Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?
I am not aware of published systematic reviews, risk models, or evidence-based guidelines for post-operative prophylaxis in renal transplant patients. Given both increased risk for VTE and bleeding, it is not surprising that there is a large variation in practice (for relatively recent survey on t...
Is there a role for SGLT-2 inhibitors in the treatment of chronic hypomagnesemia?
A meta-analysis of 18 randomized controlled trials showed that the use of SGLT2 inhibitors can result in a significant increase in the serum magnesium level. These trials, however, were not specifically designed to assess the effect of SGLT2 inhibitors on the serum magnesium level. Studies have show...
Do you have a preferred oral magnesium formulation for patients with hypomagnesemia secondary to Gitleman syndrome and who also have chronic diarrhea?
Compared to other magnesium supplements, magnesium glycinate tends to cause less diarrhea and is better tolerated by my patients with Gitelman syndrome.
How do steroids and/or DMARDs affect biopsy results if a renal biopsy for suspected lupus nephritis is delayed?
In contrast to GCA/TA, where the Mayo clinic has published data that steroid treatment for as much as circa 2-4 weeks is unlikely to result in a false-negative biopsy, as long as accounts for the skip phenomenon and carefully examines multiple sections of the biopsy, I am unaware of similar informat...
Is there a BMI cutoff for which you no longer recommend kidney transplantation in a patient with end stage kidney disease and obesity?
BMI cutoff for transplantation varies widely across institutions so it is important to know your local transplant center guidelines. In general, a BMI > 40 kg/m2 is considered to be a contraindication with many centers. Some centers will recommend bariatric surgery (often not a bypass or duodenal sw...
Do you have your patients with recurrent nephrolithiasis stop supplements such as turmeric?
That is a good question and a hard one to answer since supplements may contain a variety of ingredients of unknown quantity or impurities. I think it also depends on the stone type. For example, excessive amounts of vitamin D, as were advised by some "practitioners" during COVID, can cause or aggrav...
Are there instances when you use erythropoietin stimulating agents in patients with acute kidney injury requiring dialysis?
I cannot think of a reason to. ESA resistance is common in sick patients and I think you are wasting the drug. Please see reference: Aoun et al., PMID 35279078'Erythropoietin treatment had no impact on transfusions, renal recovery or mortality in acute kidney injury patients with anemia."
Do you alternate CT stone scans and renal ultrasounds for stone monitoring in your patients with recurrent nephrolithiasis with the goal of limiting radiation exposure?
No. Although I share your concern about radiation and expense, the purpose of monitoring kidney stone patients is to detect small differences in stone burden from year to year. Ultrasound is less accurate than CT for this purpose. Avoiding contrast views decreases CT radiation exposure and is my mon...
How do you dose gabapentin in patients with renal failure?
There are many algorithms available online about the renal dosing of gabapentin. However, it should be emphasized that the recommendations are not based on large patient studies; therefore, the efficacy of the reduced doses for neuropathic pain is not certain (Raouf et al., PMID 28184168).
What is your approach to managing hypokalemia in patients with Bartter syndrome who are on high doses of potassium chloride but cannot tolerate amiloride or ACEi/ARBs due to low blood pressures?
Since prostaglandin level is typically high in patients with Bartter syndrome, NSAIDS can be tried to treat hypokalemia in these patients who cannot tolerate amiloride or ACEi/ARB due to low blood pressure. However, close monitoring of renal function is required if NSAIDS were to be given in these p...