Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
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)...
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.
Is there a serum potassium level for when you would recommend discontinuing potassium citrate in a patient with recurrent nephrolithiasis, hypocitraturia, and hyperkalemia?
I take hyperkalemia seriously, as cardiac effects do not correlate closely with serum levels. If evaluation does not reveal a correctable cause, I would decrease potassium citrate dosage to keep serum potassium below 5.0. Stephen B. Erickson, MD
How do you manage polyuria and polydipsia from lithium?
My first step is to confirm that the symptoms, including polydipsia and polyuria, are due to NDI and not other reasons. Other potential causes that should be excluded are: Psychogenic polydipsia other substance-induced, such as caffeine, diuretics primary DM pituitary related CKD Lowering the dose...
Would you avoid a 24 hour urine collection for creatinine clearance measurement in a patient who is on fluid restriction?
No. The creatinine clearance should still be accurate if done correctly. The only problem may be if the urine output is lower, minor mistakes in urine collection will lead to bigger inaccuracies.
How often do you recommend basic metabolic panel checks in a hospitalized ESKD patient on thrice weekly hemodialysis and for whom hyperkalemia is not of major concern?
The ease (usually no venipuncture), cost (miniscule relative to the overall cost of hospitalization), blood loss (not much) and utility (varying from little to significant depending on the clinical setting) indicate at least thrice weekly BMPs. A very ill, ICU patient will need a daily BMP while an ...