Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Do you favor obinutuzumab over voclosporin for patients with lupus nephritis and significant proteinuria and a history of non-adherence to medications?
Non-adherence to medications is a common issue in lupus patients, but this can be even more of a concern in lupus nephritis, where the pill burden for patients can be so high. I usually prefer to use intravenous medications for patients who have had difficulty adhering to oral medications in the pas...
Do you recommend CT or ultrasound imaging testing when monitoring a patient with nephrocalcinosis?
I recommend CT. It is much more sensitive for detecting small changes in calcification than US. Yes, it is more expensive and requires a small amount of radiation, but if monitoring is indicated, I think sensitivity is most important. Stephen B. Erickson, MD
What are your thoughts on patients presenting with hyponatremia receiving IV fluids before urine studies are collected and the etiology is fully characterized?
Whenever possible, I try to obtain serum osmolality, urine osmolality, and urine sodium before giving IV fluids. A urine specimen requires only a small volume and can usually be collected at the same time as the initial bloodwork without meaningfully delaying care. That said, treatment should never ...
How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?
There is no osmotic diuresis, and they do not need IVFluid, the opposite is true they may appear intravascularly overloaded, and will respond to insulin alone, they do not need HD for this. They will not be K deficient, do not give K. Their potassium will likely respond to insulin alone, and should...
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?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
Do you add an SGLT2 inhibitor to mineralocorticoid receptor antagonist therapy in a patient with primary aldosteronism who is not a surgical candidate, given retrospective data showing significantly lower mortality and cardiorenal events with the combination?
I have expanded the use of SGLT2-INHs beyond the core indications of HFrEF, DM2, and proteinuric CKD to include CV risk reduction for those at higher risk. Patients with primary aldosteronism often have a high ASCVD risk by PREVENT risk calculator, and would benefit from SGLT2-INH use.
What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?
I prefer to give ferumoxytol 510 mg X 2 doses of available.
Would you pursue a kidney biopsy in an obese patient with a history of preeclampsia who has nephrotic range proteinuria, negative serologic work up, normal serum albumin, and normal creatinine?
Yes. I would wait 6 months after delivery, and if proteinuria is still present, I would do a kidney biopsy.
Do you avoid prescribing thiazide diuretics for hypertension management in ADPKD patients, given concerns about vasopressin release?
No. Although thiazide diuretics may theoretically increase vasopressin secretion through mild volume contraction, there is currently no clinical evidence that this adversely affects ADPKD progression or should preclude their use. Notably, the HALT-PKD trials, data from which established much of our ...
Which blood pressure medications do you favor using to manage ongoing hypertension post adrenalectomy for hyperaldosteronism?
If primary hyperaldosteronism is cured by adrenalectomy, it would be the usual management of HTN; otherwise, I would use spironolactone.