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Joel M. Topf, MD FACP Profile picture
Joel M. Topf, MD FACP
@kidney_boy
Saying the product of the kidneys is urine is like saying the product of a factory is pollution. Urine is a by-product. The product is homeostasis COI: link👇🏼
Laura Clark Profile picture Remus Popa Profile picture Shanil Keshwani Profile picture Ashraf Mohammed Profile picture Nick Gowen Profile picture 25 subscribed
Apr 13 • 4 tweets • 2 min read
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
Sep 17, 2023 • 12 tweets • 5 min read
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
Aug 12, 2023 • 7 tweets • 2 min read
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
Apr 14, 2023 • 9 tweets • 4 min read
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
Apr 14, 2023 • 8 tweets • 4 min read
Pseudohyperkalemia
Serum potassium is higher than plasma potassium. #NKFClinicals ImageImage Sometimes Fist clenching
Sometimes Tourniquet
in the NEJM 1990 Image
Apr 14, 2023 • 12 tweets • 7 min read
Michael Emmett on electrolyte artifacts
Pre-analytical and analytical #NKFClinicals Image 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 Image
Apr 14, 2023 • 14 tweets • 8 min read
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
Apr 13, 2023 • 6 tweets • 2 min read
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. Image 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?
Mar 29, 2023 • 10 tweets • 4 min read
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
Mar 9, 2023 • 4 tweets • 1 min read
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 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.
Dec 15, 2022 • 16 tweets • 4 min read
Next up at the Belgian Society of Nephrology. Ian MacDougall talking iron. Patients with CKD have decreased intake and increased iron loss.
Dec 15, 2022 • 10 tweets • 4 min read
The Belgian Society of Nephrology is about to get to started First up, “When to use steroids in IgAN” by Prof Martin Speeckaert
Aug 11, 2022 • 8 tweets • 3 min read
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).
Aug 10, 2022 • 5 tweets • 1 min read
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:
Jul 23, 2022 • 4 tweets • 1 min read
"Alzheimer’s experts now suspect Lesné’s studies have misdirected Alzheimer’s research for 16 years."

Number of patients x 16 years = incredible suffering "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."
Jul 17, 2022 • 5 tweets • 2 min read
At this concert tonight Landslide
Jul 9, 2022 • 11 tweets • 6 min read
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.
Jul 7, 2022 • 5 tweets • 1 min read
"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.
Jun 19, 2022 • 5 tweets • 4 min read
He seems nice And Doc Hudson showed up! #eyesondesign
Jun 14, 2022 • 10 tweets • 3 min read
I was on call last night and the ER called with a case hyperkalemia. The ER was crazy (literally there was an active shooter in the ambulance bay moments before I received the call clickondetroit.com/news/local/202…)

So you need to be quick and precise with your questions. How high is the potassium and is it confirmed on the EKG? It is always helpful to quickly establish that this is not pseudohyperkalemia. It was not.
May 22, 2022 • 4 tweets • 2 min read
Every person who ever had a high potassium on labs was told to adopt a low potassium diet. Recently, a meta-analysis and systematic review looked into the data to support this. jrnjournal.org/article/S1051-… Regarding the question of dietary restriction of potassium to lower serum K, there were 2 studies. TWO. And take a look at the weight of the two studies, Cockram has 90%. So in essence this meta -nalysis can just be replaced by looking at Cockram alone.