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

Honored to be invited to second annual Rare Kidney Disease Scientific Summit. Amazing cast of physicians in attendance. #RKDSummit

Brad Rovin and John Barratt (IGAN king) defend the focus on IgAN and FSGS. Update and recap of the last year. #RKDSummit

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

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

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.

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 Here is the YouTube channel: youtube.com/@ClinChemJoe

https://t.co/LWupt0HWN1 #NKFClinicals

Pseudohyperkalemia
Serum potassium is higher than plasma potassium. #NKFClinicals Sometimes Fist clenching
Sometimes Tourniquet
in the NEJM 1990

Michael Emmett on electrolyte artifacts
Pre-analytical and analytical #NKFClinicals Starting with pseudohyponatremia
These are real cases
The osmolality was 294, so there is a huge gap. 44ish
Implies Artifactual decrease in sodium
Her triglycerides were >6000 #NKFClinicals

At the #NKFClinicals to see @rajmehrotra1122 win the Michael Lazarus distinguished scholar award. His lecture begins, “Consider the patients’ lived experience” #NKFClinicals

Dr: “Labs look good”
Patient: “but doctor why do I feel like crap”

I presented a poster at #NKFClinicals. This came from working with ViforCSL on the KALM-1 and KALM-2 meta-analysis of the pivotal trials of difelikefalin for CKD associated pruritus (CKDaP). About a year ago we brainstomed what other lessons could we could pull from the data. A question we had was how quickly do people respond to the drug, or put more practically, if you start a patient on difelikefalin and a month later they are still having intense itch, how likely will it be that they still could respond?

Never in the history of medicine has so much been done, by so many, so incompetently, with so little consequence as in the treatment of severe hyponatremia. #Tweetorial 1/10 You shouldn't correct hyponatremia too fast. The speed limit is 8 mmol/L per day. We are terrible at it. In George et al, 41% of 1,490 pts were corrected faster than 8 mEq/L. Look at the poor slobs at the left of the nomogram whose Na actually went down 🤪 2/10

The begining of my medical career was dominated by HIV

Start med school in 91. Magic Johnson announces he is HIV+
MS3 med students do blood draws on HIV+ patients (phlebotomy refuses)
MS4 lost my first patient, advanced dementia HIV
Graduated in '95, peak HIV, 50k US deaths

https://twitter.com/dwaldenwrites/status/1633538542084186133

The whole clincal world was HIV, but you would go to the textbooks and they would still be calling HIV HLTV3. It was bonkers. It was in this envirnoment that UpToDate crushed Harrisons.

Next up at the Belgian Society of Nephrology. Ian MacDougall talking iron. Patients with CKD have decreased intake and increased iron loss.

The Belgian Society of Nephrology is about to get to started First up, “When to use steroids in IgAN” by Prof Martin Speeckaert

So we had our first renal physiology text book session of the year and we came across this paragraph in chapter one of Koeppen and Stanton's Renal Physiology #Tweetorial The addition of hypertonic saline will increase the size of the extracellular compartment through the IV infusion of fluid and through the movement of water from the intracellular (ICC) to the extracellular compartment (ECC).

Writing some acid-base questions. What do tyou think of this one?

Following multiple trauma, your patient has a surgical drain which everyone is pretty sure is in a pancreatic pseudocyst. It is draining 100-400 ml a day. Labs: Primary disorder:

"Alzheimer’s experts now suspect Lesné’s studies have misdirected Alzheimer’s research for 16 years."

Number of patients x 16 years = incredible suffering

https://twitter.com/christinespolar/status/1550412154871992321

"Yet Aβ still dominates research and drug development. NIH spent about $1.6 billion on projects that mention amyloids in this fiscal year, about half its overall Alzheimer’s funding."

At this concert tonight

https://twitter.com/emilykingmusic/status/1542952207070375936

Landslide

I'm putting together a lecture on AKI for emergency medicine doctors. Here is my outline. What am I missing? #AskRenal I wanted to be practical and stick with the realities of AKI management today rather than forward looking technologies that may be impactful in the future.

"The treatment of anuria should be conservative. If circulatory failure is present, appropriate steps should be taken to correct it. Otherwise, therapy is limited to the balanced maintenance of the patient until the kidneys have a chance to affect recovery."

Homer Smith 1951 71 years later and the most significant advance is replacing anuria with acute kidney injury.

He seems nice And Doc Hudson showed up! #eyesondesign