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Sourabh Sharma MD DNB FASN Profile picture
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13 Jun, 5 tweets, 7 min read
🌸Aminoglycoside Nephrotoxicity

♨️Cationic Amino group on drug bind to anionic Megalin on PCT
👉Endocytosis (accumulate in PCT lysosomes @ 100-1000x serum concentration)
👉ATN

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️5% of dose retained in epithelial cells lining S1 & S2 segments of PCT

♨️Non-oliguric AKI after 5-10 days
♨️Distal tubular toxicity👉 Polyuria/ K & Mg wasting

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️Risk factor:
♦️Elderly
♦️Hypotension
♦️Pre-existing renal disease
♦️Duration>7days
♦️Concurrent nephrotoxin
♦️Liver disease
♦️Sepsis
♦️Divided dose regimen

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Aminoglycoside Nephrotoxicity

♦️Most nephrotoxic- Neomycin
♦️Least nephrotoxic- Streptomycin

♨️Gentamicin>Netilmicin>Amikacin

♨️Amikacin (in Picture): Fewer Amino group per molecule👉 Less Nephrotoxic

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter ImageImage
🌸Aminoglycoside Nephrotoxicity

♨️Main approaches towards ⬇️ nephrotoxicity

🔆Single daily dose👉⬇️Accumulation
🔆Ototoxicity (& Nephrotoxicity): ameliorated by NAC

⚠️Vancomycin+: ⬆️ toxicity

Pic:ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd Image

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Sourabh Sharma MD DNB FASN Profile picture
15 Jun
🌸Kidney involvement in primary Sjögren Syndrome

🔥<10% cases (Underdiagnosed/ Neglected⁉️)
🔥Most frequent: TIN
🔥Prognosis👍
🔥Good response to steroid
🔥Cryoglobulinaemia in SS👉 Beware of Lymphoma/MPGN‼️

⚠️Always screen kidneys in SS

#NephroNotes #Nephpearls #FOAMed #MedEd
🌸Kidney involvement in primary Sjögren Syndrome

🔥Trigger: Environment/Genetics/Viruses
🔥Immune complex in glomeruli
🔥Autoab to specific renal transporters in DCT (Reason behind dyselectrolytemia‼️)

10.1038/nrneph.2015.174
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🌸Kidney involvement in primary Sjögren Syndrome

🔥Clinical presentation

♦️dRTA👉Nephrocalcinosis
♦️DI
♦️Fanconi Syndrome
♦️Bartter/Gitelman
♦️TIN
♦️MPGN

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Sourabh Sharma MD DNB FASN Profile picture
14 Jan
🌸NephroTips on AKI in Pregnancy (1/6)
#Tweetorial for budding Nephrologists

🔥Seven-point differential assessment

1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension

Unroll...
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🌸NephroTips on AKI in Pregnancy (2/6)

♨️AFLP

1️⃣>34 Week
2️⃣Vomiting
3️⃣only in severe cases
4️⃣Jaundice
5️⃣Normal platelet
6️⃣Hemolysis absent
7️⃣Hypertension absent

💡Polyuria‼️ d/t 🚫hepatic metabolism of placental Vasopressinase

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🌸NephroTips on AKI in Pregnancy (3/6)

♨️HELLP

1️⃣Mostly 1st 48 hr postpartum
2️⃣severe pre-eclampsia
3️⃣20% cases
4️⃣SGOT/PT⬆️
5️⃣Plt<1lakh
6️⃣LDH>600
7️⃣Severe HTN

⚠️Also has ⬇️ADAMTS13 level‼️
💡Variable degree renal failure

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Sourabh Sharma MD DNB FASN Profile picture
2 Sep 20
🔆Decision Algorithm for prescribing #SGLT2i #GLP1RA in #DKD

Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd ImageImage
🔆Strategies to ⬇️adverse events in #SGLT2i #GLP1RA

💡Keep genitals dry & clean
💡Prophylactic topical antifungal
💡⬇️Diuretic dose
💡Pt education-"STOP DKA" Protocol
💡Self foot examination
💡Monitor PTH/VitD

doi: 10.2215/CJN.02690320
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🔆Trials #SGLT2i #GLP1RA

Ref-CJASN
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Sourabh Sharma MD DNB FASN Profile picture
18 Jun 20
🔥Horseshoe Kidney for Nephrologist (1/n)

⚡Most common renal fusion
⚡Ectopia+Malrotation+Vascular changes
⚡Prevalence 0.25%
⚡1522: da Carpi described 1st
⚡70% Lt dominant
⚡90%: Lower pole fusion

Pics-Surg Radiol Anat;J Ped Urol
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🔥Horseshoe Kidney for Nephrologist (2/n)

⚡Anatomical variations associated with HSK

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🔥Horseshoe Kidney for Nephrologist (3/n)

⚡Congenital anomalies associated with HSK
👉Edward syndrome 67%
👉Turner syndrome 14%-20%
👉Down syndrome ~1%

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Sourabh Sharma MD DNB FASN Profile picture
17 May 20
📛Dialysis Dyseqillibrium Syndrome (1/n)
⚡Neurological deterioration in patients on Hemodialysis
⚡First described by Kennedy AC et al (Lancet, 1962)
⚡Waste basket❓
⚡Diagnosis of exclusion

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📛Dialysis Dyseqillibrium Syndrome (2/n)
⚡Pathophysiology:

I. "Reverse urea" effect
🔺️Chronic uremia👉⬇️Brain urea transporters (50%) & ⬆️AQP4 (165%)
🔺️⬆️Brain osmolality👉 cerebral edema

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📛Dialysis Dyseqillibrium Syndrome (3/n)
⚡Pathophysiology:

II. "Idiogenic osmoles" hypothesis
🔺️Generation of other osmotically active molecules
🔺️Inositol/ Glutamine/ Glutamate
🔺️Unidentified osmoles❓

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Sourabh Sharma MD DNB FASN Profile picture
9 Apr 20
🔥Uremic Hiccups

👉Could be intractable in CKD
⚡Nephrologist's nightmare‼
👉Vagal/ Phrenic N stimulation

❓Which of the following is not a usual cause of persistent hiccups in CKD🚫
@RenalFellowNtwk @askrenal @NephJC
🔢Usual causes of Hiccups in CKD
🔺️Uremia itself
🔺️Hypokalemia/Hypocalcemia/Hyperglycemia
🔺️Drugs- Steroids/BZD/Opioids/Antidopaminergics
🔺️Addictions-Alcohol/Smoking
🔺️Psychogenic/Anxiety
🔺️GERD
🔺️Infections- TB/Pneumonia/CNS infection
💠Simple age old ways could be effective (Treat Uremia first‼)
👉Usually involve glottic stimulation/ ⬆️pCO2 (Hypocarbia stimulates hiccups‼)

🔺️Holding breath
🔺️Drinking gulps of water
🔺️Eating tbsf peanut butter❗
🔺️Chewing lemon
🔺️Inhaling pepper
🔺️Breath holding
Read 11 tweets

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