Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Would you advocate for SGLT2 inhibitors if they are not fully covered by insurance in patients with moderately increased albuminuria (< 300 mg/g) who are on maximal dose ACEi/ARB?
I think the benefit would be minimal. I would not necessarily have the patient pay extra money to get them.
What is your preferred fill volume, dialysis solution, and dwell time for patients with suspected peritoneal dialysis associated peritonitis who arrive to the hospital with a dry abdomen?
I agree with Dr. @Dr. First Last's approach with one addition: prior to instilling the fluid for 2 hours, I would do a quick flush of the abdomen- fill and drain immediately- to remove the cells that accumulated while the abdomen was dry, and thereby avoid "muddying" the waters (pun intended).
What is your approach to determining if a patient treated with vancomycin has ATN related to vancomycin or the underlying infection?
For the most part, I would assume it is the underlying infection. Very high vancomycin levels and its combined use with Zosyn make me wonder about vancomycin toxicity, especially if the infection has been well treated.
How would you approach the decision to biopsy a kidney transplant recipient who previously experienced a Page kidney following a kidney biopsy?
The decision to perform a renal biopsy should be made after thorough deliberation regarding the appropriate indications and the potential diagnostic information that the procedure may yield to inform patient management. Under suitable conditions, renal biopsy is considered a safe and well-tolerated ...
Would you avoid potassium citrate initiation in a pregnant patient with hypocitraturia and recurrent calcium oxalate nephrolithiasis?
I agree with Dr. @Dr. First Last, there is no clear contraindication. However, it would not be my first step. Preferable would be to optimize dietary and fluid therapy first. Stephen B. Erickson, MD
Under what circumstances would you use tenapanor over more frequently prescribed phosphorus binders for managing hyperphosphatemia in CKD patients?
Our current experience has been using tenapanor only as an added medication to oral phosphorus binders when further reduction of serum phosphate is required. We have not used tenapanor as the primary medication to control hyperphosphatemia, but this may change in the future as we learn more about th...
Do you recommend avoiding SGLT2i use for patients with proteinuria from diabetic kidney disease if they have urinary retention requiring catheterization?
I would probably avoid SGLT-2 in such a patient because of the risk of infection. Likely, the risk is not worth the benefit.
What would be the clinical role of SGLT-2 inhibitors for lupus nephritis given it has an indication for proteinuria related to CKD?
The benefit for SGLT-2 inhibitors at slowing the progression of kidney disease or death from cardiovascular causes had been well established in patients with diabetic nephropathy. Further studies continued to demonstrate benefit in non-diabetic, proteinuric kidney disease (HR, 0.72 (95% CI, 0.64-0.8...
Do you adjust the hemodialysis bicarbonate bath to match the elevated serum bicarbonate level in ESKD patients with hypercarbia due to COPD?
I do not typically for COPD itself, but I do consider it in circumstances where there is severe resp acidemia with no other options for stabilizing their pH. In a subset of patients on home ventilation/AVAPS, they have little reserve to handle even a little more CO2 retention. I will modulate the di...
Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?
Hypocalcemia can be prevented by providing adequate calcium, 1,200-1,500 mg in divided doses daily, and adequate calcitriol to absorb it. Good results also occur when the patient has tertiary hyperparathyroidism with hypercalcemia.