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
And here is the data. #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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More from @kidney_boy

Apr 9
Tim @Maximal_Change Yau talking about Bridging the Generation Gap:Undertanding the Millennial and GenZ mind to optimize Med Ed. #NKFClinicals
Boomer 1946 to 1964. They have a landline. They read a newspaper. #NKFClinicals
Gen X 1965-1980 Saw the transition from traditional to digital media #NKFClinicals
Read 18 tweets
Apr 9
Nayan @captainchloride Aurora calls his own number to speak on stopping RASi. #NKFClinicals
The debate comes from worrying about EGFR decline, hyperkalemia vs CV health, mortality benefit, kidney benefit #NKFClinicals
In CRIC in propensity matched evaluation of RASi users vs no RASI in CKD 4/5. No difference in outcomes, Kidney Medicine 2020 Aurora. #NKFClinicals
Read 8 tweets
Apr 9
Next up Implications of lower BP thresholds in patients with advanced CKD by Paul Drawz. Starts with a question
Effects of intensive BP lowering in patients with advanced CKD likely include:
A) Prevention of ESRD
B) Increased risk of AKI
C) Increased fall risk
D) Increased risk of infection
Low BP targets and renal outcomes #NKFClinicals
Read 8 tweets
Apr 9
Slipped into the Optimizing antihypertensives medications selection in hemodialysis patients with Jennifer Flythe. #NKFClinicals
Audience response question.

The people chose fosinopril. #NKFClinicals
Treating blood pressure in HD reduces outcomes (just barely) #NKFClinicals
Read 16 tweets
Apr 9
Next up fellow Channeler, @AnnaGaddy to talk about urine Chemistries to Predict and Monitor Response to Diuretics. She’s an Assistant Professor of Medicine. #NKFClinicals
Interesting topics #NKFClinicals
Heart failure is a disease of inadequate sodium homeostasis. #NKFClinicals

Diuretics try to bring down ECF while in the long term patient returns to Na in = Na out (sodium intake is the dotted line)
Read 9 tweets
Apr 9
Pisse Prophecy workshop. First up Richard Sterns. He failed to release his slides. That sucks. @NKF should disinvite speakers that don’t release their slides. They are here to teach. #NKFClinicals
The BUMP: Basic Urine Metabolic Profile. I’m going to start ordering daily BUMPs. #NKFClinicals
All you need is the BUMP!
Read 5 tweets

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