Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Do you avoid potassium citrate in patients with recurrent nephrolithiasis and hypocitraturia if they also take antihistamine medications?
I know of no data showing effects of antihistamine meds on urine citrate or on the effects of potassium citrate on urine citrate. I made a Perplexity search which also found no evidence - this is not a topic I have personally researched because I have never encountered clinical issues about it. So -...
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...
Do you routinely continue dual antibiotic coverage or de-escalate to monotherapy based on peritoneal fluid culture sensitivities in patients with relapsing pseudomonas aeruginosa peritoneal dialysis peritonitis after peritoneal catheter removal?
If the peritoneal dialysis catheter has been removed then I would de-escalate to monotherapy based on the fluid culture sensitivities. Monitor clinical response and obtain new fluid samples for analysis if any concern for persistent infection.
Would you perform a kidney biopsy to rule out other etiologies before diagnosing Loin Pain Hematuria Syndrome in a patient with persistent microscopic hematuria, left flank pain, no proteinuria, normal renal function, normal cystoscopy, and normal imaging?
Probably not unless something changes.
What are your top takeaways from ASN Kidney Week 2025?
Atacicept (ORIGIN Phase 3 Trial)Result: At 36 weeks, atacicept achieved a 46% reduction in proteinuria from baseline and 42% vs placebo (p<0.0001). Safety profile was favorable, with fewer serious adverse events than placebo. First large-scale evidence that dual BAFF/APRIL inhibition can modify dis...
What would be your approach to managing severe ANCA-associated vasculitis in a patient who is also septic from a bacterial infection?
It is prudent to evaluate if the ANCA-associated vasculitis is being triggered by the underlying bacterial infection. Certain clues on the kidney biopsy including diffuse exudative as well as diffuse crescentic [of same age] pattern of injury on light microscopy, intense C3 staining on immunofluores...
Is the accuracy of continuous glucose monitors (DEXCOM or Libre) lower in patients undergoing dialysis?
The question of the accuracy of CGM in dialysis patients is an important one and has been debated for some time. CGM is a superior method for glucose management over fingersticks in most clinical settings. Patients with ESRD on dialysis in particular, can have very difficult-to-control diabetes. A r...
For patients on peritoneal dialysis with type 2 diabetes mellitus, do you have a preferred long- acting insulin and time of insulin administration?
Insulin management in patients on peritoneal dialysis can be tricky. In my experience, you have to be very cautious with long-acting insulin. Much of the hyperglycemia occurs during the exchanges with the dextrose solution. Therefore, using long-acting insulin can cause hypoglycemia. My suggestion i...
How do you counsel patients with CKD who are on a PPI given a prior observational study showing an association between PPI use and incident CKD?
I am a little conflicted about this topic and have changed my practice in the last 4-5 years.There are multiple observational studies that suggest an association between PPI and CKD but residual confounding remains a concern in these studies. A nice commentary on this topic was published last year i...
How do you approach the management of a kidney transplant recipient who develops de novo donor-specific antibodies but shows no clinical signs of rejection or graft dysfunction?
Context is important. Was this part of a surveillance protocol for a high risk patient to monitor for DSA early post transplant? Or checked prior to making changes to immunosuppression eg Belatacept conversion? Creatinine and proteinuria are late signs of graft damage. So even if neither is present...