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An interesting case of new onset HTN and hypokalemia in a patient with leiomyosarcoma
Serum K 2.9
BP 150/90
No accompanying acidosis or alkalosis👇🏽
1/
#onconephrology
Serum K 2.9
BP 150/90
No accompanying acidosis or alkalosis👇🏽
1/
#onconephrology
Step 1: Is the hypokalemia due to renal K losses or extra-renal K losses?
24 hour urine K was 46 mEq/L so renal K losses were contributing to hypokalemia
Serum magnesium was normal
Patient was not on diuretics👇🏽
2/
24 hour urine K was 46 mEq/L so renal K losses were contributing to hypokalemia
Serum magnesium was normal
Patient was not on diuretics👇🏽
2/
In the setting of new onset hypokalemia and new onset HTN, there was high suspicion for mineralocorticoid excess or AME
So, plasma renin activity (PRA) and plasma aldosterone were checked
‼️Both PRA and aldosterone were elevated👇🏽
3/
So, plasma renin activity (PRA) and plasma aldosterone were checked
‼️Both PRA and aldosterone were elevated👇🏽
3/
1/n🚨🔊 Hey #nephtwitter #medtwitter #Onconephrology! Tweetorial alert!
🏥What do nephrologists👩⚕️, haem- oncologists 👩⚕️,@TheSkeletonKG have in common?
Lysing 🎆tumor cells have a story🔖!
Let's read the🔖:Intricacies of pathogenesis, diagnosis & Rx of tumor lysis syndrome -TLS
🏥What do nephrologists👩⚕️, haem- oncologists 👩⚕️,@TheSkeletonKG have in common?
Lysing 🎆tumor cells have a story🔖!
Let's read the🔖:Intricacies of pathogenesis, diagnosis & Rx of tumor lysis syndrome -TLS
2/n A 13y 👦presented with
👉1 month of intermittent fever🌡️🤒
👉exertional dyspnea
👉significant weight loss⚖️.
On physical examination: He looked pale & volume-depleted.
🩸Labs were as follows:
👉1 month of intermittent fever🌡️🤒
👉exertional dyspnea
👉significant weight loss⚖️.
On physical examination: He looked pale & volume-depleted.
🩸Labs were as follows:
3/n Further investigations showed
🩸Hb = 6.3 g/dL,
🩸total WBC count = 210,000/ mm3
🩸platelet = 10,000/mm3.
🩻CXR = mediastinal mass.
🦴PS & bone marrow examination = suggestive of B-cell type acute lymphoblastic leukemia (ALL).
🩸Hb = 6.3 g/dL,
🩸total WBC count = 210,000/ mm3
🩸platelet = 10,000/mm3.
🩻CXR = mediastinal mass.
🦴PS & bone marrow examination = suggestive of B-cell type acute lymphoblastic leukemia (ALL).
Tweetorial on a new specialized fellowship in @HofstraKidney northwell.edu/news/the-lates… @jmolinet @SIbrahimMD @sfishbane @purvasharma821 @renalmyeloma
1. Applications due for July 2023 start date- interested Nephrology fellows DM me( till website is ready)
1. Applications due for July 2023 start date- interested Nephrology fellows DM me( till website is ready)
2. Glomerular diseases are rare conditions that do require special expertise and expert centers to treat patients. The @NorthwellHealth GN center run by @purvasharma and @kdjhaveri along with expert pathologists @vbijol @Yihe28745445 will help train the next generations fellows
3. #Onconephrology is a field that deals with cancer and the kidney and is very closely linked with glomerular disease and experts in @HofstraKidney will train the fellow in all aspects of this field @renalmyeloma @kdjhaveri @nupuruppal @VBijol @Yihe28745445 @onconephsociety
We kept our promise
We are back with the 2 nd issue of Onconeph
#Onconephrology
12 🔥 articles
40+ authors
Great collaborative effort
@kdjhaveri
@MegSise
@CharuThakar
@ackdonline
@NKF_NephPros
@nkf
@onconephsociety
@UCKidney
@uofcincy
@UCincyMedicine
@ucincipress
We are back with the 2 nd issue of Onconeph
#Onconephrology
12 🔥 articles
40+ authors
Great collaborative effort
@kdjhaveri
@MegSise
@CharuThakar
@ackdonline
@NKF_NephPros
@nkf
@onconephsociety
@UCKidney
@uofcincy
@UCincyMedicine
@ucincipress
🔥Our editorial speaks about the summary of the individual topics.
Paraproteinemia
TMA $
Na/K ⬇️⬆️in Ca
Palliative Rx
HSCT & kidney
Heme cancer & kidney
Paraneoplastic GN
Sickle cell ds
OncoSx and AKI
Anemia & cancer
Anti Ca Rx dosing in CKD
TxP Onconeph
Paraproteinemia
TMA $
Na/K ⬇️⬆️in Ca
Palliative Rx
HSCT & kidney
Heme cancer & kidney
Paraneoplastic GN
Sickle cell ds
OncoSx and AKI
Anemia & cancer
Anti Ca Rx dosing in CKD
TxP Onconeph
🔥Kidney in dysproteinemia
Exhaustive review by @HerrmannMd @AkazukiNinaMD Dr Seshan
@MayoClinic @WeillCornell
👉Covers entire spectrum of kidney involvement in dysproteinemias
👉Excellent path images to support the manuscript.
VA by @Elena_Cervants
Exhaustive review by @HerrmannMd @AkazukiNinaMD Dr Seshan
@MayoClinic @WeillCornell
👉Covers entire spectrum of kidney involvement in dysproteinemias
👉Excellent path images to support the manuscript.
VA by @Elena_Cervants
Hot out of press.
"AKI in critically ill patients with cancer"
@ShrutiGkidney @BWHKidney @MGHKidneys @DanaFarber
@kdjhaveri @HofstraKidney
@CJASN
@onconephsociety
@UCincyMedicine @UCKidney @UCincyIM
#Onconephrology
Causes of AKI in pts with cancer in nutshell ⬇️
"AKI in critically ill patients with cancer"
@ShrutiGkidney @BWHKidney @MGHKidneys @DanaFarber
@kdjhaveri @HofstraKidney
@CJASN
@onconephsociety
@UCincyMedicine @UCKidney @UCincyIM
#Onconephrology
Causes of AKI in pts with cancer in nutshell ⬇️
⭐️Phenotypes of AKI from monoclonal gammopathy
⭐️ Data suggest that patients with MGRS are at high risk for progression to kidney failure if not treated with clone-directed therapy (e.g., bortezomib)
Read more about it in the section "Monoclonal Gammopathies and AKI" ⬇️
⭐️ Data suggest that patients with MGRS are at high risk for progression to kidney failure if not treated with clone-directed therapy (e.g., bortezomib)
Read more about it in the section "Monoclonal Gammopathies and AKI" ⬇️
⭐️Other etiologies of AKI in cancer
Hypercalcemia
Direct kidney parenchymal infiltration
Obstruction⬇️
Hypercalcemia
Direct kidney parenchymal infiltration
Obstruction⬇️
1) #Onconephrology @onconephsociety membership Tweetorial- Join membership--how to become a member! ason-online.org/become-a-member
2)If you are interested in becoming a member of a ASON please go to ason-online.org/become-a-member and fill out the form.
3) We just need an example of scholarly activity in the prior 3 years (any manuscript, abstract, presentation related to oncology/onconephrology). We have tried to keep the requirements to a minimum, in order to encourage trainees to join as well.
Do cyclin-dependent kinase (CDK) 4/6 inhibitors cause acute kidney injury (AKI)? #onconephrology #Thread
A little #tweetorial about CDK 4/6 inhibitor-associated AKI: what we know already, and what we found
kireports.org/article/S2468-…
A little #tweetorial about CDK 4/6 inhibitor-associated AKI: what we know already, and what we found
kireports.org/article/S2468-…
3 CDK 4/6 inhibitors (palbociclib, ribociclib, and abemaciclib)have been approved for HER2-negative metastatic breast cancers. CDK 4/6 inhibitors help overcome resistance to endocrine therapies by preventing cell-cycle progression and cancer growth (frontiersin.org/articles/10.33…).
What do we know about AKI related to CDK 4/6 inhibition? In vitro studies suggest that CDK 4/6 inhibitor metabolites inhibit renal transporters, potentially leading to a reversible rise in serum creatinine (SCr) without actually changing GFR (ncbi.nlm.nih.gov/pmc/articles/P…).
Workup for detection of Monoclonal Immunoglobulin (MIg) in patients with Monoclonal Gammopathy of Renal Significance (MGRS)
(Talk by Dr. Frank Bridoux at the Kidney Week)
#Onconephrology #MGRS
(Talk by Dr. Frank Bridoux at the Kidney Week)
#Onconephrology #MGRS
Workup for detection of Monoclonal Immunoglobulin
1. Find the circulating monoclonal Ig:
-SPEP & UPEP to quantify the Monoclonal (M) spike
-Serum & Urine Immunofixation to identify the monoclonal Ig & also to monitor response to Rx
1. Find the circulating monoclonal Ig:
-SPEP & UPEP to quantify the Monoclonal (M) spike
-Serum & Urine Immunofixation to identify the monoclonal Ig & also to monitor response to Rx
2. Serum Free Light Chain Assay to identify free light chains & to monitor hematological response to Rx in Light Chain-associated kidney disorders
There are 2 different LC assays: Binding site & N-Latex assay
-Use same assay to follow LC levels
There are 2 different LC assays: Binding site & N-Latex assay
-Use same assay to follow LC levels
1. Green tea- One basic science study I found that showed some benefit in rats with cisplatin pubmed.ncbi.nlm.nih.gov/19647078/- authors postulate that green team increased the activities of the enzymes of carbohydrate metabolism, brush border membrane, oxidative stress.
2) another basic science study in rats showed the similar finding ncbi.nlm.nih.gov/pmc/articles/P…
💥Parathyroid Hormone-related Protein - PTHrP
⚡️Who was the first person to postulate the existence of PTHrP?
⚡️What is the mechanism of PTHrP mediated hypercalcemia of malignancy?
⚡️Does PTHrP have a physiological function?
#Onconephrology
#PTHrP
1/
⚡️Who was the first person to postulate the existence of PTHrP?
⚡️What is the mechanism of PTHrP mediated hypercalcemia of malignancy?
⚡️Does PTHrP have a physiological function?
#Onconephrology
#PTHrP
1/
Dr. Fuller Albright, in 1941, was the first to postulate the presence of a ‘substance’ that caused features of hyperparathyroidism in a cancer patient
2/
2/
In this report, Dr. Albright essentially described the presence of PTH-like hormone in a cancer patient.
“I suspected that the tumor might be producing PTH. I therefore had it assayed but no PTH hormone was found”-Albright👇🏽
3/
nejm.org/doi/full/10.10…
“I suspected that the tumor might be producing PTH. I therefore had it assayed but no PTH hormone was found”-Albright👇🏽
3/
nejm.org/doi/full/10.10…
Post Grand Rounds SLGT2i and the Kidney Tweetorial
- The Glucoretics - thanks @edgarvlermamd @ChristosArgyrop @jam_hirsch for some slides
Start...PART 1 nature.com/articles/s4158…
- The Glucoretics - thanks @edgarvlermamd @ChristosArgyrop @jam_hirsch for some slides
Start...PART 1 nature.com/articles/s4158…
SGLT2 is responsible for reabsorbing up to 90% (animal data) of the glucose filtered at the glomerulus. The remaining 10% (animal data) is reabsorbed by SGLT1 that is expressed on the luminal (brush border) surface of cells of the S3 segment of the proximal tubule
Pathophysiology of Diabetic Nephropathy and role of SGLT2
💥What is Monoclonal Gammopathy and when does it’s presence indicate presence of cancer?
💥What is MGUS and MGRS?
#Onconephrology
1/
💥What is MGUS and MGRS?
#Onconephrology
1/
💥Monoclonal gammopathy is presence of monoclonal immunoglobulin (Ig) in serum, urine or both
💥Monoclonal immunoglobulins are produced by either clonal Plasma cells (often) or by
B lymphocytes (less often)
2/
💥Monoclonal immunoglobulins are produced by either clonal Plasma cells (often) or by
B lymphocytes (less often)
2/
⚡️Hematologic criteria for diagnosis of cancer in the setting of monoclonal gammopathy is based on 2 factors:
1. Tumor burden (clonal mass)
2. End-organ damage
3/
1. Tumor burden (clonal mass)
2. End-organ damage
3/
💥Endocrine adverse effects of Immune Checkpoint Inhibitors - a brief Tweetorial for Nephrologists
A thread based on an article published in @NatureRevEndo
👉🏽 nature.com/articles/s4157…
#Onconephrology
1/
A thread based on an article published in @NatureRevEndo
👉🏽 nature.com/articles/s4157…
#Onconephrology
1/
⚡️It important for Nephrologists to be familiar with immune checkpoint inhibitor induced endocrinopathies as thyroid, pituitary & adrenal disorders can present with👇🏽
-Hyponatremia
-Hyperkalemia
-Metabolic acidosis
-Hypotension
2/
-Hyponatremia
-Hyperkalemia
-Metabolic acidosis
-Hypotension
2/
⚡️Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target immune checkpoint proteins:
-Cytotoxic T lymphocyte antigen 4 (CTLA4)
-Programmed cell death 1 (PD1)
-Programmed cell death ligand 1 (PDL1)
3/
-Cytotoxic T lymphocyte antigen 4 (CTLA4)
-Programmed cell death 1 (PD1)
-Programmed cell death ligand 1 (PDL1)
3/
💥‘Pseudohyperkalemia’ Tweetorial
⚡️Pseudohyperkalemia
⚡️Seasonal Pseudohyperkalemia
⚡️Reverse Pseudohyperkalemia
Let’s review these conditions
1/
#Onconephrology
#Hyperkalemia
⚡️Pseudohyperkalemia
⚡️Seasonal Pseudohyperkalemia
⚡️Reverse Pseudohyperkalemia
Let’s review these conditions
1/
#Onconephrology
#Hyperkalemia
⚡️An important point to remember is that 98% of the potassium (K) stores in the body are intracellular so even a small amount of K released from the cells can significantly affect the concentration of ‘measured’ extracellular potassium
2/
2/
⚡️When blood is drawn to measure potassium, you are measuring ‘extracellular’ potassium concentration and NOT intracellular potassium concentration
3/
3/
💥 Tweetorial on ‘Cryoglobulinemia’
⚡️What are Cryoglobulins?
⚡️When should a clinician suspect Cryoglobulinemia & Cryoglobulinemia vasculitis?
⚡️How to establish the diagnosis?
⚡️Significance of Rheumatoid Factor
1/
@GlomCon
#Onconephrology
⚡️What are Cryoglobulins?
⚡️When should a clinician suspect Cryoglobulinemia & Cryoglobulinemia vasculitis?
⚡️How to establish the diagnosis?
⚡️Significance of Rheumatoid Factor
1/
@GlomCon
#Onconephrology
⚡️Cryoglobulins are immunoglobulins that reversibly precipitate in the serum at <37 degree C & re-dissolve at >37 degree C
⚡️The fundamental mechanism behind Cryoglobulin formation is aberrant antibody (Ab) production by B cells & B cell proliferation
2/
⚡️The fundamental mechanism behind Cryoglobulin formation is aberrant antibody (Ab) production by B cells & B cell proliferation
2/
⚡️Hence diseases that interfere with B cell function can cause Cryoglobulinemia such as:
☄️B cell lymphoproliferative disorders
☄️Chronic infections such as Hepatitis C virus (HCV)
☄️Autoimmune diseases
3/
☄️B cell lymphoproliferative disorders
☄️Chronic infections such as Hepatitis C virus (HCV)
☄️Autoimmune diseases
3/
1/ Paraproteinemic kidney disease: Cast nephropathy, myeloma kidney, MGUS, MGRS, LCCN, AL, AH, MIDD, LCPT…)
Lost in the alphabet soup!!!
Time for an #MGRS #tweetorial
#NephTwitter #Hemetwitter #MedTwitter #Onconephrology #NSMC
Lost in the alphabet soup!!!
Time for an #MGRS #tweetorial
#NephTwitter #Hemetwitter #MedTwitter #Onconephrology #NSMC
2/ Let’s start with a poll: which of the following disease states can cause MGRS (monoclonal gammopathy of renal significance):
3/ Before we get to the answer, let’s dissect the term MGRS:
Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis
link.springer.com/referenceworke…
Monoclonal Gammopathy:
⚡️Signifies the presence of a "monoclonal" immunoglobulin or its components
⚡️Seen as a spike in the "gamma" region on protein electrophoresis
link.springer.com/referenceworke…
Chemotherapeutic agents associated with AKI and other forms of kidney injuries #Nephpearls
#Onconephrology 🦀
#Onconephrology 🦀
Bevacizumab associated Thrombotic Microangiopathy TMA ca. 2008 from @NEJM #Nephpearls
nejm.org/doi/pdf/10.105…
nejm.org/doi/pdf/10.105…
Pamidronate associated Collapsing FSGS ca. 2001 from @JASN_News #Nephpearls
jasn.asnjournals.org/content/jnephr…
jasn.asnjournals.org/content/jnephr…
Did my fellows' curriculum lecture today, "Images in #Nephrology"
Thought of sharing the slides as a tweetorial. Goal is to present some 'classic' images that aid in kidney-related diagnoses. Not exhaustive; plan to make 2nd part as well.
#MedEd #FOAMed Not much POCUS involved!
Thought of sharing the slides as a tweetorial. Goal is to present some 'classic' images that aid in kidney-related diagnoses. Not exhaustive; plan to make 2nd part as well.
#MedEd #FOAMed Not much POCUS involved!
1st question. Classic image but rarely encountered. Note the super high blood urea nitrogen and serum creatinine.
Here is the answer.....
International Vicenza Course on Acute Kidney Injury (AKI) and Continuous Renal Replacement Therapies (CRRT)
#37VicenzaCourse 🇮🇹
👉🏼 irriv.com/courses/events…
#37VicenzaCourse 🇮🇹
👉🏼 irriv.com/courses/events…
Dr Mehta will give a lecture on “AKI as a worldwide burden”
#37VicenzaCourse 🇮🇹 #Nephpearls
👉🏼 nature.com/articles/s4158…
#37VicenzaCourse 🇮🇹 #Nephpearls
👉🏼 nature.com/articles/s4158…
Dr Zarbock will give a lecture on “AKI in cardiac surgery”
#37VicenzaCourse 🇮🇹 #Nephpearls
👉🏼 ccforum.biomedcentral.com/track/pdf/10.1…
#37VicenzaCourse 🇮🇹 #Nephpearls
👉🏼 ccforum.biomedcentral.com/track/pdf/10.1…
Hey #Nephpearls followers‼️ Learn more about monoclonal gammopathies by following the tweets of @onconeph
#IKMG2019 🇨🇦
#Onconephrology 🦀
👉🏼 fourwaves-sots.s3.amazonaws.com/static/media/u…
#IKMG2019 🇨🇦
#Onconephrology 🦀
👉🏼 fourwaves-sots.s3.amazonaws.com/static/media/u…
MT @onconeph Categorization of MGRS-associated renal lesions ca. 2019 from @NatRevNeph
#IKMG2019 🇨🇦
#Onconephrology 🦀
#Nephpearls
👉🏼 nature.com/articles/s4158…
#IKMG2019 🇨🇦
#Onconephrology 🦀
#Nephpearls
👉🏼 nature.com/articles/s4158…
MT @onconeph Diagram of MGRS-associated renal lesions ca. 2015 from @Kidney_Int
#IKMG2019 🇨🇦
#Onconephrology 🦀
#Nephpearls
👉🏼 kidney-international.org/article/S0085-…
#IKMG2019 🇨🇦
#Onconephrology 🦀
#Nephpearls
👉🏼 kidney-international.org/article/S0085-…
