Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
What do you measure, what is your cut off, and what is your preferred kidney function assessment tool for prospective kidney transplant donors?
We measure kidney function by combination of 24 hour urine collection for creatinine clearance as well as estimated GFR using cystatin C based equation. We used to do Iothalamate clearance on a regular basis but due to staffing issue we have been doing this in very selected patients. Cutoff in gener...
Do you recommend using a risk equation or eGFR alone in deciding when to refer a patient with advanced CKD for vascular access placement?
This is not an easy question, I still rely on patients trajectory, clinical judgement.
Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?
I would probably avoid SGLT-2 inhibitors in this setting unless some compelling reason to use one. Other agents for renal protection should be optimized.
Do you offer home administration of ESAs for your patients with anemia of chronic kidney disease?
Yes, it the patient's prescription drug plan allows it. Traditional Medicare does not allow home administration of ESAs since they are covered under part B rather than part D. However, many Medicare Advantage and commercial insurers do allow for home administration of ESAs, so I offer that option to...
Would you transition a patient with recurrent calcium nephrolithiasis and hypercalciuria from chlorthalidone to indapamide if they report sexual dysfunction side effects?
Yes. Indapamide is a thiazide-like diuretic that decreases urinary calcium excretion by increasing renal tubular reabsorption of calcium. In my experience, it is less likely to create sexual dysfunction than a true thiazide diuretic. Stephen B. Erickson, MD
Do you recommend genetic testing to evaluate for primary hyperoxaluria in patients with recurrent calcium oxalate nephrolithiasis who have profound hyperoxaluria but also have a surgical history compatible with enteric hyperoxaluria?
Usually not. With that clear history, I wouldn’t think genotyping would have any yield. If the patient had a history of stones prior to the bariatric surgery, that might be different. As the price of genotyping declines, one could argue about this, especially if kidney transplantation is considered,...
How do you counsel patients on peritoneal dialysis regarding the safety of engaging in aerobic and resistance exercises, considering the risk of developing abdominal wall complications?
The effect of exercise on intra-abdominal pressure (IAP) while on PD was examined decades ago by Twardowski et al., PMID 3774076. They found that walking, jogging, or using an exercycle resulted in only modest increases in IAP, while jumping or straining (e.g. weight- lifting) resulted in more marke...
How do you approach kidney transplant candidacy in a patient over 75 who is otherwise medically fit?
Age is not a categorical but a continuous variable. ESRD patients with both cognitive and physical health and ability should receive a kidney transplant vs. dialysis if they so choose after proper education. Limiting factors should be a lack of demonstrated physical activity, prior history of CVD, c...
Do you use genetic testing as part of your work up for potential thin basement membrane disease?
Absolutely. Collagen abnormalities are often seen in thin basement membrane disease, and they can also help determine if there is concern for Alport syndrome.
Do you counsel patients to take antihypertensives at specific times of day to maximize efficacy or minimize side effects?
Generally, I emphasize medication adherence over the time of day. As long as it is a once-a-day medication and they are not having other side effects, I tell them that the best time to take their medication is the time that they will always remember.