Ndulue Chidozie

⁉️What's current CRBSI rate at your center? 🔆A catheter-related bloodstream infection rate< 1 episode/1000 catheter days is feasible & can be achieved without antimicrobial use Doi: 10.1038/nrneph.2011.28 #NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd

Hyper-reactive malarial splenomegaly (HMS) is most severe form of long-term (chronic) malarial infection in ‘SEMI-IMMUNE’ subjects (pauci-symptomatic carriers of MP) Fakunle’s Criteria -Antimalarial Abs titre) ≥1/160 -Massive splenomegaly -IgM level ≥2 SD above the local mean

Miscuffing and poor positioning drive more unnecessary prescriptions than any rare syndrome. Other silent boosters to watch: Full bladder: ~10 mmHg spike. No back support: +5–10 mmHg. Smoking/Caffeine: +5–10 mmHg. If the BP is 150/90 but the ECG and fundoscopy are pristine, recheck the technique before reaching for the Amlodipine.

BP measurement is probably the most commonly performed and most poorly performed examination in medicine. A patient can be wrongly labeled hypertensive just because: • The cuff was too small • The arm wasn’t at heart level • Legs were crossed • The patient talked during recording • BP was checked without adequate rest Incorrect technique can overestimate BP by 5 to 15 mmHg. Before treating the number, make sure the number is real. Doctors, nurses, interns, patients, everyone should know this. Source - ahajournals.org/doi/epub/10.11…

Impact of proteinuria reduction on prognosis in IgA nephropathy - justifies use as a surrogate endpoint in clinical trials From @AKronbichler at @GlomCon

@JonathanNefro @rafavaldeznefro Too bad- systemic arterial hypertension is too often blamed as a cause of CKD- in later stages (stage 4 and 5 ) it can accelerate the loss of nephron- but in earlier stages it is mostly a biomarker of underling nephron deficiency (the Brenner doctrine ).

In Rheumatology, we quietly add another major pathway to kidney failure: • Lupus nephritis • ANCA-associated vasculitis Young patient. “Just joint pain.” A few months later: RPGN, dialysis, ICU. Proteinuria + active urine sediment in autoimmune disease should never be ignored. Early urine testing saves nephrons. #Rheumatology #Lupus #Vasculitis #Nephrology #MedTwitter

La protección que ofrecen los iSGLT2 sobre la litiasis renal, no es por la diuresis osmótica; tampoco por el incremento, momentáneo, de la ingesta de agua; ni por el reordenamiento osmótico. Se explica mejor por ↓ los índices litogénico CKJ 2026 academic.oup.com/ckj/advance-ar…

Always check BP in both arms when seeing a patient for the first time, especially a young hypertensive. A simple habit like this can uncover some very interesting diagnoses before any expensive test does.

Recent studies show that exposure to microRNAs release from damaged kidneys may contribute to heart disease and may be a key tool for tracking kidney disease progression. Read the full article in #ASNKidneyNews: kidney.pub/KN1805-02

@SridattaPawar @witchdrkochi @aditya_gan3500 @DrNikhilMD Yes. It depends on the setup one is working in. That's a crystal I saw in an AKI patient months ago

Drug crystals too ,wow awesome I truly want to work under such setups You must be working in very good set up and the training varies from country to country In my place we dont have microscopy other than light microscopy And as nephrologist i have no access to those microscopy too Yes i do my own AVF screening becuz I have the machine with me It truly depends on the setup u are working at

You started Telmisartan for hypertension. A week later, creatinine doubled. The kidney just gave you a clue about the real diagnosis. 👀

@aditya_gan3500 @SridattaPawar @witchdrkochi @DrNikhilMD I am being realistic and we are discussing a critically ill patient here who couldn't have renal biopsy done quickly. U-sed is faster to do and has a quicker turnaround time than biopsy. They complement, not replace each other

@Ndulue8 @SridattaPawar @witchdrkochi @DrNikhilMD Yeah sure Like the nephrologist has nothing better to do in the OPD Let us be realistic

@aditya_gan3500 @SridattaPawar @witchdrkochi @DrNikhilMD This is typical for me

@aditya_gan3500 @SridattaPawar @witchdrkochi @DrNikhilMD Lol. I don’t wait for reports of casts. I see them myself

@DrNikhilMD @aditya_gan3500 @SridattaPawar @witchdrkochi Wow. Then what are they looking for in the slide

@aditya_gan3500 @SridattaPawar @Ndulue8 @witchdrkochi True Until you specifically ask them to look for cast they never even mention it.

@SridattaPawar @witchdrkochi @aditya_gan3500 @DrNikhilMD and classify it into proliferative GN or non proliferative GN or crescentic GN. It can also identify other intrinsic causes of AKI eg crystals These can guide initiation of therapy before renal biopsy results are out

@SridattaPawar @witchdrkochi @aditya_gan3500 @DrNikhilMD Urine protein 2+ is dipstick urinalysis, not urine sediment analysis. Let’s not conflate the two. Urine sediment analysis does not use the exact classification systems as tissue biopsy but by analyzing the cytology of the urine, one can identify GN and 1/2

@SridattaPawar @witchdrkochi @aditya_gan3500 @DrNikhilMD I routinely see dysmorphic rbcs, cast and drug crystals in critically ill AKI patients. These findings aid diagnosis and help monitor clinical progress

@Ndulue8 @witchdrkochi @aditya_gan3500 @DrNikhilMD In our country the urine routine includes everything But the reports are not very reliable Becuz reporting of casts or even dysmorphic rbcs in pure GNs case is not so common

@witchdrkochi @SridattaPawar @aditya_gan3500 @DrNikhilMD No. U-sed analysis [not dipstick urinalysis] is very specific for GN in critically ill patients

@Ndulue8 @SridattaPawar @aditya_gan3500 @DrNikhilMD Not very specific in critically ill patients

@SridattaPawar @witchdrkochi @aditya_gan3500 @DrNikhilMD and classify GN into proliferative vs non-proliferative phenotypes; which can guide treatment and infer prognosis. There are false positives and negatives with dipstick. Dipstick proteinuria is not specific for GN and cannot classify GN. But u-sed can. 2/2

Urine protein 2+ Whch glomerulonephritis is this? IgAN? Fsgs? C3gn? Irgn? Or crescentic GN? Or it is patchy cortical necrosis Proteinuria alone cannot identify the specific glomerular disease. Yes it may help us but nly to boardly classify My last few months 3 cases of Pregnancy Related AKI Rbcs+ Proteinuria +++ But biopsy acute tubular injury, patchy cortical necrosis Recently right sided pneumonia Aki non resolving Suspecting irgn but turned out to be anca vasculits 36 yrs old Proteinuria 3+ rbcs 10+ htn All blood work up negative Biopsy suspected IgAN, but turned out to be class 4 lupus Urine routine is a part of work up It can be anything underneath