Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
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...
In which patients do you obtain genetic testing for further evaluation of kidney stone disease?
First stone as a pre-adolescent, stone complicated by kidney failure, history of growth retardation, family history of stones or nephrocalcinosis or unexplained kidney failure, hearing impairment, ocular crystals High stone burden on imaging or nephrocalcinosis Concomitant low molecular weight prot...
How do you advise your kidney stone patients about optimal daily fluid intake?
Measuring urine is better than counting liters of intake and shoot for 2-3 liters/day. If they aren’t getting up most nights to urinate they probably aren’t drinking enough water. When they get tired of drinking and urinating I tell them to remember the pain associated with their stone.
What is your approach to the medical management of struvite kidney stones?
It is difficult to separate medical and surgical management of struvite stones, since these stones are typically the consequence of persistent or recurring infections. Surgically, risk factors for infection need to be addressed, which may include efforts to remove any retained stone material, follow...