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Jyoti Baharani

Jun 27 • 10 tweets • 5 min read

Offering #dialysis to patients with a new diagnosis of #malignancy is always an emotive and complex affair if they present with an #AKI or #renaldysfunction

Sometimes it’s pretty clear - like in the 30 something who presents with a cervical cancer , bilateral hydronephrosis and K of 7- one will usually explain to The patient what’s the issue and buy them time for intervention which buys time for an oncology consult and further mx

Sometimes it’s not -70 plus with metastatic lung cancer and #AKI will likely need dialysis but is that the right thing - often it’s easy saying make the shared decision with the patient - but shock and the acuteness of the situation doesn’t help and true #SDM is seldom easy

So what does one do in that circumstance?
With the advent of acute oncology newer chemotherapy not all malignancies are a lost cause - it’s important then to dialyse the patient if it’s the safest thing to do - this publication provides a clear framework thelancet.com/journals/lanhl…

This is a good read and a comprehensive review by the inimitable Norbert Lamiere on #AKI in critically Ill #cancer Patients

ncbi.nlm.nih.gov/pmc/articles/P…

And this on #AKI in #haematological
Malignancies

ncbi.nlm.nih.gov/pmc/articles/P…

This more recent publication mentions that a multidisciplinary approach is necessary with the goal of reducing the incidence of AKI in cancer patients and improving patient outcomes

academic.oup.com/ckj/article/15…

A paywalled paper but worth a search provides an overview of the epidemiology and most common causes of acute kidney injury in patients with cancer unrelated to oncological treatment

ackdjournal.org/article/S1548-…

Despite having done this for a long time no 2 patients with similar malignancies have the same outcomes and it’s always a conundrum deciding on the right thing to do at the time of presentation 🙁

it’s important therefore to be honest and transparent and make shared decisions when possible and review treatment goals often when dealing with such cases #malignancy #AKI
Fin/

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Jyoti Baharani

@renalpages

Jun 26

Speaking to a trainee doctor a few weeks ago who is scarily like me when I was a trainee - we both discussed having been labelled #aggressive at various points as men in the same scenario have been labelled #assertive

I looked up what they mean; aggressive according to the Cambridge English Dictionary is “behaving in an angry and violent way towards another person” & the more positive “assertive” is someone who “behaves confidently and is not frightened to say what they want or believe”.

So why is that women are more likely to be called aggressive rather than assertive ?

Probably as Women are expected to be warmer and more nurturing but they are also expected to demonstrate competence and be tough when they need to, without compromising