Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Do you recommend starting pyridoxine in a patient with ESKD secondary to primary hyperoxaluria type 1 who is also on lumasiran for plasma oxalate reduction?
If the patient has a monoallelic or biallelic pathogenic variant known to be pyridoxine responsive such as G170R, I would definitely maintain them on pyridoxine 5-10 milligrams/kg. For other patients, I would still air on the side of caution and maintain most patients on pyridoxine since the risk be...
Do you recommend SGLT2i use for patients with chronic kidney disease, diabetes mellitus, and polycystic kidney disease?
While we cannot conscientiously recommend this YET, I do not think it is necessarily contraindicated. I would not use it in conjunction with tolvaptan, but I think the results of the UC Denver trial will be informative. It may indeed be as useful for PKD patients as in other CKD patients, including ...
Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?
I think this is a great question. @Dr. First Last et al (NCT01933724) have conducted a study to answer that question (conveniently called TAPIR). In their analysis that was presented 1 week ago at the International Vasculitis Workshop, they found that patients on low-dose prednisone along with other...
Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?
The duration of maintenance therapy in patients with AAV depends on many factors and should be individualized. Some factors that are associated with a higher risk of relapse include PR3 positivity, seroconversion from negative to positive, ENT disease, use of a tailored approach to RTX dosing, and u...
What is your approach for steroid dosing for patients with ANCA vasculitis on induction treatment with rituximab, avacopan, and glucocorticoid therapy?
I do not personally have a one-size-fits-all approach. Remember that ADVOCATE had a screening window of up to 2 weeks where many patients got steroids before they were randomized. At the time of randomization, patients had to be on less than 20mg of prednisone which was tapered over 4 weeks.In addit...
How frequently do you recommend flushing a peritoneal dialysis catheter for patients with ESKD who are hospitalized and are not currently undergoing peritoneal dialysis?
I'm not aware of any data to guide my response, just experience and "gut". It is our practice to flush unused peritoneal catheters on a weekly basis.
Do you require lupus patients with ESKD or advanced CKD to be on minimal immunosuppression around the time of kidney transplantation?
Patients with SLE needs to have overall clinically quiescent disease to be actively listed for kidney transplant. They can be on stable/reduced dose of immunosuppression medications to keep the disease clinically under control. They can still have low complement levels (serologically active).
How do you recommend discussing family member genetic testing with a patient recently diagnosed with ADPKD?
Depends on the age of the family member (adult versus young adult versus under age 18). Depending on whether the "recently diagnosed" patient has had genetic testing, variant testing in the ADULT family member could be recommended in a straightforward manner through most testing companies. That pers...
Would you treat a patient aggressively for lupus nephritis if they have persistent proteinuria over 1 gram but cannot get a timely kidney biopsy?
It all depends. I would keep pushing for a biopsy and try to overcome the barriers ASAP. If it is the patient who is the barrier (not wanting the biopsy), I would educate them on how a biopsy ends up not even being due to SLE in some cases and immunosuppressant treatment therapy would be exposing t...
What is the optimal approach to treat isolated diastolic hypertension?
Isolated diastolic hypertension occurs less commonly in the adult population, where the majority of the outcome trials in hypertension have been conducted. Much of the treatment of hypertension in younger patients is extrapolated from these trials. In my practice, I look more closely for secondary c...