Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
Great question! For my ANCA patients and the OSU vasculitis clinic, we leave them all on Bactrim for the life of the disease. Less about PJP, and more about helping minimize infections due to the sinus and respiratory inflammation creating a nice environment for bacteria to live. Also, there is some...
How would you manage a patient with CKD4 due to lupus nephritis of unknown class who develops AKI requiring hemodialysis and nephrotic range proteinuria and is found to have atrophic kidneys on imaging?
The decision to biopsy a kidney is not based just on size. The operator should look at the kidney size compared to the height of the patient and the echogenicity on ultrasound.If the patient is short with a normal/near-normal echogenicity, even a <9cm kidney can yield useful information. This is rel...
When would you repeat a kidney ultrasound with post void residual measurement for a patient with chronic kidney disease from bladder outlet obstruction who is started on tamsulosin?
This is more of a urology question but I would think you have to wait at least six months to see a difference. In either case, I am not sure if an ultrasound is necessary. I usually just go by symptoms.
Do you reduce the steroid regimen for patients with acute interstitial nephritis who have a high risk for developing side effects from glucocorticoid therapy?
No, generally not. AIN needs adequate treatment that isn't that long anyway. You could not treat and just stop the offending drug, but the long-term outcome is worse. I think you just need to treat and then taper.
What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?
Rapid deterioration of kidney function Rapid worsening of proteinuria especially if there is severe nephrosis, hypoalbuminemia with edema Active nephritic pattern of kidney injury Virtually any other glomerulonephritis can happen on a background of diabetic nephropathy. So when suspicion for anothe...
Do you find adding fludrocortisone helpful in treating persistent hypotension in HD patients already on midodrine and without evidence of adrenal insufficiency?
That is not my practice. I doubt it would be helpful.
Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?
According to one our smart fellows "SGLT2i turns the urine into a sugary orange juice", so it should not be given at the time of UTI or in persons with high likelihood of UTI or prior recurrent UTIs. Additionally, under the real world scenario when eGFR<25 ml/min, dialysis initiation can likely be d...
Do you avoid potassium citrate due to concerns with increasing the urine pH in patients with recurrent struvite nephrolithiasis who also have hypocitraturia?
Thanks for asking! My answer is: In general, "No", but it depends... Struvite stones can only form at un-physiologically high urine pHs. This situation occurs when urease-producing bacteria cause urinary infection. Urease splits normally occurring urinary urea to ammonium, raising the urine pH >7.0 ...
Do you prefer cinacalcet or etelcalcetide for patients with hyperparathyroidism in the setting of kidney disease?
In a group of vintage ESKD patients, assuming compliance is not an issue and hypocalcemia handled and Parsabiv utilized when approved, PTH still not controlled often. Over few thousands. The main reason is that the parathyroid hyperplasia turns to be nodular and encapsulated. And it’s time for surgi...
Would you start potassium citrate in a patient with recurrent nephrolithiasis of unknown stone composition who has hypocitraturia and alkaline urine pH?
I would be slow to start potassium citrate for a patient with alkaline urine and stones of unknown composition. Alkaline urine predisposes to calcium phosphate kidney stones, and potassium citrate would likely make the urine more alkaline and worsen the formation of calcium phosphate stones. First, ...