Nephrology&nbsp;&nbsp;&nbsp;

What are some practical tips for when a patient's consistently stated goals of care do not correlate with their actions?

For example, what do you do when someone requests aggressive, life-prolonging treatments but then is not receptive to elements of day-to-day care in t...

4 Answers available

Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

How do you manage catheter-associated, upper extremity superficial venous thrombosis?

Do you prefer anticoagulation? Is there a role for aspirin? How strongly do you recommend line removal?

Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?

Patient is undergoing RT and has already started on a GnRH antagonist. If so, how long after their last fraction would be an appropriate wait time?

How has the FLUID trial, which showed no significant difference in death or readmission rates between Lactated Ringer’s solution and normal saline, influenced your approach to IV fluid management?

McIntyre et al., PMID 40503714

How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?

How does your approach vary by indication (critical illness, acute renal failure, hyponatremia, diuresis, etc.)?

Are there instances when you recommend central line access when treating a patient using 3% sodium chloride for management of severe hyponatremia?

Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?

How do you recommend incorporating B-lines on lung POCUS as part of evaluating a patient's volume status?

In particular, how do you reconcile situations where lung POCUS findings contradict other components of volume assessment (e.g. JVD, peripheral edema,...

Can tacrolimus in a transplant patient be used during radiation and concurrent chemoradiation?

Does your practice differ depending on the disease site?

In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?

What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?

For example, prolonging life-sustaining measures as they "wait for a miracle" of an unrealistic outcome.

When giving albumin challenge, for acute kidney injury with suspected hepatorenal syndrome, do you administer a single dose daily or split the dose of albumin?

Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., PMID 38320180

5 Answers available

Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?

How would you approach failure of maintenance therapy (Azathioprine) for PR3 positive, c-ANCA positive, pulmonary–renal vasculitis previously induced with cyclophosphamide, with a history of anaphylaxis to rituximab?

In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD?

How frequently do you monitor osmolarity?

How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?

4 Answers available

Do you wait until serum anti-GBM antibody titers are undetectable before hospital discharge in a patient with anti-GBM antibody disease with renal involvement who is receiving daily plasmapheresis, cyclophosphamide, and steroids?

Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

How do you determine which patients with ANCA associated vasculitis may be good candidates for reduced dose glucocorticoid tapering?

This question is part of our collaboration with ACR Convergence 2024 to Continue the Conversation from the meeeting. This question was inspi...

What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?

For example, is captopril dialyzable?

What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

Do you administer calcium to patients with K > 6.5 without EKG changes?

Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?

ACORN Randomized Clinical Trial

How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?

Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?

Are there patients with granulomatosis with polyangiitis on maintenance rituximab therapy for whom you do not co-administer glucocorticoid therapy?

Do you extend the duration of maintenance therapy past 24 months for patients with ANCA glomerulonephritis who have multiple organ involvement?

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?

What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?

How do you approach treating mild hypercalcemia in patients with sarcoidosis?

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?

How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?