Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?
Probably NS but if the Na crept up at all, would change to 1/2 NS. I dont see a need here for balanced solutions, but wouldn't argue against them.
What is your treatment approach for pregnant patients with IgA nephropathy who have worsening proteinuria during the first trimester?
Difficult question to answer without more details, but I would consider the following factors: One is whether it appears that the IgA is active. When was the last biopsy, and how much hematuria is present? Two would be if this is 'worsening proteinuria' is really just the first time proteinuria has ...
Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?
In general, I do not treat the acidosis of acetazolamide use as it occurs in everyone taking the drug. I only treat it if the symptoms of the acidosis interfere with the patient's activities of daily living.
Do you recommend checking 1,25-hydroxy vitamin D levels in patients with recurrent nephrolithiasis who have hypercalciuria of unknown etiology?
No, unless they are hypercalcemic or I suspect renal sarcoidosis. Stephen B Erickson, MD
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
Under what circumstances do you recommend targeting a systolic blood pressure of less than 120 mmHg in a patient with CKD?
I am going to deviate a bit from the KDIGO recommendations here, and will try to document my reasons. The SPRINT trial, which was the largest BP target trial for individuals with CKD, did not enroll individuals with an eGFR < 20. The automated office BP measurement used in SPRINT is still not standa...
Under what circumstances would you consider obinutuzumab instead of rituximab when treating primary membranous nephropathy?
Obinutuzumab is a Type II fully humanized glycoengineered anti-CD20 monoclonal antibody with marked B-Cell depletion along with greater antibody dependent cytotoxicity when compared to Rituximab.Currently, its use in 'primary' membranous nephropathy is limited to only refractory cases wherein Rituxi...
Would you consider a patient with spina bifida and end stage kidney disease secondary to reflux nephritis with an ileal conduit for a kidney transplant?
In general, patients with ileal conduit and those with neobladder can be considered for kidney transplantation.
Would you recommend transition to hemodialysis for a patient with calciphylaxis, hyperphosphatemia, and ESKD on peritoneal dialysis?
Changing from PD to HD is a tough decision but I would do it for calcemic uremic arteriopathy CUA (calciphylaxis) for two reasons, increase clearance and guarantee IV delivery of sodium thiosulfate (STS). Peritoneal STS has been describedMataic & Bastani, PMID 16771254But I think CUA is life-threate...
Below what platelet count would you avoid using an AV fistula in a patient with ESKD and thrombocytopenia?
Great question & the answer is likely debatable based on personal experience. Review of some case reports show no evidence of prolonged bleeding after AVF cannulation with platelet counts as low as 37,000 (1). Platelet counts can drop by 5- 15% with initiation of HD normally. They fall during the fi...