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Joel M. Topf, MD FACP

@kidney_boy

Jan 3

Help me with something I don't understand about COVID-19

I have heard people say Omicron is outcompeting Delta.

And this looks like the case as omicron is exploding, delta has nearly disappeared. But I don't understand how.

The fact that Omicron is more infectious should only come into play if you are simultaneously exposed to both viruses and even though COVID is exploding the absolute incidence is still pretty low (number of people currently infectious per 100,000) so...

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Joel M. Topf, MD FACP

@kidney_boy

Dec 18, 2021

Reading twitter on a Friday night? You sound like just type of person we are looking for in the Nephrology Social Media Collective (NSMC) Internship.

The NSMC is a free, one-year, remote internship where you will learn how to make infographics, run a #NephJC twitter chat, create #Tweetorials, and record, edit and publish a podcast.

We take applications for only a few weeks in December and early January. Most interns are Nephrology Fellows or early career faculty, but we have had full professors, nurses, residents, a medical student, basic scientists, dietitians, all complete the experience.

Read 6 tweets

Joel M. Topf, MD FACP

@kidney_boy

Dec 10, 2021

I am going to try to recap my recent grand rounds on race and GFR in a few #tweetorials. Here is the fifth one. You can find the presentation files and a video of me presenting at pbfluids.com/2021/12/the-ne…………… 1/10

Use of race in eGFR is doesn't work because race is a social construct. “A person who could be categorized as black in the United States might be considered white in Brazil or colored in South Africa” Racial identity shifts with experience and time. 2/10 nytimes.com/roomfordebate/…

I spoke Danish at home. I ate Danish food. At Christmas we danced around the Christmas tree singing Danish carols. But when I went outside my home, I was black. nytimes.com/roomfordebate/… 3/10

Read 11 tweets

Joel M. Topf, MD FACP

@kidney_boy

Dec 9, 2021

I am going to try to recap my recent grand rounds on race and GFR in a few #tweetorials. Here is the fourth one. You can find the presentation files and a video of me presenting at pbfluids.com/2021/12/the-ne………… 1/10

So both MDRD and CKD-EPI found that Black Americans had a higher GFR (on average) for the same creatinine compared to White Americans. Also NHANES showed that Black people have higher creatinines than White people. Why? ajkd.org/article/S0272-… 2/10

Looking at non-creatinine determinants of GFR there are a limited number of variables. Though I included "metabolism" that only comes in play at high serum creatinine so that can't be the factor here.

Increased production from increased muscle mass was the prime suspect. 3/10

Read 11 tweets

Joel M. Topf, MD FACP

@kidney_boy

Dec 9, 2021

I am going to try to recap my recent grand rounds on race and GFR in a few #tweetorials. Here is the third one. You can find the presentation files and a video of me presenting at pbfluids.com/2021/12/the-ne……… 1/10

In the 1980's the hot idea in nephrology was low protein diets to preserve GFR. The NIH funded a Big Science study to test the theory, the Modification of Diet in Renal Disease study, MDRD. The study was a mess and fell on its face, but they did collect a lot of cool data! 2/10

Among that data was iothalamate clearances which are a really good approximation of GFR. So Andy Levey and friends took those data and combined it with age, gender, and race to come up with the MDRD formula. 3/10

Read 10 tweets

Joel M. Topf, MD FACP

@kidney_boy

Dec 8, 2021

I am going to try to recap my recent grand rounds on race and GFR in a few #tweetorials. Here is the second one. You can find the presentation files and a video of me presenting at pbfluids.com/2021/12/the-ne…… 1/10

To understand how nephrology got itself into this eGFR and race mess I want to unpack what is going on in the equations. What are they trying to do and how do they work. 2/10

Estimated GFR depends on people being in steady state. Steady state means the Day 1 creatinine = Day 2 creatinine = Day X creatinine. It doesn't matter if the cr is 0.6 or 4.4, as long as the cr is roughly the same from day to day they are in steady state. 3/10

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Joel M. Topf, MD FACP

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