Mohan Rathi

What's your diagnosis: 40/f consult for polyuria, adm for pancreatitis sp lap chole, on TPN, Saline 125/hr Output 6.4 litres Sodium 132, bun 10, serum Osm 310 TG 1006, glucose 250 Urine studies attached

@JohnRMontford It's a policy in most units here. Burden, sure. I couldn't find direct data. We know incidence of hyperkalemia is 2.0 to 2.4 times after long interdialytic interval. Dialysis units don't ve tele...for discuss, what would be YOUR threshold of missed treatments for sending to ER?

Does your dialysis unit have a policy that if patient misses [X] number of treatments, they cannot dialyze in-center and must go to ED for evaluation? If so do you think it’s a good idea or not? #AskRenal

Update: Biopsied. 80 glomeruli, beautiful smaple. Hypertensive nephropathy. 30% glo-sclerosis,20%IFTA. No necrosis. Surprisingly no AIN or ANCA vasculitis or interstitial nephritis

Part2: Workup p-anca 1:40 Mpo 53 (strongly positive) UA 10-20 wbc, no rbc 24 hr urine protein 92 mg Gfr stable... Abs eos down 323 1. Can you see high MPO in ac interstitial nephritis 2. Would you biopsy / approach

#askrenal #nephropath #anca #mpa Part 1: 87 yo female with no recent med changes but prolonged PPI usage. Wors ring gfr last few months. Progressive eosinophilia from 6% to 9% (aec 202 to 470) , gfr 31. No precious UA from pcp.... PPI changed to h2 on first consult

@simonjsmiths Would add ENaC inhibitor

@doc_kidney Thanks for the advice. On max MRA, suggest switch to ENaC inhibitor? Pre stent values in SI units: aldo 860pmol/L, renin 480mIU/L, ratio 2 - consistent with hyperreninism

30yo male, renal artery stenosis, stented with initial improvement in BP but recurrence of HTN. eGFR >90. Patent stents on repeat imaging. Maxed out ACE, BB, thiazide, alpha blocker. Did not tolerate CCB. Next option for BP management? Methyldopa? #askrenal

Part 2 Given selectivity of proteinuria, wonder if the treatment approach should be any different than Ace/arb+SGLT2+Karendia ?

#askrenal #nephrocase Part 1 48/M with Diabetes w/ retinopathy. Cr 1.8. proteinuria 2.5 gram per gram. UA no micro hematuria. Albumin 4. LDL 78 (on statin at consult) UPEP 89% albumin. Repeat UPEP 86% albumin. Kidney bx Nodular diabetic Glomerulosclerosis. Thicked BM as expected

@Momen_Abbasi Useful aid ! A picture is worth a million words..!

VA That explains to patients why its important to check PD Adequacy ! #Nephrology #NephTwitter #MedTwitter

@arkanalabs Atheroembolic disease

In a patient with progressively rising serum creatinine and a history of CABG 2 months prior, what is your diagnosis? #NephTwitter #kidneypath

@GlassockJ Amlodipine Gabapentin Metoprolol tartarate Famotidine (dropped pantoprazole)

@doc_kidney Please give full list of all medications taken by the patient. Then decide on kidney biopsy.

@bottomleymatt No extra renal manifestations..Tiredness and fatigue (multifactorial). Noted some cases of anca presenting interstitial nephritis in literature.... No microhematuria seems unusual if active lesions... No asthma /respiratory history

@doc_kidney Unless extra renal vasculitic manifestations, in which case you already have the diagnosis.

@MeloneyOliveira @TWhittier_RUSH @Rush_Nephrology @RushDOIM Was this patient kept NPO between labs 1 day ago and subsequent 6 am? Starvation ketosis ? Especially if non-oliguric that can give the associated gap and non gap acidosis. Hypoglycemia also concerning for same.urinalysis with ketones? Will check Beta hydroxy butyrate

How can this drop in bicarbonate be possible so quickly?! 🤔🤔 Lactic acid is normal. VBG 7.24/29/12.1. No obvious additives to his inpatient meds. Admitted for treatment of Rt toe OM. Hx of unknown abdo surgery 20 yrs ago. @TWhittier_RUSH @Rush_Nephrology @RushDOIM #askrenal

@NephroGuy @GlassockJ @askrenal Correct No large efficacy trials of spironolatone in dkd for hard renal outcomes. Finerinone has composite renal outcome data.

#askrenal #hyperaldosteronism #diabeticnephropathy #angiotensin Would ace inhibitors/arb be still as efficacious for diabetic nephropathy in a patient with concomicant primary hyperaldosteronism given that renin/ angiotensin pathway is significantly suppressed anyway ?

@RenalFellowNtwk Quite a common scenario unfortunately in a lot of hospitals. When nephrologists are consulted, we can be effective gatekeepers. Establishing PICC team protocols with a reflex nephrology communication for any PICC in eGFR<45 can be helpful...

Why be PICC-Y about Central Lines in Patients with CKD? - renalfellow.org/2022/08/26/why…

@ISNeducation @tulunsokit @myadla Minimal change

2/n #ECneph @tulunsokit @myadla Lets check the Biopsy findings and the treatment details 1st biopsy in sept, 2019 What do you think is the diagnosis ?

@ISNeducation @tulunsokit @myadla MPGN

12/n #ECneph @tulunsokit @myadla Kidney biopsy impression Whats the DD at this point ? Is it FSGS /MPGN ? What the renal HPE diagnosis ?