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23 Oct, 6 tweets, 5 min read
PetervRatcliffe presenting Homer W. Simith State of the Art Lecture. #KidneyWk
Rejected by @nature once, but he did’t falter. Which reminds me that success is never a straight line #KidneyWk
VHL was key for his work, the missing link if you will. #KidneyWk
Knowledge builds on knowledge. Connect the dots, discover new genes (HIF) Win a Nobel! #Kidneywk
Now the trick was to use this discovery to our advantage, fooling cells into thinking there is hypoxia, increasing EPO production, and avoiding side effects. Enter #Roxadustat and #Daprodustat. They may have other potential advantageous effects. #KidneyWk
The next step is to integrate science, precision medicine and clinical pharmacology #KidneyWk

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More from @NephroGuy

Alex Meraz Profile picture
23 Oct
Fluid overload is bad news for patients:
1. Causes AKI
2. Prevents organ and patient recovery
3. Increases mortality

Ill share some of the data masterfully presented by @criticalbeansmd today at #KidneyWk starting with the take home points, in case this is the only tweet you see Image
Fluid Overload is very common, is all over the place and it has several definitios.

Patients accumulate weight at least for the first 7 days if the ICU doesn’t have some sort of FLUID STEWARDSHIP program in place. Remember fluids are drugs #KidneyWk. ImageImage
There is no single situation in which Fluid overload is beneficial for patients. On the contrary. It is bad in every situation, doesnt matter how we slice or present the data. Liberal fluid strategies are always worse #KidneyWk ImageImageImageImage
Read 13 tweets
Alex Meraz Profile picture
23 Oct
All nephrologists should be learning #POCUS now. It is safe, reproducible, cheap!!! Some uses are:
1. Rule out obstruction
2. Dx cause of hemodynamic inestability
3. To guide vascular access

@WBeaubien #KidneyWk ImageImage
Beyon the basic applications in #AKI
1. Assessment of kidney perfussion
2. Detection of early AKI
3. Prediction ofpersistent AKI
4. Detect kidney congestion

2D US is ok, but using other modalities like doppler we can get more granular data on kidney hemodynamics.

#kidneywk ImageImageImage
However using only color doppler or power doppler is not good enough. #KidneyWk ImageImage
Read 9 tweets
Alex Meraz Profile picture
23 Oct
#EmperorReduced. Patients enrolled with eGFR as low as 20 ml/min #Kidneywk
Impresive MAKEreduction #kidenywk
Results of EMPEROR #Kidneywk
Read 7 tweets
Alex Meraz Profile picture
23 Oct
#Fidelio is now being presented #Kidenywk
Finerenone reduces decline of GFR and key secondary outcomes. Hyperkalemia was not really an issue #Kidneywk
Very safe drug in a trial context. Less hyperK than with spironolactone #kidneywk
Read 6 tweets
Alex Meraz Profile picture
22 Oct
🚬Smoking increases 10x the risk of ESKD in #IgAN #Kidneywk Image
Steroids are no walk in the park in #IgAN. With very good supporting care loss of kidney function is very mild (-1.6 ml/min/year). Testing had to be terminated prematurely due to adverse events. #KidneyWk ImageImage
10 year follow up of #STOPIgA. No differences. And now with #SGLT2i or hydroxichloroquine thess curves may separate without the use of steroids. #KidneyWk Image
Read 4 tweets
Alex Meraz Profile picture
22 Oct
Dr. Jardine on side effects of SGLT2i. Where is evidence coming from? #Kidneywk
Mostly is coming from CREDECE since it has the largest population of advanced CKD. Side effects are not different across different stages of CKD #Kidneywk
Hypoglycaemia not common, about 1%. DKA is rare (1 case per 1000 users) but real mostly seen in people who require insulin. #kidneywk
Read 13 tweets

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