🔥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

Unroll…
#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

Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter

⁉️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

🌸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

🌸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 🌸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

🔥What are causes of Foamy urine in absence of Proteinuria⁉️
#Tweetorial

💡Any surfactant in urine can cause frothuria‼️
👉Surfactant has amphiphilic properties which helps trap pocket of gas in liquid and produce foam

Ref-CJASN
#NephroNotes #FOAMed #MedTwitter #MedEd 🔥How do you define foamy urine⁉️

💡Not everything bubbly in urine pot is Frothuria‼️

☄Definition-
Appearance & "persistence" of "multiple" layers of small to medium bubbles in voided urine

🚫Single layer of large bubbles- Neglect‼️

#NephroNotes #FOAMed #MedTwitter #MedEd

🌸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

Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd

🔆Decision Algorithm for prescribing #SGLT2i #GLP1RA in #DKD

Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd 🔆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

🔥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

📛Dialysis Dyseqillibrium Syndrome (1/n)
⚡Neurological deterioration in patients on Hemodialysis
⚡First described by Kennedy AC et al (Lancet, 1962)
⚡Waste basket❓
⚡Diagnosis of exclusion

Unroll...
#NephroNotes #Nephpearls #FOAMed 📛Dialysis Dyseqillibrium Syndrome (2/n)
⚡Pathophysiology:

I. "Reverse urea" effect
🔺️Chronic uremia👉⬇️Brain urea transporters (50%) & ⬆️AQP4 (165%)
🔺️⬆️Brain osmolality👉 cerebral edema

Unroll...
#NephroNotes #Nephpearls #FOAMed
Pic- CKJ; Pediatric Nephrology

🔥Uremic Hiccups

👉Could be intractable in CKD
⚡Nephrologist's nightmare‼
👉Vagal/ Phrenic N stimulation

❓Which of the following is not a usual cause of persistent hiccups in CKD🚫
@RenalFellowNtwk @askrenal @NephJC 🔢Usual causes of Hiccups in CKD
🔺️Uremia itself
🔺️Hypokalemia/Hypocalcemia/Hyperglycemia
🔺️Drugs- Steroids/BZD/Opioids/Antidopaminergics
🔺️Addictions-Alcohol/Smoking
🔺️Psychogenic/Anxiety
🔺️GERD
🔺️Infections- TB/Pneumonia/CNS infection