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May 27 • 11 tweets • 7 min read
1/10 We often talk about evaluation of AKI in the context of ⬆️ creatinine, but let’s take a step back and think about eGFRs. Here is an approach to interpreting ⬇️ in eGFR! #NephTwitter #MedTwitter #FOAMed #MedEd
2/ This differential focuses on the estimated GFR (eGFR), which is calculated using serum creatinine +/- serum cystatin C levels (we will take a look at the equations in a bit). Biomarkers that actually measure GFR (such as inulin) are not clinically practical to obtain.
3/ Thanks to @ZacNephron for explaining GFR vs eGFR, referring me to Chapter 2 of @BookBurton, and sharing this thread to deepen my understanding of the utility of GFR:
4/ Not all ⬇️ in GFR are bad! After posing about a question related to this, @NephroMD and @VelezNephHepato reminded me that some drugs transiently ⬇️ GFR but actually preserve GFR in the long-term (reminder that we will see Cr ⬆️ with these medications).
5/ In order to break down this approach, we need to look at the calculations that go into estimating GFR. @NKF has the CKD-EPI Creatinine Equation (2021) and the CKD-EPI Creatinine-Cystatin Equation (2021). Make sure to pay attention to which equation your institution uses!
6/ If your institution still uses an eGFR calculator that uses race as a variable, this is a good opportunity to advocate to change that. Thanks to @MichaelAyoubMD for sharing this thread by @kidney_boy
7/ Using the above equations, we can look at the factors that cause a ⬇️in eGFR:
⬆️ age
⬆️ creatinine
⬆️ cystatin C
8/ Here is a non-exhaustive list of causes of ⬆️ creatinine. The medications listed that ⬇️ renal tubular secretion of creatinine are from a question that I posed:
9/ Here is a non-exhaustive list of causes of ⬆️ cystatin C
10/10 Here is a summary slide. Would love to #askenal for any feedback! Thanks to @ZacNephron, @MichaelAyoubMD and @DxRxEdu for reviewing this thread. And for those using Glass.Health, here is the shared link to my schema on reduced eGFR: glass.health/read/Lurauiy15…
@MedTweetorials

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More from @SatyaPatelMD

Satya Patel Profile picture
Feb 23
1/10 As someone who struggles with test-taking, I made a framework for tackling some common test-taking hurdles. I had the opportunity to go over this with all our @uclaimchiefs housestaff and decided to make it into a 🧵 #MedTwitter #MedStudentTwitter #FOAMed
2/ Test scores are important because they are what you need to become board-certified. Scores are often conflated with competency - that is quite a fallacy as so many other factors go into competency.
3/ Here is a non-comprehensive set of examples of test-taking hurdles. Let’s go through each of them systematically in a way that resonates with internists - problem listing! FYI, all of these end of overlapping a lot
Read 11 tweets
Satya Patel Profile picture
Nov 2, 2021
1/12 The cognitive load on rounds can be high, so I like using daily e-mails as an adjunct to teaching on rounds. Here is a 🧵 on my approach! #MedTwitter #MedEd #FOAMEd
2/ I am of the opinion that you can form an outline of a lesson plan BEFORE you even start on service! My group attends for 14 days at a time, so this tells me how much “time” I have allotted to teach (more on this later).
3/ Make sure to include every learner who will rotate with you while you are on (I use amion to figure out which trainees are on with me). They might appreciate getting learning when they are off service and if there is an ongoing thread of teaching, they won’t miss out!
Read 12 tweets
Satya Patel Profile picture
Oct 27, 2021
1/8 Medical education has evolved tremendously, and I am a HUGE fan of having a peripheral brain. An common question trainees ask me is “how do you cultivate references?” A 🧵 on my methodology for organizing information #MedTwitter #MedEd
2/8 Before we start, it is important to categorize the purpose of the info you are gathering:
1⃣ To teach others
2⃣To teach myself
I don’t organize my references this way, but I start here to remind myself that everyone learns best with different modalities!
3/8 Now that we’ve acknowledged that, you must create a list of modalities that you can consistently categorize information into. Here is my organizational system.
Read 8 tweets
Satya Patel Profile picture
Sep 6, 2021
1/18 Chest pain is a frequently seen reason for admission. Here's my take on when to consider ACS in patients with chest pain!
#MedTwitter #CardioTwitter #MedEd #FOAMed #MedTweetorial @MedTweetorials
2/18 Our evaluation of ACS starts with 3 things:

1⃣ History
2⃣ EKG
3⃣ Troponin

The primary focus of this thread is going to be on the history (a heads up - the flowchart at the end will go a little bit out of order)!
3/18 When taking a chest pain history, we ask lots of questions about associated symptoms and alleviating/aggravating factors, mostly because we were taught to obtain and report this history. But is there a more focused way to approach this? Image
Read 18 tweets
Satya Patel Profile picture
Aug 30, 2021
1/5 How can you calculate the estimated DAILY risk of ischemic stroke (and other events) in patients with atrial fibrillation?

#MedTwitter #HemeTwitter #CardioTwitter #MathTwitter #FOAMed #MedEd

Note: the original post was deleted due to a mathematical error
2/5 While the CHADSVASc is helpful for annual estimation of ischemic stroke risk (and other events), what is the risk of DAILY risk? Turns out we can do some math to derive it from the annual risk estimation!
3/5 The math here doesn't EXACTLY reflect the daily risk of for patients because there are countless variables that we cannot control. @JessieCurrier17 describes the rationale using probability quite nicely. Image
Read 5 tweets
Satya Patel Profile picture
Aug 25, 2021
1/7 Considering how to manage community-acquired pneumonia (CAP)? Is it CURB-65 or should it be CARB-65? No idea what I am talking about? Let's talk about azotemia and uremia!

#MedTwitter #FOAMEd #MedEd #NephTwitter #IDTwitter
2/7 The CURB-65 score has been used for diagnosis and treatment of adults with community-acquired pneumonia (CAP). The most recent IDSA CAP guidelines in 2019 (pubmed.ncbi.nlm.nih.gov/31573350/) referenced the 2007 IDSA CAP criteria for defining severity
3/7 The original article that describes validation of the CURB scoring system (ncbi.nlm.nih.gov/pmc/articles/P…) does NOT use the word "uremia," but instead references an serum urea level cutoff.
Read 7 tweets

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