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Sourabh Sharma MD DNB FASN FISN Profile picture
@iamnephrologist
Jun 15, 2021 • 6 tweets • 8 min read • Read on X
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🌸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
#NephroNotes #FOAMed #MedEd #Nephpearls #NephTwitter
🌸Kidney involvement in primary Sjögren Syndrome

🔥Clinical presentation

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

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

🔥Differentials

⚠️Exclude other inflammatory disorders
SLE/ Chronic HCV/ IgG4 related disease

doi:10.1038/nrneph.2015.174
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Kidney involvement in primary Sjögren Syndrome

🔥Frequent infiltration of interstitium with B cells & plasma cells

👉Basis for B-cell targeted therapy

doi:10.1038/nrneph.2015.174
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Kidney involvement in primary Sjögren Syndrome

🔥Management

👉Renal outcome better in MPGN than TIN‼️
⚠️key-Early diagnosis & prompt t/t
👉Rituximab
👉TIN: Steroid(≥0.5mg/kg/day)
👉MPGN (cryo): CS+Ritux+TPE

doi:10.1038/nrneph.2015.174
#NephroNotes #Nephpearls #FOAMed #MedEd

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More from @iamnephrologist

Sourabh Sharma MD DNB FASN FISN Profile picture
Oct 1, 2022
🔥Hello #NephTwitter

💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin

⚡️After ruling out most infective causes👉Look for non-sepsis causes too

Unroll…
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥Fever in Inflammation

⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines

⚡️Autoimmune diseases

⚡️Autoinflammatory conditions
👉Periodic fever syndromes

Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🔥Drug induced fever

💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever

⚡️Stimulation of non-shivering thermogenesis

Unroll…
doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
Read 7 tweets
Sourabh Sharma MD DNB FASN FISN Profile picture
Apr 8, 2022
⁉️How frequently do you diagnose "Treatment Induced Neuropathy" or Insulin Neuritis in your diabetic patient presenting with painful neuropathy ?

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes (TIND)

💡Iatrogenic complication of aggressive glycemic control

🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️

Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes

♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA

Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
Read 8 tweets
Sourabh Sharma MD DNB FASN FISN Profile picture
Jun 13, 2021
🌸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
Read 5 tweets
Sourabh Sharma MD DNB FASN FISN Profile picture
Jan 23, 2021
🔥What are causes of Foamy urine in absence of Proteinuria⁉️
#Tweetorial

💡Any surfactant in urine can cause frothuria‼️
👉Surfactant has amphiphilic properties which helps trap pocket of gas in liquid and produce foam

Ref-CJASN
#NephroNotes #FOAMed #MedTwitter #MedEd Image
🔥How do you define foamy urine⁉️

💡Not everything bubbly in urine pot is Frothuria‼️

☄Definition-
Appearance & "persistence" of "multiple" layers of small to medium bubbles in voided urine

🚫Single layer of large bubbles- Neglect‼️

#NephroNotes #FOAMed #MedTwitter #MedEd
Image
Image
🔥Have you ever wondered why beer is frothy⁉️

☄Foam in beer is due to
amphipathic protein derived from barley
👉Lipid Transport Protein1‼️

Ref-CJASN
Ref-SorensenSB et al. Barley lipid transfer protein1involved in beer foam.MBAA TQ1993
#NephroNotes #FOAMed #MedTwitter #MedEd Image
Read 7 tweets
Sourabh Sharma MD DNB FASN FISN Profile picture
Jan 14, 2021
🌸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...
#NephroNotes #FOAMed #MedTwitter #MedEd
🌸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

Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
🌸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

Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
Read 6 tweets
Sourabh Sharma MD DNB FASN FISN Profile picture
Sep 2, 2020
🔆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
#NephroNotes #Nephpearls #FOAMed #MedEd Image
🔆Trials #SGLT2i #GLP1RA

Ref-CJASN
#NephroNotes #FOAMed #MedTwitter #MedEd ImageImageImage
Read 20 tweets

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