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Joel M. Topf, MD FACP Profile picture
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8 Aug, 4 tweets, 2 min read
#AskRenal Patients can get hypotensive after relieving urinary obstruction. Does clamping the foley and slowing bladder decompression protect against the hypotension?
Not in this RCT: pubmed.ncbi.nlm.nih.gov/23859894/
Or in this Case Control trial: ncbi.nlm.nih.gov/pmc/articles/P…
And of course RebelEM @srrezaie covered it here: rebelem.com/urinary-retent…

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
30 Jul
🧂 Hyponatremia #CaseReport #Tweetorial

(and a gif for the people who want to rename this hyperhydronemia)
Patient came to the hospital with abdominal pain, nausea, and vomiting. Patient has alcohol use disorder. Last drink was about a day prior to admission.

After arrival to the ER the patient has a seizure.
Besides the weirdly elevated anion gap, and the hypokalemia, the initial labs just show some AKI. I don't have an ABG but I suspect combined metabolic alkalosis and lactic acidosis.
Read 17 tweets
Joel M. Topf, MD FACP Profile picture
20 Jul
Next up Alkesh Jani to talk about literature review in transplant #AspenKidney Image
Wait list is stable and transplants are going up to more deceased donors. #AspenKidney ImageImage
Kidneys and Patients are doing better over time #AspenKidney ImageImageImage
Read 6 tweets
Joel M. Topf, MD FACP Profile picture
20 Jul
Next up is @doc_faubel again for a lit review in AKI. She starts out saying that she will not be able to go over all 68,000 articles in pubmed on the topic. Also nice shout out to #NephJC

#AspenKidney Image
Dose of dialysis Ronco CRRT 20 ml/kg/hr vs 35 vs 45 from 2000 #AspenKidney ImageImage
ATN 20 ml/kg/hr vs 35 CRRT or 3 day/week or 6 d/wk with IHD
She says this is one of the greatest RCT ever done in nephrology.

The study was negative with a bunch of negative outcomes with intensive dialysis #AspenKidney
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
20 Jul
Next up is Joshua Thurman with a lot review of GN ImageImage
first study is BLISS-LN. Mentions that 2 years of infusions in 448 patients is a big lift. Points out they changed the outcome (probably listens to @NephJC_Podcast (nephjc.com/freelyfiltered…) #AspenKidney
Her is underwelmed with the magnitude of the effect size. He is not sure how to use it. #AspenKidney Image
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
20 Jul
Her original title was “Beyond the ouch hypothesis, a new paradigm to explain the harm in AKI.” #AspenKidney
Mortality in ICU:
No AKI, No HD 5%
ESRD HD 11%
AKI no HD 23%
AKI with HD 58%

Standardized for APACHE 2 scores

#AspenKidney
Injured kidneys may be lashing out, releasing substances that cause systemic effects contributing to mortality. These substances are unique from substances that accumulate with zero GFR.

#AspenKidney
Read 15 tweets
Joel M. Topf, MD FACP Profile picture
19 Jul
Next up Mats Wahlstrom on The Next Generation of Dialysis. Former CEO of Fresenius and Gambro. #AspenKidney
We are seeing a major investment in home therapies. Credits government initiatives. We are currently at 2% home hemo and 10% PD. #AspenKidney
He credits NextStage as putting home hemo back on the map. Small. Portable. Easy to use. Online dialysat4e production. Major driver of success: Capturing commercial payers! #AspenKidney
Read 16 tweets

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