Tweet

Joel M. Topf, MD FACP

6 Oct, 4 tweets, 1 min read

Wow, the Steve Jobs film at Apple.com is really good. Don't miss it.

I know that Steve was an asshole to a lot of people and was greedy when he didn't need to be and did some shameful acts. But for many years he was a singular hero and inspiration.

My career arc is a result of thinking differently. Many nights as I worked on projects I felt kinship with the team who developed the Macintosh. The ability to stay focused on making something insanely great in a world where good enough is usually all that anyone expects.

I met Steve only briefly and exchanged a couple of words with him, but my vision of his ethos accompanied me for years as I established what I was doing in medicine. Thank you Steve for all of that.

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More from @kidney_boy

Joel M. Topf, MD FACP

@kidney_boy

8 Aug

#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…

Read 4 tweets

Joel M. Topf, MD FACP

@kidney_boy

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

@kidney_boy

20 Jul

Next up Alkesh Jani to talk about literature review in transplant #AspenKidney

Wait list is stable and transplants are going up to more deceased donors. #AspenKidney

Kidneys and Patients are doing better over time #AspenKidney

Read 6 tweets

Joel M. Topf, MD FACP

@kidney_boy

20 Jul

@doc_faubel

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

Dose of dialysis Ronco CRRT 20 ml/kg/hr vs 35 vs 45 from 2000 #AspenKidney

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

@kidney_boy

20 Jul

Next up is Joshua Thurman with a lot review of GN

@NephJC_Podcast

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

Read 12 tweets

Joel M. Topf, MD FACP

@kidney_boy

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

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