Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Do you recommend initiating immunosuppression and plasmapheresis in patients with dialysis dependent AKI in the setting of anti-GBM disease who do not have pulmonary involvement?
Anti-GBM disease is a rare disorder (incidence perhaps 1:1,000,000 adults/year) that is characterized as a small vessel vasculitis mediated by anti-GBM antibodies directed against the alpha-3-chain of collagen IV in basement membranes. Perhaps half of patients have disease that involves both the kid...
Are there instances when you use letermovir without the addition of acyclovir when managing a kidney transplant recipient for CMV prophylaxis?
I am assuming this question is about initial viral prophylaxis after transplant and exposure to induction immunosuppression. We have not used often letermovir as first line CMV prophylaxis outside of a research study, or during valcyte shortages. Cases where one might consider Letermovir as prophyla...
What is your approach to using calcium containing medications for patients with recurrent nephrolithiasis and hyperoxaluria?
Depending on their 24 hour urine, I suggest taking calcium with meals to bind oxalate and follow 24 hour urines.
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
Would you recommend initially starting twice-weekly outpatient hemodialysis with close lab monitoring for nonoliguric AKI patients?
It is unusual in my experience to initiate dialysis for AKI as an outpatient. More often, patients with prolonged dialysis-requiring AKI may need to be transitioned from an inpatient setting to outpatient dialysis while awaiting improvement in kidney function. The question of when to initiate dialys...
What is your approach to preventing exercise-associated hyponatremia?
Exercise-associated hyponatremia is typically due to fluid intake in excess of fluid loss. Therefore, athletes should avoid overconsumption of fluids. Rather, athletes should drink according to thirst. In addition, it is important to recognize that electrolyte-containing sport drinks does not provid...
Are there instances when you use a 3% sodium chloride infusion for patients with chronic hyponatremia secondary to SIADH but who are asymptomatic or have only mild symptoms?
One thing about 3% is that properly administered, the Na will rise. I have used it when I just want the PNa to increase ASAP, which for non neurological reasons may be something as simple as allowing the patient to go to the OR (they often have a minimal Na that they will give general anesthesia to)...
Do you recommend vitamin C supplementation with PO iron in patients with iron deficiency?
Vitamin C supplementation is unnecessary. Taking the iron with a glass of orange juice away from food and especially coffee optimizes absorption. That being said vitamin C does no harm. See vonSiebenthal et al eClinical Works 2023 (Lancet publication), Benson et al, Lancet Haem 2025 or Auerbach et a...
Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?
No. Stopping denosumab leads to rebound bone resorption and loss of all gains. The hypocalcemia indicates insufficient calcium and/or calcitriol. Calcium intake should be 1,000-1,200 mg daily from food and/or supplements in divided doses with food.
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...