Nithin Karakala

@AhmedArslanMD @VelezNephHepato @HrsHarmony MAP is an extremely factor. But my part of the discussion was volume management

@VelezNephHepato @runningbean26_2 @HrsHarmony Love the idea of using POCUS to initiate and guide treatment instead of blindly volume expanding everyone. However, I think adding systemic blood pressure or MAP to this algorithm would be useful. Some patients may be on pressors and need diuretics at the same time.

Provocative protocol for #HRS management by ⁦@runningbean26_2⁩ #POCUS ⁦@HrsHarmony⁩ #KidneyWk

@swissnephro @VelezNephHepato Glad you share that view.

Loving this! Great starting point to get out of the current mess of volume management in hepatorenal syndrome #HRS #Kidneywk @runningbean26_2 @VelezNephHepato

Large VA study from TN ⁦@VUMCKidney⁩ confirms our previous observation: APOL1 polym is associated with > risk of CoV-AKI ⁦@renalpathdoc⁩ ⁦@Tiff_Caza⁩ ⁦@TJ_Wickman⁩ ⁦@NephroRock⁩ @LuisMatute2016⁩ ⁦@OchsnerNephro⁩ #KidneyWk

@ebtapper @VelezNephHepato @HrsHarmony We look at the IVC changes and also LVOT VTI which is a surrogate for CO

@runningbean26_2 @VelezNephHepato @HrsHarmony But what are you looking for when you do PLR? And how reliable is it? I love the idea on personalizing AKI treatment. But …

@drobeirne @VelezNephHepato @HrsHarmony The goal would be to identify hemodynamics changes even before the clinical examination of tense abd. We saw IVC changes in patients with large as items even in the absence of tense abd. Tense abd could also be cause from SBP.

@ebtapper @VelezNephHepato @HrsHarmony I use POCUS including PLR as my everyday examination tool in cirrhotic patients with AKI

@VelezNephHepato @runningbean26_2 @HrsHarmony Very exciting Questions: Tell me about PLR and #cirrhosis with ascites? The criteria in your protocol is more specific, right? Is there data for this protocol

@ebtapper @VelezNephHepato @HrsHarmony We have collected PLR data in the study I showed but did not use it in decision making. Working on a protocol for a RCT with PLR included.

@NephroGuy @VelezNephHepato @HrsHarmony Thank you

@VelezNephHepato For us it is a tale of 2 hospitals. One hospital lower incidence of AKI, but the other hospital still a very high incidence of AKI. Wondering if incidence of AKI is related to age.

In the era of #COVID19 (really #COVID21), a common diagnosis in the problem list: “dexamethasone-induced azotemia”. While it’s heartbreaking to be back in this tough situation, it’s encouraging to see a lot less AKI-RRT compared to the 1st wave in 2020 #GetVaccinated

@Nephro_Sparks The situation is bad, and the prediction is that it will get worse. The expected peak cases will be at the end of the month. Not sure how the state can handle it. I my now begging my patients to get vaccinated.

The situation is my home state of Arkansas is devastating

@PulmCrit I hope this just a joke, because nothing bad happens at a potassium of 4. Yes humans can’t survive at potassium level of 4 meq/dl which is 40 meq/l and the normal is 3.5 to 5 meq/l

interns, be careful!! this is what happens when the potassium falls below 4.0 mEq/dl: twitter.com/kevinbparry/st…

@DrAliHosin I’m pretty sure that was triggered by a few surgical residents requesting anesthesia in an unprofessional manner. Unfortunately, it’s not an uncommon scenario during medicine-surgery inpatient interactions. Residents probably act under pressure and led by bad example. Fixable.

@VelezNephHepato @UQMedicine @OchsnerNephro @CayetanoHeredia It is always exciting to add new things to your CV. But I am sure it felt great removing one word from your CV.

updating my CV mode #milestone #academics @UQMedicine #GratefulToMyParents #bigdeal #VamosPorMas @OchsnerNephro @CayetanoHeredia

Levophed definitely worked for HRS here. Initially, worsening cr on octreotide, midodrine, and albumin. Baseline MAP 70 pushed to 85-90 with minimal levophed. Patient made 4L in the first 24 hrs and cr improved immediately. Intervened early with great outcome!

@KIDNEYcon great talk on MAP and flow by @criticalbeansmd

@DavidJuurlink I am a physician and I got my vaccine. It is not only going to protect me, but I feel it is my responsibility as a healthcare provider to get the vaccine to protect my loved ones, and patients when heard immunity is achieved.

“Doctors and nurses are declining the vaccine” is exactly the message anti-vaxxers want you to hear. Retweet if you’re a healthcare worker who’s already been vaccinated or is eagerly awaiting vaccination.

That’s it. MRA concept finally succeeds in proteinuric CKD #KidneyWk

#kidneywk @VelezNephHepato on Terlipressin in HRS CONFIRM trial