Sourabh Sharma MD DNB FASN FISN
@iamnephrologist
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A/Prof Nephrology @SJHDELHI l #ISNeducation #ERA ISN🇮🇳 SoMe I D/Chair Dialysis WG ISN l UTI WG ISAC | A/Editor @IndiaSoTx Newsletter | SoMe Editor NDT | SARB
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🔥How does Hypomagnesemia cause refractory Hypokalemia⁉️
⬇️Intracellular Mg👉🚫 Mg mediated inhibition of ROMK ch👉 ⬆️K secretion
💥Mg def alone not necessarily cause hypoK‼️
💥⬆️Distal Na delivery/⬆️Aldo required‼️
Pic-JASN
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
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368
🔥One of the best examples of employment of Renal Functional Reserve is Glomerular Hyperfiltration in Diabetes
⚜️Renal functional reserve is defined as renal capacity to⬆️its function in states of demand or disease
Ref-JASN
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
0
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♨️Don’t be in hurry to diagnose LN when you see a Full-House
🔥Full-house IF(IgG/M/A/C3/C1q) can be found with varying intensity in:
🔆IgAN
🔆C1q nephropathy
🔆PIGN
🔆1º MN
🔆Fibrillar GN
🔆AAV
🔆Cryoglobulinemic GN
🔆1º MPGN
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
5
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💥Hey
#NephTwitter
, want to start
#Finerenone
in your patient?
💡Keep in mind the “Rule of 5” by
@AgarwalRajivMD
1️⃣Start at K<5
2️⃣Stop at K>5.5
3️⃣GFR>25
4️⃣convince your pt it ⬇️CKD risk by 5th
5️⃣convince it ⬇️CV risk by 5th
#MedEd
#MedTwitter
#NephPearls
#FOAMed
#NephTwitter
2
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129
💥Which Bicarbonate preparation have you used in practice?
🧪Shohl's solution
🏷️140gm citrate + 90gm Na citrate
🏷️1ml~1mEq/L HCO3
🧪K citrate
🏷️1ml~2mEq/L HCO3/K
💊Tab NaHCO3
🏷️325mg~4mEq/mmol HCO3
💉Inj NaHCO3 (7.5% w/v)
🏷️0.892 mEq/ml
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
8
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🌸Hyponatremia Treatment
👉For those who think 3%NS and Tolvaptan is only treatment for Hyponatremia
⚠️Hyponatremia is not deficiency of sodium‼️
👉Treat the cause
doi:10.1038/nrendo.2010.229
#NephroNotes
#NephPearls
#FOAMed
#MedEd
#MedTwitter
3
38
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💥Why we do CD19 Assay (not CD20) after Rituximab (anti-CD20)⁉️
🔥RTX🚫CD20 binding site👉Ab used in flow cytometry can't recognize CD20 molecule on B cell
🔥Concomitant use of CD19 marker provide better info on extent of B cell depletion
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
2
34
95
🔆Gadolinium & risk of Nephrogenic Systemic Fibrosis
🙋Which GBCA group has lowest NSF risk⁉️
🙋♂️Which GBCA has hepatic excretion⁉️
🙋♀️Is GBCA viscosity related to osmolarity⁉️
💥Expand table to know👇
10.21037/qims.2019.07.11
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
27
84
🔥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
6
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🔥Executive summary 2020 KDIGO Diabetes Management in CKD Guideline
☄ACEI/ARB must
☄Quit Tobacco‼️
☄Individualize HbA1c
☄Protein 0.8gm/Kg‼️
☄1st line: Metformin & SGLT2i (GFR>30)‼️
☄GLP1 RA if unable to use Met/SGLT2i
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
@goKDIGO
0
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♨️Don’t label each case of bilateral multicytic enlarged kidneys as ADPKD❗️
🔥Here are differentials in order of incidence
1️⃣ADPKD
2️⃣TSC2- PKD1 deletion syndrome
3️⃣VHL
4️⃣OFD1
5️⃣HNF1B
6️⃣Advanced ACKD
#NephroNotes
#NephPearls
#FOAMed
#MedEd
#MedTwitter
#medicine
1
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🔆Decision Algorithm for prescribing
#SGLT2i
#GLP1RA
in
#DKD
Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
2
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74
🌸High Anion Gap Metabolic Acidosis
💡GOLDMARK
doi: 10.1053/ j.ajkd.2021.02.341
#NephroNotes
#NephPearls
#FOAMed
#MedTwitter
#MedEd
1
27
73
💥There is more to
#Finerenone
& Figure of Five‼️
🔥Finerenone Pentad
🔆Selection Pentad
👉Five points of inclusion
👉Five points of exclusion
👉Five points regardless
🔆Monitoring Pentad
🔆Outcome Pentad
#NephPearls
#FOAMed
#MedEd
#MedTwitter
#diabetes
#kidney
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💥CMV: Once infected, always infected‼️
♨️sharing CMV
#CheatSheet
🔆1956- 1st isolated (salivary gland)
🔆1965- 1st isolated KTR
⚜️Weller-Term "CMV"
⚜️Principle reservoir- CD13+ WBC
⚜️Immediate Early Ag- Most immunomodulatory
Unroll..
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
3
27
70
🏵Cyst Infection in ADPKD: How do you approach❓ (1/n)
👉Will discuss what I've learnt practically and theoretically
Yes, there's a diagnostic criteria for this too (Suwabe's criteria; CEN,2012)‼
Unroll...
#NephTwitter
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
1
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🔥Approach to polyuria
🔆1st step: Urine osmolality
☄Water diuresis👉 Water deprivation test
☄Solute diuresis👉Measure Glucose/ Urea/ ⁉️other exogenous solute
Pic-CJGIM
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
2
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📛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
8
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💥Hey
#NephTwitter
♨️Do you know about most common Monogenic HTN⁉️
1/n
🌼Liddle Syndrome
🍁Monogenic HTN
⚜️Dr Grant Liddle(1963)
⚜️Pseudohyperaldosteronism
⚜️AD
⚜️GOF mutation🧬encoding ENaC
β/Y subunit
👉🚫bind Nedd4(ENaC removal protein)
#Nephpearls
#MedEd
#FOAMed
#MedTwitter
3
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67
🌸Dose adjustment of Heparins & DOAC in CKD
DOI:10.1002/clc.23196
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
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💥To all
#NephTwitter
Residents
♨️Uremic Hiccups frequently encountered in practice
Here’s🧵
👉can be Intractable
⚠️Nephrologists nightmare
👉Vagal/Phrenic N stimulation
Q. Persistent hiccups in CKD: Which of following is not usual cause?
#NephPearls
#FOAMed
#MedEd
#MedTwitter
🎯Hyperkalemia
174
🎯Hypocalcemia
109
🎯Hyperglycaemia
184
🎯Smoking
155
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♨️
#NephTwitter
Residents
Suggesting again
“7 point differential assessment” for
💥AKI in Pregnancy (1/6)
1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension
Unroll...
#NephroNotes
#FOAMed
#MedTwitter
#MedEd
#NephPearls
2
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💥Chronic Tubulointerstitial Nephropathy of Agricultural Communities
🔥Risk Factors
🔥Etiological Triad
🔥Pathogenesis
🔗 …
#NephPearls
#FOAMed
#MedEd
#MedTwitter
0
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🔥
#NephTwitter
Residents
♨️Ten syndromes in nephrology
☑️Acute/RPRF
☑️Acute nephritis
☑️CKD
☑️Nephrotic syn
☑️Asymp urinary abnormality
☑️UTI/Pyelonephritis
☑️Renal tubular defects
☑️HTN
☑️Nephrolithiasis
☑️Urinary tract obstruction
#NephroNites
#NephPearls
#FOAMed
#MedEd
2
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59
💥If you see mesangial IgA deposits, Don’t be in hurry to label IgAN
🔥History is important
🔥D/D:
🔝IgAN
☄️HSP
☄️Lupus nephritis
☄️Alcoholic Liver Diz
☄️Schistosomal Nephropathy
☄️IgA monoclonal gammopathy
☄️IgA dominant PIGN (S aureus)
#NephPearls
#FOAMed
#MedEd
#MedTwitter
0
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Sad NEWS
Dr Burton D Rose (Inventor of UpToDate) passed away‼
▪️He launched UpToDate in 1992 along with Dr Joseph Rush out of his home
▪️They started with Nephrology and had since added >20 other specialties
RIP🙏
5
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📛Full-house pattern IF (IgG, IgM, IgA, C3 & C1q) of LN can be found with varying intensity in:
🔺️IgA nephropathy
🔺️C1q nephropathy
🔺️PIGN
🔺️Primary MN
🔺️Fibrillar GN
🔺️AAV
🔺️Cryoglobulinemic GN
🔺️Primary MPGN
#NephroNotes
#Nephpearls
#FOAMed
6
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🌸SIADH: Both overdiagnosed & missed
💡Causes we don't think of:
⚠️SSRI, Ciprofloxacin, NSAIDs, PPI
⚠️Nausea, pain & stress
⚠️TB, Malaria, Asthma
Doi:10.2147/TCRM.S206066
10.3389/fnins.2019.01170
10.4103/2230-8210.84870
#NephroNotes
#NephPearls
#FOAMed
#MedEd
#MedTwitter
1
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⚡️Animal models in Nephrology ⚡️
@aakashshingada
@agrawalkris
@krishnadoctor1
@shubharthikar
1. 💢Diabetic Nephropathy
👉Type1: Streptozocin model(STZ); OVE6 Model🐭
👉Type2: Db/Db model; BTBR Ob Ob model 🐭
👉Podocytes injury: ZDF-Fa/Fa model; Goto Kakizaki rat 🐭
3
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54
💥Honoured to be part of South Asia Regional Board,
@ISNkidneycare
🙏Thank you
@Narayansgpgims
sir and Prof Muhammad Rafiqul Alam
9
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🚨Beware
#Medicine
Residents
⬆️ Creatinine is not always renal dysfunction ‼
🔥False ⬆️ Serum Creatinine
🔆Ketotic state/ Hyperglycemia(Jaffe method)
🔆Cephalosporins(Jaffe method)
🔆Flucytosine(enzymatic method)
🔆Cimetidine/ Trimethoprim (block secretion)
🔆Vigorous
1
15
52
🔥Vascular Calcification in CKD
🔆Review Article by Dr Himanshu Verma
@dm_himanshu
, HOD Nephrology
@SJHDELHI
#NephPearls
#NephroNotes
#FOAMed
#MedEd
#MedTwitter
4
13
52
🔆ADPKD: Let's revise Key interventional trials
☄TEMPO
☄REPRISE
☄ALADIN
☄DIPAK
☄LIPS
☄TAME
☄HALT-PKD
☄PREVENT-ADPKD
Ref-CKJ
doi:10.1093/ckj/sfy103
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
23
51
💥What things do you rule out in Sterile pyuria⁉️
🔥Few interesting
#NephPearls
🔆Appendicitis(close to ureter/UB)‼️
🔆Pelvic irradiation
🔆Treated UTI (~2wk)
🔆Olsalazine/Nitrofurantoin‼️
🔆AIN
🔆Renal vein thrombosis‼️
🔆Papillary necrosis
Pic-NEJM
#FOAMed
#MedTwitter
#MedEd
0
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52
🌸Amphotericin B
🔥Have you wondered what does "B" stand for in Amphotericin B⁉️
💡1955: Extracted from Streptomyces nodosus
👉From soil at Orinoco River region,🇻🇪
💡2 substances isolated- A & B
👉B: Better antifungal
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
1
23
51
🔆Magnesemia and Hypertension
♨️Mg is natural CCB‼️
🌟Hypomagnesemia associated with Hypertension
🌟Mg supplementation improves HTN
🌟Mg improves effectiveness of all antiHTN‼️
🌟Ionic hypothesis of Resnick
Ref- JHypertension, IJH
#NephroNotes
#NephPearls
#FOAMed
#MedTwitter
1
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50
1. 💢Cardiorenal syndrome ❤️
🎖Ronco classification is most commonly utilized
💫ADHERE Registry: Out of 100,000 Acute HF patients only 9% had normal renal function
#NephroNotes
@NephJC
@ASNKidney
@ISNeducation
2
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49
💥Have you ever diagnosed High Altitude Renal Syndrome⁉️
☄️Hyperuricemia
☄️HTN
☄️Glomerular hyperfiltration
☄️⬇️RPF ⬆️FF
☄️GFR preserved
🔥Core adaptation: Systemic fluid balance & renal regulation
🔥Hypoxic diuretic response
Ref-ndt,JASN
#NephPearls
#FOAMed
#MedTwitter
#MedEd
0
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48
💥You look for Parvovirus B19 in case of unresponsive anaemia in post transplant case
⚜️Do you know it’s Pathognomic feature in BM Biopsy⁉️
"Giant Pronormoblasts" with
prominent cytoplasmic vacuoles & intranuclear inclusions
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
1
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48
💥Celebrated birthday today distributing meals to poor and underprivileged attendants of patients of
@SJHDELHI
and
@aiims_newdelhi
🙏
7
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☄Rituximab & Plasma Exchange
Beware‼️
⚡Rituximab removed by PLEx
⚡At least 48 hrs should elapse between RTX & next PLEx‼️
⚡At least 50% of RTX dose to be administered after completion of PLEx course‼️
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
1
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47
💢Kimmelstiel had coined term Diabetic Nephropathy in 1936 and had specifically defined it as-
👉Clinical syndrome of
1️⃣Arterial HTN +
2️⃣Overt proteinuria +
3️⃣Worsening kidney function
⁉️Could there be Diabetic Nephropathy without Hypertension
Pic-AdvCKD
#MedEd
#NephroNotes
1
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45
♨️Don’t ignore Chloride in critically ill
💥regulates TG feedback, BP, transcellular shifts, Gastric acidity & acid-base equilibrium
💥Hyperchloremia, independent of iv fluids a/w higher AKI incidence‼
Ref-Int Care Med Exp
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
#MedEd
1
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45
🔥How does Hypomagnesemia cause refractory Hypokalemia⁉️
⬇️Intracellular Mg👉🚫 Mg mediated inhibition of ROMK ch👉 ⬆️ K secretion
👉Mg def alone doesn't necessarily cause hypoK‼️
👉⬆️Distal Na delivery/⬆️ Aldo required‼️
Pic-JASN
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
1
27
45
🌸Possible causes of Hemolysis in Hemodialysis
doi: 10.1053/j.ajkd.2020.11.024
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
0
23
45
🔆Constipation in CKD
🔥Under-recognized (perceived benign‼️)
🔥CKD👉Gut help Uremic toxin disposal & acid-base/mineral homeostasis
🔥Altered gut microbiota👉Independently a/w adverse outcomes (ESKD, CV)‼️
🔥Newer drugs✔
Ref:KI Reports
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
1
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45
🌸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
2
23
45
🌸Diuretics in Hypertension
🔥Sites of Action in Nephron
🔥Pharmacokinetic Characteristics of Thiazides
🔥Physiological Effects after Initiation & Cessation of Diuretics
🔥Common Clinical Problems with Thiazides
Ref-NEJM
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
15
44
💢Interesting facts about diuretics‼️
⚡️Max Na loss- Loop Diuretics
⚡️Max K loss- Acetazolamide
⚡️Max UA loss- Acetazolamide
⚡️Max Chloride loss - Ethacrynic acid
⚡️Diuretic causing Fluoride reabsorption- Acetazolamide
@NephJC
@RenalFellowNtwk
4
23
42
🌸Denovo DSA
👉13-30% in previously non- sensitized pts
⚡Class II DSA; Mainly DQ
⚡Chronic/ Subclinical AbMR
⚡IgG2 & G4
⚡Weak/ No complement binding
⚡C4d negative
⚡Less responsive to treatment
⚡Late graft loss
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
15
43
💥How much Protein do you recommend to your HD/PD patients⁉️
♨️Nutritional recommendations in CKD
👉You can skip K restriction in PD‼️
👉🏻Ph- depend on protein intake
👉🏾Vit E supplementation: What’s your take?
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
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42
🌸CKD: Bone metabolism target levels: Comparative view
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
3
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42
🌸While managing Hyponatremia, Remember this list
🔆NSAIDs
🔆Acetaminophen‼️
🔆Cyclophosphamide
🔆Amitriptyline
🔆Haloperidol
🔆Oxytocin
🔆Carbamazepine
doi:10.1038/nrneph.2012.246
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
0
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☄Lupus Nephritis: Natural History
🔆Beautiful chart depicting course of illness from SLE diagnosis to ESRD due to LN
Ref- Lupus 0(0)
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
0
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🌟Lithium associated DI
⚡️AVP Resistant‼️
🔆Polyuria= 50% impaired concentrating ability + 20% nDI‼️
🔆rarely Hypercalcemia‼️
🔆dRTA
⚡️May persist despite cessation
💠Use Amiloride
💠Avoid Thiazide‼️(Risk of acute Li intoxication)
#NephroNotes
#NephPearls
#FOAMed
#MedTwitter
0
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40
🌸Let's revise mechanism of action of Urate lowering drugs
Doi: 10.1038/s41572-019-0115-y
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
#MedTwitter
0
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💥Linear IgG staining on Direct Immunofluoroscence
⚠️Not always AntiGBM disease
🚫AntiGBM ab⁉️Look for👉
⚜️Post-Tx Alport
⚜️DKD
⚜️Elderly HTN Nephropathy
⚜️SLE
⚜️Fibrillary GN
⚜️Autopsy
⚜️Post-perfusion(cadaveric)
#Nephpearls
#NephroNotes
#FOAMed
#MedEd
#MedTwitter
0
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🌸Loop Diuretics: Furosemide
🛑Threshold dose
👉10mg in normal renal function
👉80-160mg in kidney failure
🛑Ceiling dose (Max FENa)
👉80-200mg in CKD/NS
👉40-80mg in CHF/Cirrhosis
🛑t1/2: 1-1.5hrs
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
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41
💥Have you heard of “Poor man's PTH”⁉️
🔥It’s ALP
👉gives an idea of PTH (⬇️expense)
🔥t-ALP: Highest concentration- Bone/Liver
⚠️Also Intestine/Placenta/Kidney/Leucocyte
⚠️Child: Normal-high
🔥b-ALP bone specific
Ref-Arch Pharm,IJCB
#NephPearls
#FOAMed
#MedTwitter
#MedEd
1
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40
🌸Resistant Hypertension
⚡ABPM is must
⚡ABPM classifies it further
👉White coat RH (40%‼)
👉True RH
👉Sustained controlled RH
👉Masked RH
⚡Add MRA
⚡Role of Non-steroidal MRA emerging (Finerenone)
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
Ref-HTN Reasearch 2013
1
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🔆Urine Chemistries 1/2
💡More productive than serum chemistries‼️
Pics-CJASN
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
1
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♨️Conversions in Nephrology
🔹Cr 1mg/dl👉 88.42 μmol/L
🔸Ca 4 mg/dl👉 1mmol/L
🔹Mg 1 mg/dl👉 0.41 mmol/L
🔸Urea 1mg/dl👉 0.357 mmol/L
🔹HCO3 1 mEq/L👉1mmol/L
🔸PO4 3.1 mg/dl👉 1 mmol/L
▪️Urea= 2.14 x BUN
@RenalFellowNtwk
@NephJC
@Renaltubules
@shubharthikar
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1. 💢ABO incompatible Renal Transplantation: Glycosorb & Adsopak columns
4
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🌸First patient to survive AKI by Hemodialysis
✴Sofia Schafstadt
♨️September 1945
🔥Irony- She was Dutch Nazi sympathiser in detention awaiting trial‼️
🔥Sepsis associated AKI
Doi:10.1111/j.1755-6686.2005.tb00396.x
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
1
19
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🌸Nuances in Nephrology- Immune checkpoint inhibitors nephrotoxicity in native kidney
By
@HerrmannMd
@ISNeducation
@isnkidneycare
#ISNwebinar
#ThisIsISN
1
15
40
🌸C3 Glomerulopathy
✴Pathogenesis
✴Treatment Algorithm
✴Management strategies
Ref- Adv Chronic Kidney Dis. 2020;27(2):104-110
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
2
16
40
🔥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
Hyperkalemia
53
Hypocalcemia
13
📛Uremia
5
💊Drug induced
10
3
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40
💥A question frequently asked in Nephrology DM/DNB exam viva voce
⚜️FENa is used to differentiate types of Acute Kidney Injury
🔥However, it's not practical in cases with metabolic alkalosis & Diuretics‼️
👉AKI with metabolic alkalosis:
🔰Fractional excretion of Chloride
0
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♨️Malignant FSGS
(1/n)
💢FSGS with fast ⬇️ renal function
🚩First described by CB Browne in 1978
📝Original description
👉 11 FSGS Pts
👉Renal failure in 30m
👉Young, severely nephrotic, HTN
👉Microscopic hematuria+
👉Extremely hyperchl
#NephroNotes
#NephPearls
#FOAMed
#MedEd
1
10
38
💮Why no edema in Primary Hyperaldosteronism❓
⚡"Aldosterone Escape"‼
👉Within few days of Na/H2O retention, once Wt>3Kg, Spontaneous diuresis occurs due to-
🔺️⬆️ANP
🔺️Pressure Natriuresis
🔺️⬇️Thiazide sensitive NCCT in DTs
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
1
14
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🔥Dialyzability of antihypertensives
Pic-Absolute Nephrology
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
@ISHBP
@alta_schutte
1
24
36
🌸AKI in Multiple Myeloma
✴Mechanisms of FLC induced AKI
✴Screening algorithm
✴Diagnostic approach
✴Renal injuries induced by FLC
#NephroNotes
#FOAMed
#MedTwitter
#MedEd
Ref-NatureReviews
doi:10.1038/nrneph.2011.168
0
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🔥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
1
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37
⚡How do ACE inhibitors cause anemia❓❓
1. ⬇️Circulating IGF-1👉Restrict erythropoiesis
2. ⬆️Plasma AcSPKD (N-Acetyl Seryl Aspartyl Lysoproline-‼🙂)
Which prevent recruitment of pluripotent erythropoietin stem cells
#NephroNotes
#Nephpearls
@askrenal
@NephJC
@RenalFellowNtwk
2
20
37
🏵Xanthogranulomatous Pyelonephritis
⚡Described by Schlagenhaufer (1916)
⚡~1%PN cases
⚡Chronic infective PN
⚡DM/Obstruction(renal calculi+ HDN)
⚡Middle aged♀/Elderly
⚡Unilateral
⚡Pseudotumor/Inflammatory tumor
Unroll
Pic-NEJM
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
2
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💥Latest
@NDTsocial
💠Hyperkalemia treatment standard
By Prof Biff F Palmer
🔥Go through the article and develop new concepts in management of Acute and Chronic Hyperkalemia
🔗
Video 🔗👇
1
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🌸Secondary Hypertension
#Nephpearls
💥Never miss OSA
💥Analyze urine
💥Hyperuricemia~ Endothelial damage (Given no diuretics)
💥muscle aches are significant ‼
💥Yes, Thyroid profile for HTN work-up
💥Labile HTN👉Pheochromocytoma
Pic-JHyperten
#NephroNotes
#FOAMed
#MedTwitter
1
17
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🔥Dysuria in adults
⚠️Don't always try to prove it UTI
👉Detailed History & physical examination
🔆Gynecological examination missed
👉Missed uterine prolapse‼️
🔆Interstitial cystitis
🔆Bladder irritant
🔆Overactive bladder
Tables-AAFP
#NephroNotes
#Nephpearls
#FOAMed
#MedEd
1
17
37
🌸TMA Mimickers
⚠️Diagnostic dillema
💡Cryoglobulin
💡MIg-Renal dis
💡Crystalglobulin
💡AAV
💡Histiocytic Glomerulopathy
💡Cryofibrinogen Glomerulopathy
💡Lipoprotein Glomerulopathy
💡LCAT Def
Ref-ndt
doi: 10.1093/ndt/gfaa230
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
0
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1
15
36
0
22
36
♨️
#MedTwitter
Here’s checklist for fresh Young Hypertensive
⚠️Young chap suffers if you miss:
💥Signs of secondary HTN
💥Target organ damage
💥Out of office BP
💥Urine/Biochem
💥DASH diet
⚠️DON'T CHASE BP
🏃🏃♀️CHASE THE CAUSE
doi:10.1038/nrdp.2018.14
#Nephpearls
#FOAMed
#MedEd
0
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📛Intradialytic Hypertension
⚡Optimal BP control in HD is via volume control & not by antiHTN medication (DRIP)
⚡Drugs removed during HD
🔺️ACEI (except Quinapril)
🔺️Beta blocker (except Propanolol & Carvedilol)
🔺️Minoxidil
#NephroNotes
#Nephpearls
#FOAMed
3
16
34
🔥Newer antiHTN under investigation:
🔆Ocedurenone- Non-steroidal MRA
🔆Baxdrostat- Aldosterone synthase inhibitor
🔆Aprocitentan- Dual endothelin receptor antagonist
⁉️What are future opportunities in HTN pharmacology👇
🔗
@NDTsocial
@hjanders_hans
0
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🌸Iron status in CKD: Recommended range
♦️S Ferritin: 100-500 mcg/L
♦️TSAT: 20-40%
♦️Hypochromic RBCs <10%
♦️Reticulocyte Hb content >29pg/Cell
♦️S Tranferrin Receptor: Not established
♦️Erythrocyte Zn Protoporphyrin: Not established
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
1
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🌸Do you look often Chloride levels in your critically ill patient❓
💥Its important
💥Hyperchloremia, independent of iv fluids associated with higher AKI incidence‼
Ref-Pfortmueller et al. Intensive Care Medicine Experimental
#Nephpearls
#NephroNotes
#FOAMed
#MedTwitter
1
13
33
🔥Permissive Hypercreatinemia
⚡Concept in HFpEF
⚡30%⬇️ in eGFR with SGLT2i/ ACEI/ARB/Diuretic permissible (Altered periglomerular hemodynamics)👉Well tolerated👉🚫change therapy‼️
⚡But rule out any obvious cause of AKI
⁉️How to balance RAASi🖇️AKI/K
👇Don’t miss this ERA JC
🚨Register now for our next Journal Club!
📅Thursday 29 June
⏰5 to 6 PM CEST
🧑🤝🧑Join the experts to discuss:
🆓registration:
0
10
15
0
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💥
@VinBhargava
@drmanishasahay
@priti899
and Team did tremendous job in writing A Textbook of Kidney Transplantation in Indian Context
🔥Launch of textbook
@DrAKBhalla3
@vjha126
@genppvarma
#ISNCON22
@isncon22
1
7
35
Our abstract accepted at
#ISNWCN21
Will be delighted to showcase results
👉Treating HCV in CKD in resource limited settings
👉Developing countries
@ISNeducation
@ISNWCN
@ISNkidneycare
@FerArceAmare
@arvindcanchi
@shubharthikar
4
11
35
🔥ISN-KDIGO Webinar Series on Complement in GN: Role of Complement Beyond GN
💥Complement and Transplantation
@LVRiella
@ISNkidneycare
.
#ISNwebinar
#ThisIsISN
1
12
35
🌸Next week onwards, I will be tweeting
#Onconephrology
pearls for few weeks
☀️Will try to cover important points for Nephrology fellows
🌟Follow
#OncoNephNotes
#NephroNotes
#NephPearls
#FOAMed
#MedEd
#MedTwitter
@kdjhaveri
@NephroGuy
1
6
34
🌸Mechanisms of UTI
✴Pathogenesis
✴Virulence factors of uropathogens
✴Virulence factors: E coli
✴Pathogenesis of CAUTI
doi:10.1038/nrmicro3432
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
#MedEd
2
16
35
♨️The three forms of ISN World
Congress of Nephrology- Live, Virtual and Hybrid: Impact of transition on attendance and social media coverage
🔆KI Reports
🙏ISN Education Team
#ISNWCN
#WCN22
#WCN21
#WCN19
#NephTwitter
#MedTwitter
#FOAMed
#MedEd
3
9
34
🔥Primary FSGS: Diagnostic Algorithm to Novel Biomarkers
Ref-CKJ
@ERAEDTA
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
0
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💥Do you wonder why no edema in Primary Hyperaldosteronism⁉️
⚜️"Aldosterone Escape"‼
❇️Within few days of Na/H2O retention, once Wt>3Kg, Spontaneous diuresis occurs by-
🔰⬆️ANP
🔰Pressure Natriuresis
🔰⬇️Thiazide sensitive NCCT in DT
#Nephpearls
#MedEd
#FOAMed
#MedTwitter
0
12
33
💥Thanks to all respected seniors and colleagues, for electing as Executive Council Member of Indian Society of Organ Transplantation
🙏
@IndiaSoTx
9
1
34
🔥LONG-TERM RENAL BENEFIT
OVER 2 YEARS WITH NEFECON VERIFIED: THE NEFIGARD PHASE III FULL TRIAL RESULTS
By Prof Richard Lafayette
#ERA23
1
5
33
🌸Sterile pyuria: Few interesting points
🌀Appendicitis is a cause‼(appendix close to ureter/UB)
🌀Pelvic irradiation
🌀Treated UTI may be cause upto 2wk
🌀Olsalazine and Nitrofurantoin may be a cause‼
🌀AIN-Never ignore‼
Pic-NEJM
#NephroNotes
#Nephpearls
#FOAMed
#MedTwitter
1
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