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Joel M. Topf, MD FACP

@kidney_boy

Apr 7, 2022 • 8 tweets • 4 min read • Read on X

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Next up is Wendy St Peter Pharm D on the Challenges in Anemia Management. She starts with a Polling Question

@nephrologyPharm

Spoiler, according to table mate @nephrologyPharm, MSL for Amgen it is A. #NKFClinicals

Quick tour through Beserab CREATE, CHOIR, TREAT. Meta analysis #NKFClinicals

What effects the trials had on ESA use: Gold is Hgb, Grey is weekly EPO dose. TREAT caused overnight change in dosing.

LOUDER FOR THE PEOPLE IN THE BACK OF THE ROOM, “No significant association was found between improvements in Hgb levels with treatment and any of the 5-dimensions of quality of life.” #NKFClinicals

Now on to the Pivotal Trial of IV iron. N=2141 she reports is as no difference, but I thought after the correction there was a reduction in events? #oops #NKFClinicals

Just looked it up, I’m pretty sure I’m right here. #DoBetter #NKFClinicals

Okay, that distracted me and I missed the rest of her talk, but here is her conclusion slide #NKFClinicals

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More from @kidney_boy

Joel M. Topf, MD FACP

@kidney_boy

Sep 21

Next session started by Rovin to talk about IGAN pathophysiology and the selection of therapeutics

4-hit model
1. formation of IGA galactose deficient
2. formation of autoantibodies against these IgA
3. Formation of circulating IgG-IgA1 immune complexes
4. Deposition of the immune complexes in the kidney

#RKDSummit

1st case
Hematuria on U/A
Gross hematuria after covid vaccine
10 RBC/HPF, no casts
Scar 0.9 mg/dl, 24-hr urine 750 mg of protein

#RKDSummit

A bit “Juicy”
Mesangial expansion (arrows, fig 1)
Mesangial hypercellularity (circle, fig 2)
Biopsy has no chronicity (fig 3)
Lights up with C3 and IgA (fig 4)

#RKDSummit

Read 35 tweets

Joel M. Topf, MD FACP

@kidney_boy

Sep 21

Honored to be invited to second annual Rare Kidney Disease Scientific Summit. Amazing cast of physicians in attendance. #RKDSummit

Brad Rovin and John Barratt (IGAN king) defend the focus on IgAN and FSGS. Update and recap of the last year. #RKDSummit

Agenda look interesting.
Rovin says he is going to call out people from the audience. #RKDSummit

Read 21 tweets

Joel M. Topf, MD FACP

@kidney_boy

Apr 13

When we published our study <> of ODS and hyponatremia we were pummeled for including people at low risk of ODS because we included Na levels between 120 and 130. They said it is well known "that ODS is incredibly rare/non-existent at those levels." 1/4evidence.nejm.org/doi/10.1056/EV…

Of course one of the reasons it was thought to be incredibly rare was that no one looked for CPM in patients with Na from 120-130. We found a fair number (≤5 of 12). 2/4

Our findings are replicated in a study from Australia. The authors took a different approach to investigating ODS. Instead of starting w/ hyponatremia and working forward to ODS, they started with a dx of ODS and worked backwards
3/4ncbi.nlm.nih.gov/pubmed/35717664

Read 4 tweets

Joel M. Topf, MD FACP

@kidney_boy

Sep 17, 2023

Gadolinium in dialysis patients.
What's up with that?
#Tweetorial
1/11

Nephrogenic systemic fibrosis (NSF) is an iatrogenic disease that presents with hardening of the skin and other organs. It is often lethal. I treated 5 people with this condition (including one with AKI). Terrible.
2/11

The etiology of NSF was unknown and there were many theories. In 2006, Thomas Grobner published a small case series showing 5 patients developing NSF within weeks of receiving gadolinium contrast for MRI.
3/11pubmed.ncbi.nlm.nih.gov/16431890/

Read 12 tweets

Joel M. Topf, MD FACP

@kidney_boy

Aug 12, 2023

I just recently recommended the Renal Physiology book by Bruce Koeppen and Bruce Stanton. I thought it was a good medical student level text book: pbfluids.com/2023/08/ouwb-s…

But I came across this question in Chapter 8 Regulation of Acid Base. It is a straight forward question asking the learner to interpret simple acid-base cases.