Next up is Dr. Uribarri to savage the urinary anion gap. Sorry @Dan_Batlle.
The urine anion gap is not real, but allows you to see what is not measured. There is no gap. Cations must equal anions.
Since 24 urine Na, K, Cl equal their dietary intake, then the urine anion gap must reflect relative dietary intake not ammonia in the urine. #NKFClinicals
Hey Siri, show me a scatter plot. No relationship between urine anion gap and urine NH4. N=24,000. #NKFClinicals
Says the source of the early data showing the success of urine anion gap was the administration of ammonium chloride which directly increased the urine chloride which made the urine anion gap more negative. #NKFClinicals
Brilliant and convincing presentation. #NKFClinicals
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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...