A bit later is better than never. Here is the distilled and refined
#NephJC
summary of this week on chapters 1, 2, and 6 from
@goKDIGO
chronic kidney disease guideline
✍️By
@stephanietr612
and
@DrMedhavi_G
⚔️Are you ready for the feisty discussions?
T0: HRS-1 is the diagnosis we hate to make, given it’s prognosis (untreated = median survival 2 weeks)
Here are the criteria for diagnosing HRS-1 (under the alternative name of HRS-AKI)
Do the criteria work? What’s good, what’s bad?
Image courtesy of
@drkeithsiau
#nephjc
Take a look at the amazing
#visualabstract
made by
@divyaa24
🎨
@goKDIGO
LN guideline has already started some controversies. ⚔️ If curious or if you'd add some perspective, come to
#NephJC
chats
💬Chat 1: 9 pm EDT, Feb 6
💬Chat 2: 9 pm IST, Feb 7
1/
#Tweetorial
#NephJC
#Hypernatremia
Reviews and guidelines say to correct hypernatremia in adults by no more than 10 mmol/L per day. This is based on little hard data, has little support in literature and may be harmful
T0g: Among balanced crystalloid solutions,
Plasma-Lyte 148 is
❤️isotonic,
❤️no lactate
❤️comparable chloride content with plasma
Do you think it is better fluid?
#NephJc
T3c:
Are the results comparable with CREDENCE and DAPA-CKD?
The renal benefits were consistent
Check out this amazing infographic by the uber-talented
@priti899
which captures all 3 in a snapshot
#NephJC
If you only read one
#TenTweetNephJC
this year, make it this one.
EMPA-KIDNEY is one of those landmark trials it is worth knowing inside-out, but you can still rapidly catch up on the key findings & author tweetchat secrets in the thread below👇
T0e
There is a hypothesis that hyperchloremia can lead to vasoconstriction, reduced kidney perfusion, renal ischemia, reduced urine output and adverse renal outcomes.
But do you know how? H/T
@pulmcrit
#NephJC
Tob: Back to basics: do you remember why bicarb is good for the kidneys?
#NephJC
It seems oral bicarb delays progression of CKD through protection of the proximal tubules and inhibition of the complement activation
#NephJC
Take home:
Empagliflozin ⬇️kidney disease progression & CV death in CKD ✅/❌DM
⬇️eGFR initiation cut-off to 20
⬆️benefits in those with albuminuria
How would EMPA-KIDNEY change your practice? Did it turn you into a flozinator?
#NephJC
The
#NephJC
team has put together some resources for
#COVID19
from the kidney perspective here
We will keep updating it live
Keep checking back and share widely
#CoronaKidney
According to the American Society of Apheresis Guideline, AAV is a category II indication for PLEX (BUT not every AAV requires PLEX)
*RPGN (Cr ≥ 5.7 mg/dl) or,
*diffuse pulmonary hemorrhage.
Other AAV parameters fall into category III (below myeloma!). Do you agree??
#NephJC
So in summary, kidney pathology in COVID19 includes: ATI/ATN, glomerular ischemia/endothelial injury, virions, peritubular capillary congestion and/or fibrin thrombi, and collapsing glomerulopathy - possibly an exacerbation of APOL1 nephropathy.
#NephJC
Did you miss some of the nephrology literature in 2022?
Do you love rhyming couplets?
Then read our end of year round-up of the 23 most important papers in one thread!
(in the order all were covered by
#NephJC
, with links to the super-rapid
#TenTweetNephJC
trial catch-ups)
👇
T0c: Acetaminophen has 2 mechanisms for analgesic & antipyretic effects:
- By inhibiting the same COX, prostaglandin H2synthase. Different from NSAIDs, it blocks the enzyme at its peroxidase catalytic site.
- By interacting with cerebral endogenous cannabinoid receptors
#NephJC
Both Piperacillin & Tazobactam are substrates for OAT1&3, the organic anion transporters, & Vancomycin suppresses expression of these pumps. Is rise in creatinine reflective of true renal injury?
#NephJC
🔔New
@goKDIGO
guideline for lupus nephritis was published so fast after the last one!
📰What is the news, then?
💬 Let's discuss more on
#NephJC
chats on February 6 and 7
T0j:
🧂 2013 US guidelines recommend <8 mEq/l for high risk pts and 10-12 mEq/l for normal risk/chronic hypoNa
🧂2014 European guidelines strictly recommend <10 mEq/l/24h correction rate in moderate, symptomatic hypoNa patients
✨Infographic by
@Nephroseeker
#NephJC
as we come to the end of the year, let's do a quick recap of the year in review for
#NephJC
We discussed 24 topics in 2021, including
14 RCTs
6 observational studies
3 guidelines
1 book club
T0c: This diuretic resistance can be classified into: pre-renal & intra-renal, which can be further divided depending on the anatomic site in the nephron.
Do you know other mechanisms for resistance?
#NephJC
Fast or slow? How fast is fast in correcting hyponatremia?
Will a few sodium mEq/l make a difference in grand scheme of central myelinolysis or will it change the unbeatable mortal human condition?
👇Next
#NephJC
@NEJMEvidence
🧂Season ur arguments!
T0e: Taking this further, here is a great figure from in
@AJKDOnline
showing urine sediment and biomarkers based on different sites of nephron injury
#NephJC
#NephJC
Let’s get the fire started! Less than 1 hour ....
And a fascinating question for nephrologists: which one are you?
H/T
@torra_roser
, photo taken during
@ERAkidney
‘22 congress
Many nephrologists make decisions about which anticoagulant (if any) to recommend for atrial fibrillation in patients on haemodialysis on a weekly basis.
And we finally have more randomised data!
Enjoy a rapid catch-up with
#TenTweetNephJC
28/
Now, on a slightly positive note, how comfortable are u using the two new FDA approved drugs for LN as initial therapy?
#nephjc
Check out the awesome infographic which resumes and compares voclosporin and belimumab
By our fab
@divyaa24
👇
T0c: The 2012 KDIGO guidelines recommend ACR as the most appropriate way to evaluate proteinuria. Between urine dipstick, PCR, and ACR, which test(s) do you routinely get on your clinic patients? Why?
#NephJC
Welcome to tonight’s discussion on therapeutic drug monitoring of Mycophenolic Acid (MMF) (fun fact MMF is derived from the mold Penicillium Glaucum that gives the blue to blue cheese)
#NephJC
BEATing Calciphylaxis 👉a comprehensive summary by
@manasib33
, explaining what adaptative platform trials mean and how they can bring hope even to the darkest maladies in nephrology: calciphylaxis
Join
#Nephtrials
@ISNkidneycare
⏰ Nov 21, 9pm EST
T0e: Check out the summary of prior trials of ET-A antagonists in proteinuric renal diseases! And a bit of preview of today’s talk
#NephJC
🌈 infographic by
@DrPallaviPrasad
and
@Nephroseeker
T0c: C3G is subclassified in: C3GN and DDD.
Both share many overlapping features making it a diagnostic challenge.
Check out this nice overview❗️
#NephJC
🖼️ by
@AnvithaRangan
Applications for the 2019 NSMC social media internship are closed.
We are really appreciative of the interest. This year 114 people applied, up 75% year over year.
T0e: Principle of HDF= Convection + Diffusion
Each institution has its own way of explaining HDF - I was told convection is like Tsunami - takes whatever comes in its way
How were you explained?
#NephJC
T0b: What do we know so far about steroids in treating IgAN?
The
@landmark_neph
has a visual overview &
#NephJC
has recently discussed TESTING 2.0 👉
Beautifully updated
#IgAN
Trials infographic from
@divyaa24
👇
Nearly 2 million academic reports published annually, up to 50% are read only by the authors, journal editor and reviews – and the majority ARE NEVER CITED!!
#NephJC
Rituximab, Remission, & Relapses in ANCA-associated Vasculitis
This week we will discuss the resounding triumph of rituximab in maintenance therapy for ANCA-associated vasculitis.
🪦RIP Azathioprine?
👏 Summary by
@Myasirbaloch
&
@Nihal_Hamary
#NephJC
T0c: This diuretic resistance can be classified into: pre-renal & intra-renal, which can be further divided depending on the anatomic site in the nephron.
Do you know other mechanisms for resistance?
#NephJC
Tonight, we are rehashing the fluid war between balanced crystalloid vs saline in critically ill patients.
The link to the paper: ).
And here is the brilliant summary and VA by
@hellokidneyMD
.
#NephJC
T3d: There are few risk scores described in AAV, nephrologist can use:
- Berden classification: % crescents
- Mayo clinic: glomerular and tubulointerstitial involvement
- Brix score: histopath & GFR at diagnosis
Do you use any in your practice? When?
#NephJC
Immunoglobulin G4 (
#IgG4
)-related disease is a true chameleon with multisystem involvement.
Most common manifestation of IgG4-related disease in the kidneys is tubulointerstitial nephritis
#TIN
.
#NephJC
#NephMadness
@edgarvlermamd