💊 Hydralazine (Hz) was first introduced to the market in 1951.

The first case of Hz autoimmunity was in 1953, and the first series of Hz induced ANCA vasculitis overlapping with lupus was in 1984!

But, who is really at high risk and what are the outcomes? #nephsky #nephtwitter 🤔 Determining if Hz is the cause of glomerulonephritis can be challenging. But there may be a few clues.

1. multiple autoantibodies and anti-histone
2. presence of VERY high ANCA titers
3. overlap with vasculitis and lupus on biopsy

🧵Let's talk hypernatremia

So often we discuss the correction rate of hyponatremia, but what about hypernatremia? #medtwitter #nephtwitter #meded

🧐What is your correction rate for chronic hypernatremia? Older guidelines recommend a correction of no more than 8-10 mEq/dL in 24 hours borrowed from pediatric literature

“Fast” correction is generally considered to be more than 12 mEq/dL per day

pubmed.ncbi.nlm.nih.gov/20412412/

⁉️What is the difference between mineral and organic acidosis?
⁉️Why does one cause more hyperkalemia than the other?

Join me on this 🐇🕳️rabbit hole #tweetorial on metabolic acidosis and it's effect on potassium.

📊To start, which type of acidosis causes more hyperkalemia? Metabolic acidosis is defined as a ⬇️low pH due to a ⬇️decrease in bicarbonate extracellularly

💎Mineral acids (aka inorganic acids) are “synthesized from earth minerals.”

🥬Organic acids are metabolized by the cell and occur naturally.

The 🎩baron of kidney stone prevention has been citrate supplementation.

📖Let’s quickly review hypocitraturia and its relationship to stones.

Where is most of your citrate reabsorbed? Which condition is ❌NOT associated with hypocitraturia?

🤔🔬Why are kidney stones so interesting?
Because the 🔑tubules > glomeruli

Disagree if you like, but it’s true.

A short thread on some mechanisms associated with calcium stones...

#nephtwitter #FOAMed #MedEd #uronephrology #kidneystone #nephrolith Which is a risk factor for calcium oxalate stones?

Which is your favorite hypertension syndrome #eponym? So a short #VisualMnemonic quiz thread on some of the #HTNsyndromes I can never remember🤔 (list is not all inclusive)

Some are better than others.🤷‍♀️If nothing else, hope it's fun.🎉
#timetostudy #boardprep

Is being pregnant magical🌟?
I’m not so sure, but let’s give OB a Nephrology twist. 🍼🐣

#nephtwitter #obtwitter #endotwitter #reallythekidneysarethecoolest #medtwitter #tweetorial

Why do you gain weight when you are pregnant? The average woman ⬆️gains a plasma volume of 1250 mL (an increase of 45-55%).

Significant lab values changes include
- Plasma Na ⬇️reduced by ~ 5 mmol/L
- Plasma osmolality ⬇️reduces by ~10 mOsm/kg
- Cr ⬇️decreases by 0.3 mg/dL due to increased GFR among other changes

The Tale of the Low Chloride

Once there was 34 year old man who used marijuana and was 🤮nauseous, vomitting, and confused. The resident 📞calls and says, "All the electrolytes are abnormal!! Can you help?"

renalfellow.org/2019/12/16/ske…

@TheSkeletonKG #FOAMED #medtwitter #tweetorial You say of course and see the patient. 🥼🩺His BP was 131/87 mmHg with a HR of 142 bpm. He was fatigued, but AOx3. Moist mucous membranes, normal skin turgor, and no LE edema.

💉Labs are shown and reveal a serum osmolality of 263 with ALL normal labs 3 months prior.

HIV. Sickle cell pain crisis. Metabolic acidosis and hypokalemia. 🥼⚕️Just another night on call. Let's break it down in the inaugural #tweetorial by the #FOAMED #medtwitter @TheSkeletonKG

Full post here! @RenalFellowNtwk renalfellow.org/2019/10/03/the… 30 yo woman with sickle cell anemia and HIV on lamivudine, tenofovir, alafenamide, and efavirenz presents with a pain crisis. 💉💉Labs are shown.