽
2/ Image
📌 IgAN: All patients should receive supportive care:
🔸 Optimal BP management
🔸 Maximally tolerated ACEi/ARB
🔸 Lifestyle modification
🔸 Reduction of cardiovascular
risk👇🏽
3/ ImageImage
Read 23 tweets
Aisha Shaikh Profile picture
Jun 28, 2022
📌 Tweetorial on Diagnosis & Pathogenesis of IgA Nephropathy (IgAN) based on @goKDIGO webinar by @AgnesFogo & Dr. Jurgen Floege
#IgAN
🔸Interesting fact: IgAN is not a new disease
First known case of IgAN was found in Prince Joseph of Austria (1776-1847)
1/
📌 IgAN is characterized by:

🔸Mesangial immune-complex deposits which sometimes can extend to the capillary loops & sub-endothelial locations

🔸 Dominant IgA deposits compared to the other immunoglobulins
2/
📌 IgA deposits in IgAN are typically polyclonal & lambda is more prominent than kappa

🔸This is thought to represent the mucosal IgA
3/
Read 22 tweets
Aisha Shaikh Profile picture
Dec 21, 2021
Dr. Carlos Flombaum from @MSK_Neph gave a holiday lecture full of historic pearls. We are so lucky to have Dr. Flombaum in our division!
Did you know how Cisplatin was ‘accidentally’ discovered?👇🏽
1/
Did you know that allopurinol was first studied as an anti-neoplastic agent. Well, it didn’t work as a cancer therapy but it was eventually used to treat gout and hyperuricemia
2/
In the 1970s, the Renal division at @sloan_kettering was called the Division of Clinical Physiology. Not too surprising as we all know that to be a good nephrologist you have to know physiology
3/
Read 6 tweets
Aisha Shaikh Profile picture
Dec 2, 2021
Workup for detection of Monoclonal Immunoglobulin (MIg) in patients with Monoclonal Gammopathy of Renal Significance (MGRS)

(Talk by Dr. Frank Bridoux at the Kidney Week)
#Onconephrology #MGRS
Workup for detection of Monoclonal Immunoglobulin

1. Find the circulating monoclonal Ig:

-SPEP & UPEP to quantify the Monoclonal (M) spike

-Serum & Urine Immunofixation to identify the monoclonal Ig & also to monitor response to Rx
2. Serum Free Light Chain Assay to identify free light chains & to monitor hematological response to Rx in Light Chain-associated kidney disorders

There are 2 different LC assays: Binding site & N-Latex assay
-Use same assay to follow LC levels Image
Read 9 tweets

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