Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
What is your daily correction goal for those patients being treated for hypernatremia?
There is no correction per se. Although, older guidelines recommend a correction of no more than 8-10 mEq/dL in 24 hours. The theoretical risk of correcting hypernatremia too fast is the development of cerebral edema. However, a recent study (Chauhan et al., PMID 30948456) showed no evidence of cere...
What is your approach to the use of desmopressin prior to performing a kidney biopsy to potentially prevent procedural associated bleeding?
I do not routinely request a bleeding time or administer desmopressin prior to performing a percutaneous kidney biopsy. The bleeding time is very operator dependent and therefore could be prolonged even when platelet function is normal. I ask patients to hold aspirin one week before performing a kid...
Is there a platelet count threshold when you would avoid performing a kidney biopsy in patients with thrombocytopenia?
The kidney biopsy is considered a high-risk procedure. The society of Interventional Radiology recommends: INR less than 1.5 and platelet more than 50,000.We follow these recommendations!Patel et al., PMID 22513394
Are there instances when you perform a repeat kidney biopsy in patients whom tolerated the first procedure but are still without a definitive diagnosis?
Of course. In general, every time I re-biopsied a patient, I found the same diagnosis that second time around. Of course, if the sample is inadequate then I often re-biopsy. I always suggest to re-review the biopsy already taken before re-biopsying.
What is your mmHg threshold to cancel a kidney biopsy for patients with pre-procedural elevated blood pressures?
I am most comfortable doing a percutaneous kidney biopsy at a BP<140/90. Patients are often anxious prior to the biopsy and this can raise their BP. I usually administer an anxiolytic prior to the procedure. I also administer oral antihypertensives such as clonidine or short-acting nifedipine in the...
Do you require patients who undergo a kidney biopsy to be admitted to the hospital for observation?
We do but that is not the common practice. We do send some patients home if the biopsy is done early enough and we can watch them in IR but the majority stay overnight. When IR does the biopsy, they do not admit the patient.
Under what conditions do you perform a post-procedural kidney ultrasound in patients who recently underwent a kidney biopsy?
The most important complication of renal biopsy is bleeding. Ultrasound helps in the detection and monitoring of an enlarging hematoma. In some practices, the patient is discharged after 6-8 hours after a biopsy. Ultrasound is done at 1 hour (which detects only 20% of bleeding) and then at the time ...
Do you advise patients to limit physical exertion including lifting heavy objects following a kidney biopsy?
I don’t think there is data on this, who would do a trial, but for an uncomplicated biopsy I tell them to take it easy for 3 days, usually over the weekend, a reason I like to do them on a Friday. No sports no working out no heavy lifting. I also tell them not to just lay around because if they are ...
Which patients do you recommend referral to interventional radiology to perform a kidney biopsy?
There are a few instances when I would refer to an IR to perform a kidney biopsy: Obese patients when the kidney is deep Biopsy of target lesions within the kidney Transjugular kidney biopsy
How frequently do you obtain 24 hour urine stone risk profiles in your patients with kidney stone disease who pass less than one stone per year?
When I do 24h urine collections in patients, I repeat the collection in order to see if the goal of therapy was achieved. Whether that was fluids, dietary changes, or medications, I usually want to see if we were successful. After that, I'm less interested in repeating the study especially if the st...