Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Is there a role for early GLP-1 therapy for weight loss in patients with early-stage ADPKD and obesity, given the association between obesity and the risk of progression to ESKD?
Indeed, maintaining a healthy BMI is an important evidence-based guideline in ADPKD, but no data exist for early GLP-1 therapy and early-stage ADPKD at this time. Weight loss has not yet been shown to be protective of eGFR in ADPKD, although of course, conceptually, we believe that to be true. That ...
In a hospitalized patient who undergoes a MRI with gadolinium contrast study, would you perform hemodialysis if they have AKI with prior dialysis requirements but do not currently otherwise meet criteria for dialysis?
I would not. Although gadolinium contrast has been associated with nephrogenic systemic fibrosis in patients with advanced CKD or AKI, the risk is much lower for the newer generation contrast agents with more tightly chelated Gd. That said, the risk is not zero, as reviewed in a recent CJASN perspec...
Can contrast instilled through a displaced PEG tube that extravasates into the abdomen cause acute kidney injury?
That's an interesting question. Gastrografin (diatrizoate), used for gastrointestinal (GI) imaging, is poorly absorbed from the GI tract. Nonetheless, low levels of renal excretion of Gastrografin can be seen in some normal individuals and in patients with losses of GI mucosal integrity. Leakage of ...
What criteria do you use to determine if a patient with chronic asymptomatic hyponatremia is safe to proceed with surgery?
A patient with chronic hyponatremia is generally considered safe to proceed with surgery when the serum sodium level is ≥ 125 mmol/L (preferably ≥ 130 mmol/L) if the level is stable and truly chronic and the patient is clinically asymptomatic. In addition, the surgical team should be advised on the ...
What is your approach to differentiating Randall plaques from actual small non-obstructing stones when reviewing imaging testing for your patients with recurrent nephrolithiasis?
I don't worry about the distinction, since that would not impact my recommendations for lowering risk for stones. In a previously identified stone former, the goal is to prevent the accumulation of stones, so this finding would simply establish the state of their disease at a time point that can be ...
How does VExUS evaluation differ in a patient with a transjugular intrahepatic portosystemic shunt (TIPS)?
This is a very interesting question, and I don't think I have ever tried to look at VExUS in a patient with a TIPS before! Although, based on what I understand about this study, I would be cautious about relying on the original VExUS algorithm that incorporates hepatic vein, portal vein, and intrare...
Do you take any special considerations for a patient with ESKD who has an ileostomy/colostomy and wishes to start peritoneal dialysis?
My special considerations are to probably avoid PD. But it depends on what the surgical history was for that ileostomy or colostomy, e.g., there may be a lot of scar tissue. When PD works (flows easily in and out), it works; when it doesn',t it doesn't and if doesn't it usually doesn't get better (4...
Do you routinely mention the risk for encapsulating peritoneal sclerosis as part of your consent process for dialysis initiation in a patient with advanced CKD who is considering the different dialysis options?
I do not do so. The incidence of EPS within the first 5 years of PD is extremely low. Just as I do not discuss with patients the possible occurrence of rare complications of HD (e.g., osteomyelitis), I do not discuss EPS either. The ISPD recommendation is to consider discussing the possibility of EP...
Do you plan to incorporate fish-oil supplementation into the care of hemodialysis patients to reduce cardiovascular events in light of the PISCES trial results?
I showed the paper to an Internal Medicine friend of mine who is more statistically savvy than me. He wrote this: "So I read the study, and I’m still at a loss to understand it. I’m pretty Bayesian, but this study breaks my priors. Prior studies were basically negative, not to mention that nothing e...
Do you recommend zinc for patients with advanced CKD who have dysgeusia?
I do not recommend routine zinc supplementation for advanced CKD patients with dysgeusia due to mixed evidence and the risk of copper deficiency due to zinc supplementation. Zinc can interfere with copper absorption and may potentially cause copper deficiency. However, a trial of zinc supplementatio...