Discover and read the best of Twitter Threads about #NephroNotes
Most recents (12)
🔥Hello #NephTwitter
💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin
⚡️After ruling out most infective causes👉Look for non-sepsis causes too
Unroll…
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
💥Every other patient in our OPD comes with fever
⚠️But Beware‼️Every fever is not infective in origin
⚡️After ruling out most infective causes👉Look for non-sepsis causes too
Unroll…
#NephroNotes #NephPearls #FOAMed #MedTwitter #MedEd
🔥Fever in Inflammation
⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines
⚡️Autoimmune diseases
⚡️Autoinflammatory conditions
👉Periodic fever syndromes
Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
⚡️Fever in malignancy
👉~10%: Tumor is direct cause
👉Tumor necrosis/ Pyrogenic cytokines
⚡️Autoimmune diseases
⚡️Autoinflammatory conditions
👉Periodic fever syndromes
Unroll…
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🔥Drug induced fever
💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever
⚡️Stimulation of non-shivering thermogenesis
Unroll…
doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
💥Often missed
💥Beta lactams can be a cause‼️
👉Look at medicines causing Drug fever
⚡️Stimulation of non-shivering thermogenesis
Unroll…
doi 10.1186/s13054-016-1375-5
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca and Bayer & is intended for #healthcare providers. See faculty disclosures ckd-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium was first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
1) Welcome to our #accredited #tweetorial on optimal mgt of #hyperkalemia in the patient with #CKD. Earn 0.5h #CME/CE credit by following this thread. I am Sourabh Sharma MD DNB FASN 🇮🇳 @iamnephrologist & u have found the ONLY source for CE credit delivered entirely on Twitter!
2) This program is supported by educational grants from AstraZeneca, Bayer, & Chiesi & is intended for #healthcare providers. See faculty disclosures cardiometabolic-ce.com/disclosures/. Educational credit for #physicians #physicianassociate #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇪🇺🇬🇧
3) Potassium first isolated by Humphry Davy in 1807 by electrolysis (Coined word from “Potash” [Dutch]). The periodic table symbol K was derived from kali (alkali) [Arabic].
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
en.wikipedia.org/wiki/Potassium
#NephroNotes #NephPearls #FOAMed #MedEd @MedTweetorials #CardioTwitter
⁉️How frequently do you diagnose "Treatment Induced Neuropathy" or Insulin Neuritis in your diabetic patient presenting with painful neuropathy ?
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes (TIND)
💡Iatrogenic complication of aggressive glycemic control
🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️
Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
💡Iatrogenic complication of aggressive glycemic control
🔥Underdiagnosed
💡>10% cases with diabetic neuropathy symptoms have actually TIND‼️
Ref- Brain;Autonomic Neuroscience
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🌸Treatment Induced Neuropathy of Diabetes
♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA
Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
♨️aka Insulin Neuritis
🔥1st report: Caravati (1933)
🔥Actual incidence>Expected incidence
🔆Painful small fiber/Autonomic neuropathy
🔆T1DM>T2DM
🔆Insulin>OHA
Ref-BRAIN2015:138;43-52
#NephroNotes #NephPearls #FOAMed #MedEd #MedTwitter
🌸Kidney involvement in primary Sjögren Syndrome
🔥<10% cases (Underdiagnosed/ Neglected⁉️)
🔥Most frequent: TIN
🔥Prognosis👍
🔥Good response to steroid
🔥Cryoglobulinaemia in SS👉 Beware of Lymphoma/MPGN‼️
⚠️Always screen kidneys in SS
#NephroNotes #Nephpearls #FOAMed #MedEd
🔥<10% cases (Underdiagnosed/ Neglected⁉️)
🔥Most frequent: TIN
🔥Prognosis👍
🔥Good response to steroid
🔥Cryoglobulinaemia in SS👉 Beware of Lymphoma/MPGN‼️
⚠️Always screen kidneys in SS
#NephroNotes #Nephpearls #FOAMed #MedEd
🌸Kidney involvement in primary Sjögren Syndrome
🔥Trigger: Environment/Genetics/Viruses
🔥Immune complex in glomeruli
🔥Autoab to specific renal transporters in DCT (Reason behind dyselectrolytemia‼️)
10.1038/nrneph.2015.174
#NephroNotes #FOAMed #MedEd #Nephpearls #NephTwitter
🔥Trigger: Environment/Genetics/Viruses
🔥Immune complex in glomeruli
🔥Autoab to specific renal transporters in DCT (Reason behind dyselectrolytemia‼️)
10.1038/nrneph.2015.174
#NephroNotes #FOAMed #MedEd #Nephpearls #NephTwitter
🌸Kidney involvement in primary Sjögren Syndrome
🔥Clinical presentation
♦️dRTA👉Nephrocalcinosis
♦️DI
♦️Fanconi Syndrome
♦️Bartter/Gitelman
♦️TIN
♦️MPGN
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🔥Clinical presentation
♦️dRTA👉Nephrocalcinosis
♦️DI
♦️Fanconi Syndrome
♦️Bartter/Gitelman
♦️TIN
♦️MPGN
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸Aminoglycoside Nephrotoxicity
♨️Cationic Amino group on drug bind to anionic Megalin on PCT
👉Endocytosis (accumulate in PCT lysosomes @ 100-1000x serum concentration)
👉ATN
Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
♨️Cationic Amino group on drug bind to anionic Megalin on PCT
👉Endocytosis (accumulate in PCT lysosomes @ 100-1000x serum concentration)
👉ATN
Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
🌸Aminoglycoside Nephrotoxicity
♨️5% of dose retained in epithelial cells lining S1 & S2 segments of PCT
♨️Non-oliguric AKI after 5-10 days
♨️Distal tubular toxicity👉 Polyuria/ K & Mg wasting
Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd
♨️5% of dose retained in epithelial cells lining S1 & S2 segments of PCT
♨️Non-oliguric AKI after 5-10 days
♨️Distal tubular toxicity👉 Polyuria/ K & Mg wasting
Pic-ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
#NephroNotes #Nephpearls #FOAMed #MedEd
🌸Aminoglycoside Nephrotoxicity
♨️Risk factor:
♦️Elderly
♦️Hypotension
♦️Pre-existing renal disease
♦️Duration>7days
♦️Concurrent nephrotoxin
♦️Liver disease
♦️Sepsis
♦️Divided dose regimen
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
♨️Risk factor:
♦️Elderly
♦️Hypotension
♦️Pre-existing renal disease
♦️Duration>7days
♦️Concurrent nephrotoxin
♦️Liver disease
♦️Sepsis
♦️Divided dose regimen
#NephroNotes #Nephpearls #FOAMed #MedEd #MedTwitter
🌸NephroTips on AKI in Pregnancy (1/6)
#Tweetorial for budding Nephrologists
🔥Seven-point differential assessment
1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
#Tweetorial for budding Nephrologists
🔥Seven-point differential assessment
1️⃣Period of gestation
2️⃣Prodromal symptom
3️⃣Coagulopathy
4️⃣LFT
5️⃣Platelets
6️⃣Hemolysis evidence
7️⃣Hypertension
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
🌸NephroTips on AKI in Pregnancy (2/6)
♨️AFLP
1️⃣>34 Week
2️⃣Vomiting
3️⃣only in severe cases
4️⃣Jaundice
5️⃣Normal platelet
6️⃣Hemolysis absent
7️⃣Hypertension absent
💡Polyuria‼️ d/t 🚫hepatic metabolism of placental Vasopressinase
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
♨️AFLP
1️⃣>34 Week
2️⃣Vomiting
3️⃣only in severe cases
4️⃣Jaundice
5️⃣Normal platelet
6️⃣Hemolysis absent
7️⃣Hypertension absent
💡Polyuria‼️ d/t 🚫hepatic metabolism of placental Vasopressinase
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
🌸NephroTips on AKI in Pregnancy (3/6)
♨️HELLP
1️⃣Mostly 1st 48 hr postpartum
2️⃣severe pre-eclampsia
3️⃣20% cases
4️⃣SGOT/PT⬆️
5️⃣Plt<1lakh
6️⃣LDH>600
7️⃣Severe HTN
⚠️Also has ⬇️ADAMTS13 level‼️
💡Variable degree renal failure
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
♨️HELLP
1️⃣Mostly 1st 48 hr postpartum
2️⃣severe pre-eclampsia
3️⃣20% cases
4️⃣SGOT/PT⬆️
5️⃣Plt<1lakh
6️⃣LDH>600
7️⃣Severe HTN
⚠️Also has ⬇️ADAMTS13 level‼️
💡Variable degree renal failure
Unroll...
#NephroNotes #FOAMed #MedTwitter #MedEd
🔆ADPKD: Let's revise Key interventional trials
☄TEMPO
☄REPRISE
☄ALADIN
☄DIPAK
☄LIPS
☄TAME
☄HALT-PKD
☄PREVENT-ADPKD
Ref-CKJ
doi:10.1093/ckj/sfy103
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
☄TEMPO
☄REPRISE
☄ALADIN
☄DIPAK
☄LIPS
☄TAME
☄HALT-PKD
☄PREVENT-ADPKD
Ref-CKJ
doi:10.1093/ckj/sfy103
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
🔆ADPKD: Let's revise Predictive tools for judging rapid disease progression
Ref-CKJ
doi:10.1093/ckj/sfy103
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
Ref-CKJ
doi:10.1093/ckj/sfy103
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
🔆Concluded & ongoing trials in ADPKD
DOI: 10.1007/s40620-019-00679-y
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
DOI: 10.1007/s40620-019-00679-y
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
🔆Decision Algorithm for prescribing #SGLT2i #GLP1RA in #DKD
Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
Ref-CJASN
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedTwitter #MedEd
🔆Strategies to ⬇️adverse events in #SGLT2i #GLP1RA
💡Keep genitals dry & clean
💡Prophylactic topical antifungal
💡⬇️Diuretic dose
💡Pt education-"STOP DKA" Protocol
💡Self foot examination
💡Monitor PTH/VitD
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedEd
💡Keep genitals dry & clean
💡Prophylactic topical antifungal
💡⬇️Diuretic dose
💡Pt education-"STOP DKA" Protocol
💡Self foot examination
💡Monitor PTH/VitD
doi: 10.2215/CJN.02690320
#NephroNotes #Nephpearls #FOAMed #MedEd
🔥Horseshoe Kidney for Nephrologist (1/n)
⚡Most common renal fusion
⚡Ectopia+Malrotation+Vascular changes
⚡Prevalence 0.25%
⚡1522: da Carpi described 1st
⚡70% Lt dominant
⚡90%: Lower pole fusion
Pics-Surg Radiol Anat;J Ped Urol
#NephroNotes #Nephpearls #FOAMed #MedTwitter
⚡Most common renal fusion
⚡Ectopia+Malrotation+Vascular changes
⚡Prevalence 0.25%
⚡1522: da Carpi described 1st
⚡70% Lt dominant
⚡90%: Lower pole fusion
Pics-Surg Radiol Anat;J Ped Urol
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (2/n)
⚡Anatomical variations associated with HSK
Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
⚡Anatomical variations associated with HSK
Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
🔥Horseshoe Kidney for Nephrologist (3/n)
⚡Congenital anomalies associated with HSK
👉Edward syndrome 67%
👉Turner syndrome 14%-20%
👉Down syndrome ~1%
Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
⚡Congenital anomalies associated with HSK
👉Edward syndrome 67%
👉Turner syndrome 14%-20%
👉Down syndrome ~1%
Pics-Surg Radiol Anat
#NephroNotes #Nephpearls #FOAMed #MedTwitter
📛Dialysis Dyseqillibrium Syndrome (1/n)
⚡Neurological deterioration in patients on Hemodialysis
⚡First described by Kennedy AC et al (Lancet, 1962)
⚡Waste basket❓
⚡Diagnosis of exclusion
Unroll...
#NephroNotes #Nephpearls #FOAMed
⚡Neurological deterioration in patients on Hemodialysis
⚡First described by Kennedy AC et al (Lancet, 1962)
⚡Waste basket❓
⚡Diagnosis of exclusion
Unroll...
#NephroNotes #Nephpearls #FOAMed
📛Dialysis Dyseqillibrium Syndrome (2/n)
⚡Pathophysiology:
I. "Reverse urea" effect
🔺️Chronic uremia👉⬇️Brain urea transporters (50%) & ⬆️AQP4 (165%)
🔺️⬆️Brain osmolality👉 cerebral edema
Unroll...
#NephroNotes #Nephpearls #FOAMed
Pic- CKJ; Pediatric Nephrology
⚡Pathophysiology:
I. "Reverse urea" effect
🔺️Chronic uremia👉⬇️Brain urea transporters (50%) & ⬆️AQP4 (165%)
🔺️⬆️Brain osmolality👉 cerebral edema
Unroll...
#NephroNotes #Nephpearls #FOAMed
Pic- CKJ; Pediatric Nephrology
📛Dialysis Dyseqillibrium Syndrome (3/n)
⚡Pathophysiology:
II. "Idiogenic osmoles" hypothesis
🔺️Generation of other osmotically active molecules
🔺️Inositol/ Glutamine/ Glutamate
🔺️Unidentified osmoles❓
Unroll...
#NephroNotes #Nephpearls #FOAMed
⚡Pathophysiology:
II. "Idiogenic osmoles" hypothesis
🔺️Generation of other osmotically active molecules
🔺️Inositol/ Glutamine/ Glutamate
🔺️Unidentified osmoles❓
Unroll...
#NephroNotes #Nephpearls #FOAMed
🔥Uremic Hiccups
👉Could be intractable in CKD
⚡Nephrologist's nightmare‼
👉Vagal/ Phrenic N stimulation
❓Which of the following is not a usual cause of persistent hiccups in CKD🚫
@RenalFellowNtwk @askrenal @NephJC
👉Could be intractable in CKD
⚡Nephrologist's nightmare‼
👉Vagal/ Phrenic N stimulation
❓Which of the following is not a usual cause of persistent hiccups in CKD🚫
@RenalFellowNtwk @askrenal @NephJC
🔢Usual causes of Hiccups in CKD
🔺️Uremia itself
🔺️Hypokalemia/Hypocalcemia/Hyperglycemia
🔺️Drugs- Steroids/BZD/Opioids/Antidopaminergics
🔺️Addictions-Alcohol/Smoking
🔺️Psychogenic/Anxiety
🔺️GERD
🔺️Infections- TB/Pneumonia/CNS infection
🔺️Uremia itself
🔺️Hypokalemia/Hypocalcemia/Hyperglycemia
🔺️Drugs- Steroids/BZD/Opioids/Antidopaminergics
🔺️Addictions-Alcohol/Smoking
🔺️Psychogenic/Anxiety
🔺️GERD
🔺️Infections- TB/Pneumonia/CNS infection
💠Simple age old ways could be effective (Treat Uremia first‼)
👉Usually involve glottic stimulation/ ⬆️pCO2 (Hypocarbia stimulates hiccups‼)
🔺️Holding breath
🔺️Drinking gulps of water
🔺️Eating tbsf peanut butter❗
🔺️Chewing lemon
🔺️Inhaling pepper
🔺️Breath holding
👉Usually involve glottic stimulation/ ⬆️pCO2 (Hypocarbia stimulates hiccups‼)
🔺️Holding breath
🔺️Drinking gulps of water
🔺️Eating tbsf peanut butter❗
🔺️Chewing lemon
🔺️Inhaling pepper
🔺️Breath holding
