The line-up #NKFClinicals
Matt Weir, Ajay Singh, and Glenn Chertow. All-star line up.
First up Matt Weir for the CKD outcomes in the DIAMOND Trial #NKFClinicals
RAASi are underutilized and underdosed in heart failure. Can potassium binders help with that? #NKFClinicals
We underuse and underdose because of hyperkalemia. This data represents the best case story and still one in four develop hyperkalemia. #NKFClinicals
The US Sucks at prescribing RAASi in CKD #NKFClinicals
No clinical studies show the utility of dietary management of hyperkalemia. #NKFClinicals
Patiromer is a calcium potassium exchange binders.
DIAMOND Trial is a CV outcome clinical trial to see if potassium mitigation moves the needle on CV events.
Enrolled people with hyperkalemia, then run-in with everyone on patiromer and then change half to placebo. But COVID got in the way and they had to knock down to a more modest outcomes. This study became underpowered to show reduced events. #FuckCovid#NKFClinicals
Table 1. People were on high doses of RAASi and MRA #NKFClinicals
Less hyperkalemia with the binder, no difference in events. #NKFClinicals
Pre-specified subgroup analysis of patients with GFR < 60 #NKFClinicals
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)
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
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/
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.
But the question falls apart when you look at the answer...