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Joel M. Topf, MD FACP

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23 Oct, 7 tweets, 4 min read

@jordy_bc

Great talk by @jordy_bc on obesity and CKD. It is not all obesity glomerulopathy #KidneyWk

@kamkalantar

Obesity paradox alive and well in ESRD #KidneyWk @kamkalantar

Possible mechanisms #KidneyWk

Weight loss (bariatric surgery) slows progression of CKD #KidneyWk

Additional data #KidneyWk Bariatric Surgery FTW!

Bariatric surgery in ESRD is "safe" despite that frightening spike of 30-day mortality (you need to compare to other ESRD not CKD, and when you do that the spike is not different from the background rate of mortality and hospital admission) #KidneyWk

Short term risk, but pretty amazing long-term survival benefit of bariatric surgery in dialysis patients. #KidneyWk

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More from @kidney_boy

Joel M. Topf, MD FACP

@kidney_boy

22 Oct

AKI in COVID? Nothing fancy, mostly just ATN #KidneyWk

Hold the presses, though a number of cases of collapsing glomerulopathy. Patients often (always?) with 2 risk alleles for APOL1

See #KidneyWk

Read 4 tweets

Joel M. Topf, MD FACP

@kidney_boy

5 Oct

Patient with advancing CKD, currently stage 4. Labs show HCO3 19 on the last two lab draws. Anion gap 13. What do you do?

So the current thinking is that correcting metabolic acidosis (CO2 < 22) slows the progression of CKD. This has been shown in RCTs with oral sodium bicarbonate (placebo controlled):

kidney-international.org/article/S0085-…

And again (against usual care)

jasn.asnjournals.org/content/20/9/2…

Read 11 tweets

Joel M. Topf, MD FACP

@kidney_boy

18 Sep

How not to write a letter of recommendation for nephrology fellowship

How to write a letter of recommendation for nephrology fellowship:

1. know your audience. Offer to write letters to programs where you know key people. When I read letters from people I know it moves the needle. Otherwise not so much.

2. Be honest. Don't lie and exaggerate the skills of an applicant. We received a letter with glowing praise for a fellow who turned out to be less than stellar. I no longer trust that program's LOR. In this game it is one strike and you are out.

Read 7 tweets

Joel M. Topf, MD FACP

@kidney_boy

12 Sep

https://twitter.com/tonlajr/status/1304011343226437637

1/ This is like the Bat Signal for me... #Tweetorial #Hyponatremia #LoudlyForThePeopleAtTheBackOfTheRoom

https://twitter.com/tonlajr/status/1304011343226437637

2/ The first question in hyponatremia is...

👏Is👏the👏patient👏seizing?👏

If you have a patient with cerebral edema from acute hyponatremia you need to 3% Saline first and ask questions later.

3/ If patients have hyponatremia and have severe symptoms it is 150 ml of 3% then recheck the sodium and give another 150 ml of 3% (I'm using the European guidelines) eje.bioscientifica.com/view/journals/…

Read 20 tweets