Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Would you perform plasmapheresis for an ABO-incompatible kidney transplant recipient who has titers of 1:16 and a stable creatinine 3 months post-transplant?
I would not perform plasmapheresis for an ABO-incompatible patient with titers of 1:16 (which are not that high and presumably IgG) based on the stable kidney function. At this point, there should be "accommodation" of the graft to anti-blood group antibodies and there is no need to check titers thi...
What is your approach to genetic counseling prior to obtaining genetic testing in young asymptomatic patients suspected of having autosomal dominant polycystic kidney disease?
If you feel comfortable, a nephrologist who sees a lot of PKD patients is usually capable of doing the counseling. For me, I discuss the pros and cons and alternatives to genetics testing such as imaging, which has limitations at young ages, and considering blood pressure monitoring and other genera...
For patient with polycystic kidney disease and proteinuria who are on maximum dose of ACEi/ARB, what are other anti-proteinuric medications that should be considered?
This is a great question because it highlights that patients with ADPKD should have proteinuria worked up as with any other patient with CKD - sometimes even by biopsy if needed (if tissue can be obtained safely, usually requiring urology and possibly using laparoscopic approach if ultrasound is not...
Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?
No. There are insufficient data to routinely recommend plasmapheresis for the treatment of ODS at this time. Current evidence is based predominantly on case series. In the absence of a control group, it is difficult to assess the effectiveness of plasmapheresis in the treatment of ODS.
Is your decision to prescribe empagliflozin for CKD patients without albuminuria influenced by a recent cost-utility analysis showing that empagliflozin was not cost-effective for this group?
I have not been in the habit of prescribing these medications in the absence of proteinuria.
Do you recommend patients with chronic kidney disease avoid supplements containing creatine?
I do not have patients necessarily avoid these supplements. I do advise with supplements in general we don't always know what else is in the supplement and how supplements interact with each other and prescribed medications.
What is your approach to establishing a dry weight in a pregnant patient with ESKD on hemodialysis given the expectation of weight increase and pregnancy-related edema?
I think there is a lot of nuance managing weight in pregnant patients with ESRD. Pregnant patients have better fetal and maternal outcomes when clearance is increased. Outcomes are best with >36 hours of dialysis per week. Adjustment of dry weight should include assessment of volume status, blood pr...
Would you recommend proceeding with a kidney biopsy for patients' with Waldenström's macroglobulinemia who have hematuria and normal kidney function?
The answer to this question would certainly depend on the clinical scenario.As we are aware, there are many different etiologies of hematuria. If the patient were to have gross hematuria, then I would start with cross-sectional imaging to ensure there is no nephrolithiasis or tumor and even consider...
How do you approach treatment for patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) with end-stage renal disease who are considering kidney transplant?
Monoclonal gammopathy of renal significance includes a variety of renal pathologies: MIDD (LCDD, LHCDD, HCDD). Monoclonal immunotactoid glomerulonephritis or type 1 cryoglobulinemic glomerulonephritis. Light chain proximal tubulopathy or crystal-storing histiocytosis. C3 glomerulopathy with monoclon...
Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?
Hyperparathyroidism does increase the risk of developing kidney stones. A study in New England Journal of Medicine, Broadus et al., PMID 7351950, reported that patients with elevated concentrations of 1,25-dihydroxyvitamin D are at increased risk for kidney stones. The reason is that 1,25-dihydroxyv...