Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
How do you advise an ESKD patient who wants to drink pickle juice to reduce intradialytic muscle cramps?
Salt is addicting! Acknowledge that changing habits is hard. Make a case that the reason for cramps is RATE at WHICH fluid is being removed. Ask the patient to recall the days when the goal of fluid removal was low. During those treatments, the risk and occurrence of cramps were less likely when com...
Would you start patiromer in a patient with CKD who has persistent hyperkalemia despite taking sodium zirconium cyclosilicate and adherence to a low potassium diet?
If the question is in addition to, I would first ensure adherence with SZC and diet (maybe measure 24-hour urine K) and maximize dose. Then, you might consider switching to patiromer rather than adding.
Would you recommend SGLT2 inhibitors for patients with sickle cell nephropathy and severely increased albuminuria despite the potential medication associated risk for vaso-occlusive crises?
No
How do you recommend incorporating B-lines on lung POCUS as part of evaluating a patient's volume status?
Great question! As you allude to in your question, it is important to address this problem holistically in the context of the patient's history, exam, labs, and other imaging. I find that this happens all of the time, and here is how I typically break them down when applying lung ultrasound. 1) 1-2 ...
At what initial sodium level do you recommend strict avoidance of overcorrection (e.g., no more than 6 mEq/L in 24 hours) in patients with hyponatremia?
Less than 120.
What factors do you consider when advising a patient with lupus nephritis on the safety of becoming pregnant?
I agree with Dr. @Dr. First Last's excellent suggestions (with just one exception!). I don't increase prednisone prophylactively for lupus pregnancy - I would only add or increase steroid if there is a flare. The risks of steroid in pregnancy impact both maternal and pregnancy outcomes, so we try to...
What are your criteria for starting tolvaptan in adult patients diagnosed with autosomal dominant polycystic kidney disease?
This question is probably a bit too broad to answer in detail here, but in broad strokes, depending on the age, imaging criteria (Mayo class / total kidney volume), and kidney function of the patient, as well as other clinical factors, you assess the patient's risk of rapid disease progression to ma...
Would you use argatroban or citrate catheter lock in a patient with ESKD and HITT?
I would use 4% citrate. I have no experience using argatroban as a catheter lock solution, but have significant experience using 4% citrate solution. For our inpatients, we only use 4% citrate solution (and have done so for many years). While I believe you can buy prefilled 4% citrate syringes comme...
Do you recommend patients temporarily hold cilostazol prior to and after a kidney biopsy?
Kidney biopsy is considered a high-risk bleeding procedure by SIR (Society of Interventional Radiology).Cilostazol is a PDE inhibitor leading to the inhibition of platelet aggregation. The Drug has a half-life of 10 hours. In the past, it was recommended to stop the drug at least 24 hours before a p...
Would you recommend immediately exchanging a peritoneal dialysis catheter, or waiting until the completion of antibiotics with transition to HD, if a PD patient presents with peritonitis and a nonfunctional PD catheter?
Optimally, peritonitis should be completely resolved before placing a new (and hence sterile) foreign body into the peritoneum. That said, all attempts to restore PD catheter function without invasive measures (non-surgical) should be attempted first. If the PD catheter can be restored with minimall...