Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Are there instances when you use a 3% sodium chloride infusion for patients with chronic hyponatremia secondary to SIADH but who are asymptomatic or have only mild symptoms?
One thing about 3% is that properly administered, the Na will rise. I have used it when I just want the PNa to increase ASAP, which for non neurological reasons may be something as simple as allowing the patient to go to the OR (they often have a minimal Na that they will give general anesthesia to)...
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
No. Stopping denosumab leads to rebound bone resorption and loss of all gains. The hypocalcemia indicates insufficient calcium and/or calcitriol. Calcium intake should be 1,000-1,200 mg daily from food and/or supplements in divided doses with food.
How do you counsel patients on peritoneal dialysis regarding the safety of engaging in aerobic and resistance exercises, considering the risk of developing abdominal wall complications?
The effect of exercise on intra-abdominal pressure (IAP) while on PD was examined decades ago by Twardowski et al., PMID 3774076. They found that walking, jogging, or using an exercycle resulted in only modest increases in IAP, while jumping or straining (e.g. weight- lifting) resulted in more marke...
Is there a serum potassium level for when you would recommend discontinuing potassium citrate in a patient with recurrent nephrolithiasis, hypocitraturia, and hyperkalemia?
I take hyperkalemia seriously, as cardiac effects do not correlate closely with serum levels. If evaluation does not reveal a correctable cause, I would decrease potassium citrate dosage to keep serum potassium below 5.0. Stephen B. Erickson, MD
How do you manage polyuria and polydipsia from lithium?
My first step is to confirm that the symptoms, including polydipsia and polyuria, are due to NDI and not other reasons. Other potential causes that should be excluded are: Psychogenic polydipsia other substance-induced, such as caffeine, diuretics primary DM pituitary related CKD Lowering the dose...
Would you avoid a 24 hour urine collection for creatinine clearance measurement in a patient who is on fluid restriction?
I don't think there is a reason to avoid a 24-hour urine collection in this setting. The excretion of creatinine in a 24-hour period is independent of urine flow rate.
What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?
I prefer to give ferumoxytol 510 mg X 2 doses of available.
How often do you recommend basic metabolic panel checks in a hospitalized ESKD patient on thrice weekly hemodialysis and for whom hyperkalemia is not of major concern?
The ease (usually no venipuncture), cost (miniscule relative to the overall cost of hospitalization), blood loss (not much) and utility (varying from little to significant depending on the clinical setting) indicate at least thrice weekly BMPs. A very ill, ICU patient will need a daily BMP while an ...
What is your approach to nephrology referral for patients with lupus nephritis?
The answer to this question "depends" on many factors.I had the luxury of learning under some lupus nephritis greats in the 1990s (John "Jack" Klippel, H Austin, and J Balow... the high-dose NIH CYC regimen guys). Therefore, I am fortunate to feel confident in my abilities to care for LN better than...
What is your approach to treating antibody-mediated rejection in a pregnant patient with a kidney transplant?
This is a very difficult situation. Presumably, this is late AMR, and to begin with, we would have very few treatment options. I would first optimize immunosuppression and consider IVIG and solumedrol, and defer further treatment until after delivery. We have not used rituximab in pregnancy. Rituxim...