Joel M. Topf, MD FACP Profile picture
Apr 14, 2023 14 tweets 8 min read Read on X
At the #NKFClinicals to see @rajmehrotra1122 win the Michael Lazarus distinguished scholar award. Image
His lecture begins, “Consider the patients’ lived experience” #NKFClinicals

Dr: “Labs look good”
Patient: “but doctor why do I feel like crap” ImageImage
Dialysis is a 4-6 hour time commitment. There is no other chronic condition that takes a greater commitment by patients.

One way to help patients is give them a choice of modality.

#NKFClinicals
The past:

Home dialysis is for some people by some doctors for some time

And this is an improvement from the truly horrible

“PD is a second class therapy for second class patients provided by second class doctors”

#NKFClinicals
PD is good #NKFClinicals
There is no difference in mortality PD v HD ImageImage
As we have expanded the PD population we are not adding people that are bad candidates that may do worse. Not happening. New additions are doing fine. #NKFClinicals

#NKFClinicals Image
Wow. @rajmehrotra1122 is giving a masterclass on delivering a compelling keynote. Great slides. Powerful message. #NKFClinicals Image
The second half of his talk will focus on symptom management.

So much research focused on mortality, but one of the top complaints in fatigue. We should be paying attention to dialysis associated fatigue. It doesn’t always have to be mortality. #NKFClinicals Image
Doctors think the solution to every problem is more dialysis
Patients want the least amount of dialysis necessary. #NKFClinicals
Depression should he treated and addressed regardless of the downstream effect. #NKFClinicals Image
Not all uremic symptoms gets better with dialysis.
Appetite does improve with dialysis
Dyspnea gets better with dialysis
Total number of symptoms does not go done with dialysis
Depression does not improve with dialysis

#NKFClinicals Image
More dialysis did not improve insomnia.
Shown in both HEMO and FHN #NKFClinicals ImageImage
Cognitive behavior therapy is effective but is a big ask for people that are already going to dialysis three days a week. #NKFClinicals
A shout out to CKD associated pruritus and difelikefalen #NKFClinicals ImageImage

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More from @kidney_boy

Sep 21
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
Image
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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)

#RKDSummit


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Read 35 tweets
Sep 21
Honored to be invited to second annual Rare Kidney Disease Scientific Summit. Amazing cast of physicians in attendance. #RKDSummit
Image
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Brad Rovin and John Barratt (IGAN king) defend the focus on IgAN and FSGS. Update and recap of the last year. #RKDSummit Image
Agenda look interesting.
Rovin says he is going to call out people from the audience. #RKDSummit Image
Read 21 tweets
Apr 13
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 Image
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
Read 4 tweets
Sep 17, 2023
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 Image
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/
Read 12 tweets
Aug 12, 2023
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. Image
But the question falls apart when you look at the answer... Image
Read 7 tweets
Apr 14, 2023
Lab guy from Yale up next Joe El Khoury He is on YouTube. Episode 1 was on pseudohyponatemia
209 subscribers. Clinical Chemistry with Joe El-Khoury Image
Here is the YouTube channel: youtube.com/@ClinChemJoe

https://t.co/LWupt0HWN1 #NKFClinicals
Despite calling it “laboratory error”, a lot of the problem happens long before the sample gets to the lab. #NKFClinicals Image
Read 9 tweets

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