𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇

@NDTsocial selected my RBC cast image for their September issue! 🥳academic.oup.com/ndt/issue/39/9 thank you @hjanders_hans and thank you @jrseltzer 🤩 for teaching me everything I know about #UrineMicroscopy 🔬

8/ That revolving door is the part that feels most demoralizing to me. The patients who suffer, survive, decline, and return because so much of what drives illness sits outside the ICU.

@SteveCurryMD x.com/DavidJuurlink/…

MedTox Fellows: Hypertensive 57 YOF on 100 mg losartan daily (151/96). Switched to Valsartan and BP fell to 134/82. PGx panel below. What may explain the response to valsartan, but not to losartan?

short thread - or a story rather on the use of NAC (N-acetyl cysteine) and how it has lead us astray 1/

@GlassockJ NAC interferes with enzymatic reaction to reduce creatinine - but no effect if you check it with Jaffe It’s all an artifact

Delighted that FIND CKD has meet its primary endpoint. Fantastic news for patients with non-diabetic CKD, including those with GNs, including IgAN Thank you to Bayer, all the investigators, study teams & patients who have made FIND-CKD possible bayer.com/media/en-us/fi…

@intensivaev @msiuba @ThinkingCC I had a very similar case. Trauma activation after syncope. Medics found him hypotensive and no response to IVF. eFAST upon arrival showed big RV. Additional quick scans w/ McConnell’s, low TAPSE, and ESN. Given milrinone neb and VP gtt w/ BP normalization CT scan w/ PE

@khaycock2 that should 100% trigger an M&M, ridiculous

Example: Patient found down on anticoagulant. Activated as trauma. EFAST: plethoric IVC, EF <10%, B pleural effusions & dense B-lines. Hypoxemic while supine. Labs result with serum osm slightly high and lactate 2.1. 500 cc NS given for “dehydration”. This is stupidity.

100% accurate. The problem with crystalloids is that the administration is often a brainstem generated reflex for all kinds of dumb reasons and complications of inappropriate administration are rarely blamed on the fluids because it’s considered largely “safe”.

@nickmmark I'm glad we need a study to tell us that nasal cannula are more comfortable than whole face masks

The SOHO (Standard Oxygen versus High-Flow Oxygen Therapy in Acute Hypoxemic Respiratory Failure) is so bad. They compared HFNC to non-rebreather masks at 12 lpm - hardly “standard oxygen therapy.” They anticipated a 33% reduction in mortality, and by their own admission were wildly underpowered. Yet they did find a marked reduction in intubation + improved patient comfort with HFNC. The classic poorly designed “negative trial” that is actually positive and practice affirming (assuming you use HFNC…)

🚨 Just had an absolute BLAST recording Episode 98 of @icuscenarios on RV failure in the ICU - with sepsis + renal failure making it extra brutal. We break down the real-world chaos: - Why POCUS can fool you - CVP trends - Why vasopressin is my PVR-sparing go-to pressor - Aggressive early diuresis guided by spot urine Na - Why intubating is like walking a tightrope - Avoid the killers that crank up PVR and doom the RV Huge thanks to the host for the deep dive. This stuff saves lives in the trenches every night. Listen now: icuscenarios.com/episode-98-rv-… And grab my new open-access review for the full framework: Acute Right Ventricular Failure in the Medical ICU (Lung 2025) → doi.org/10.1007/s00408… What’s your clutch move when the RV starts failing in mixed shock? Drop it below -> let’s talk shop #RVFailure #CriticalCare #MICU #FOAMed #RightHeart #PulmonaryHypertension #Noctensivist

RBC cast - brightfield and darkfield, unstained - Urine preserved (and stored at room temperature) from 2023 case of IRGN - #UrineMicroscopy #UrinarySediment

@brian_rifkin @JonathanNefro @set_fortess the evidence is them doing this👋👋

@JonathanNefro @set_fortess So this is interesting. No nephrologists on panel. Wondering about the evidence to continue in ESKD? I’m not aware of any new studies in dialysis.

Las nuevas recomendaciones para manejo de dislipidemia en personas con enfermedad renal crónica G3 o más, la guía ACC/AHA 2026: •Estátinas de alta intensidad, ezetimibe y/o iPCSK9 para meta de LDL <55mg/dL •Continua estatinas en hemodiálisis JACC 2026 doi.org/10.1016/j.jacc…

@JonathanNefro @set_fortess Yeah, low evidence and basically they hedge by saying “individualize treatment”, but it is 2B/C-LD so really opinion without evidence

Honored to celebrate @OSUWexMed's @BradRovin who was named the 2026 Donald W. Seldin Award recipient by the @nkf. He is recognized for decades of leadership in clinical nephrology and transformative research in lupus nephritis. #Nephrology #LupusNephritis #KidneyHealth

@jrseltzer sneaky!

Look what's hiding among these dense "muddy brown" granular casts, rendered visible by polarized light: hundreds of calcium oxalate monohydrate crystals ! #UrineMicroscopy #UrinarySediment

Antibiotics probably aren’t beneficial for patients with cirrhosis & GI bleeding It will take time to change practice on this, but this is probably ripe for some antimicrobial stewardship The idea that a few doses of ceftriaxone improve *mortality* in GI bleed was always sus…

@ministeriosalud @ISNkidneycare Does better BP control truly “prevent” CKD? If so what is the evidence and what are the appropriate goal to optimize prevention and minimize adverse effects. ?

@IM_Crit_ #blessed

ICU Rounds: I don’t want to brag about myself but 2 days ago I managed *without giving albumin* a septic patient who was on norepinephrine 0.32 mcg/kg/min & vasopressin 0.04 u/min & had albumin of 1.5 g/dl. Today he is off pressors. Who could imagine? #foamed #foamcc #meded

Today is #WorldKidneyDay 🫘 Kidney diseases affect nearly 37 million people in the United States and 850 million worldwide. Yet kidney health often receives far less attention than other chronic conditions. 1/3