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Sourabh Sharma MD DNB FASN Profile picture
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Oct 1 • 7 tweets • 8 min read
🔥Hello #NephTwitter

💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin

⚡️After ruling out most infective causes👉Look for non-sepsis causes too

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#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥Fever in Inflammation

⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines

⚡️Autoimmune diseases

⚡️Autoinflammatory conditions
👉Periodic fever syndromes

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#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🔥Drug induced fever

💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever

⚡️Stimulation of non-shivering thermogenesis

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doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🔥Brain injury Fever

⚡️Trauma/ Vascular event

💥Thermal dysregulation (Hypothalamic Inj)
💥⬆️Cerebral pyrogenic cytokines
💥Ischemic repercussion injury

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doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥Endocrine fever

💥Hyperthyroidism
💥Adrenal insufficiency
💥Pheochromocytoma

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doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥How does fever affect kidneys⁉️

⚡️GFR⬇️ with 2°C ⬆️
⚡️⬆️Urea/Cr
⚡️Glomerular capillary dilatation
⚡️Interstitium hemorrhage
⚡️Vascular stasis
⚡️RAS⬆️👉⬇️RBF
⚡️Direct injury
⚡️Renal hypoperfusion
⚡️Rhabdomyolysis

doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed
🔥Fever is not always a sign of antibiotics deficiency

#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd

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More from @iamnephrologist

Sourabh Sharma MD DNB FASN Profile picture
Apr 8
⁉️How frequently do you diagnose "Treatment Induced Neuropathy" or Insulin Neuritis in your diabetic patient presenting with painful neuropathy ?

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes (TIND)

💡Iatrogenic complication of aggressive glycemic control

🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️

Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes

♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA

Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
Read 8 tweets
Sourabh Sharma MD DNB FASN Profile picture
Jun 15, 2021
🌸Kidney involvement in primary Sjögren Syndrome

🔥<10% cases (Underdiagnosed/ Neglected⁉️)
🔥Most frequent: TIN
🔥Prognosis👍
🔥Good response to steroid
🔥Cryoglobulinaemia in SS👉 Beware of Lymphoma/MPGN‼️

⚠️Always screen kidneys in SS

#NephroNotes #Nephpearls #FOAMed #MedEd
🌸Kidney involvement in primary Sjögren Syndrome

🔥Trigger: Environment/Genetics/Viruses
🔥Immune complex in glomeruli
🔥Autoab to specific renal transporters in DCT (Reason behind dyselectrolytemia‼️)

10.1038/nrneph.2015.174
#NephroNotes #FOAMed #MedEd #Nephpearls #NephTwitter
🌸Kidney involvement in primary Sjögren Syndrome

🔥Clinical presentation

♦️dRTA👉Nephrocalcinosis
♦️DI
♦️Fanconi Syndrome
♦️Bartter/Gitelman
♦️TIN
♦️MPGN

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
Read 6 tweets
Sourabh Sharma MD DNB FASN Profile picture
Jun 13, 2021
🌸Aminoglycoside Nephrotoxicity

♨️Cationic Amino group on drug bind to anionic Megalin on PCT
👉Endocytosis (accumulate in PCT lysosomes @ 100-1000x serum concentration)
👉ATN

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️5% of dose retained in epithelial cells lining S1 & S2 segments of PCT

♨️Non-oliguric AKI after 5-10 days
♨️Distal tubular toxicity👉 Polyuria/ K & Mg wasting

Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd Image
🌸Aminoglycoside Nephrotoxicity

♨️Risk factor:
♦️Elderly
♦️Hypotension
♦️Pre-existing renal disease
♦️Duration>7days
♦️Concurrent nephrotoxin
♦️Liver disease
♦️Sepsis
♦️Divided dose regimen

#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
Read 5 tweets
Sourabh Sharma MD DNB FASN Profile picture
Jan 14, 2021
🌸NephroTips on AKI in Pregnancy (1/6)
#Tweetorial for budding Nephrologists

🔥Seven-point differential assessment

1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension

Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
🌸NephroTips on AKI in Pregnancy (2/6)

♨️AFLP

1️⃣>34 Week
2️⃣Vomiting
3️⃣only in severe cases
4️⃣Jaundice
5️⃣Normal platelet
6️⃣Hemolysis absent
7️⃣Hypertension absent

💡Polyuria‼️ d/t 🚫hepatic metabolism of placental Vasopressinase

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#NephroNotes #FOAMed #MedTwitter #MedEd
🌸NephroTips on AKI in Pregnancy (3/6)

♨️HELLP

1️⃣Mostly 1st 48 hr postpartum
2️⃣severe pre-eclampsia
3️⃣20% cases
4️⃣SGOT/PT⬆️
5️⃣Plt<1lakh
6️⃣LDH>600
7️⃣Severe HTN

⚠️Also has ⬇️ADAMTS13 level‼️
💡Variable degree renal failure

Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
Read 6 tweets
Sourabh Sharma MD DNB FASN Profile picture
Sep 2, 2020
🔆Decision Algorithm for prescribing #SGLT2i #GLP1RA in #DKD

Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd ImageImage
🔆Strategies to ⬇️adverse events in #SGLT2i #GLP1RA

💡Keep genitals dry & clean
💡Prophylactic topical antifungal
💡⬇️Diuretic dose
💡Pt education-"STOP DKA" Protocol
💡Self foot examination
💡Monitor PTH/VitD

doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedEd Image
🔆Trials #SGLT2i #GLP1RA

Ref-CJASN
#NephroNotes #FOAMed #MedTwitter #MedEd ImageImageImage
Read 20 tweets
Sourabh Sharma MD DNB FASN Profile picture
Jun 18, 2020
🔥Horseshoe Kidney for Nephrologist (1/n)

⚡Most common renal fusion
⚡Ectopia+Malrotation+Vascular changes
⚡Prevalence 0.25%
⚡1522: da Carpi described 1st
⚡70% Lt dominant
⚡90%: Lower pole fusion

Pics-Surg Radiol Anat;J Ped Urol
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (2/n)

⚡Anatomical variations associated with HSK

Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (3/n)

⚡Congenital anomalies associated with HSK
👉Edward syndrome 67%
👉Turner syndrome 14%-20%
👉Down syndrome ~1%

Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
Read 5 tweets

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