Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?
According to one our smart fellows "SGLT2i turns the urine into a sugary orange juice", so it should not be given at the time of UTI or in persons with high likelihood of UTI or prior recurrent UTIs. Additionally, under the real world scenario when eGFR<25 ml/min, dialysis initiation can likely be d...
Do you avoid potassium citrate due to concerns with increasing the urine pH in patients with recurrent struvite nephrolithiasis who also have hypocitraturia?
Thanks for asking! My answer is: In general, "No", but it depends... Struvite stones can only form at un-physiologically high urine pHs. This situation occurs when urease-producing bacteria cause urinary infection. Urease splits normally occurring urinary urea to ammonium, raising the urine pH >7.0 ...
Do you prefer cinacalcet or etelcalcetide for patients with hyperparathyroidism in the setting of kidney disease?
In a group of vintage ESKD patients, assuming compliance is not an issue and hypocalcemia handled and Parsabiv utilized when approved, PTH still not controlled often. Over few thousands. The main reason is that the parathyroid hyperplasia turns to be nodular and encapsulated. And it’s time for surgi...
Would you start potassium citrate in a patient with recurrent nephrolithiasis of unknown stone composition who has hypocitraturia and alkaline urine pH?
I would be slow to start potassium citrate for a patient with alkaline urine and stones of unknown composition. Alkaline urine predisposes to calcium phosphate kidney stones, and potassium citrate would likely make the urine more alkaline and worsen the formation of calcium phosphate stones. First, ...
Is there a maximum dose of potassium citrate you would use for patients with recurrent calcium oxalate nephrolithiasis and hypocitraturia?
I don’t think there is a maximum dose of potassium citrate. Hyperkalemia can occur, especially if GFR is impaired, and monitoring for that is important. In my experience, diarrhea is the most common dose limiting effect. Taste fatigue is common; fortunately there are multiple preparations available ...
What is your approach to managing patients with recurrent calcium oxalate nephrolithiasis since childhood who are found to be gene carriers for mutations in genes associated with primary hyperoxaluria?
Thank you for this question. In general, there is no good evidence that patients with a carrier of 1 of the 3 primary hyperoxaluria genes (AGXT, GR/HPR or HOGA1) has any phenotype consistent with primary hyperoxaluria, or that these genes are enriched in the general stone forming population. That be...
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
Yes, captopril is dialyzable with about ~35% of the drug being removed during intermittent hemodialysis. It is not recommended to be used if an AN69 hemofilter is used for iHD, as it is associated with anaphylaxis with that particular filter. There does not appear to be any contraindications to usi...
How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?
Correction of hypovolemia with isotonic saline may result in overly rapid correction of hypovolemic hyponatremia once the stimulus for ADH secretion is removed, resulting in the excretion of a very dilute urine. Therefore, urinary electrolytes and osmolality should be closely monitored every 3-4 hou...
Do you use any urinary staining techniques when performing urine microscopy for patients with acute kidney injury?
No. Not at this time. At one point, about 10 years ago, we did have Wright stain to stain for eosinophilluria but it seemed too labor-intensive and not that helpful, so we stopped using it.
Have you considered priming CRRT machines with renal replacement solutions during the current crystalloid solution shortage?
I agree with Dr. @Dr. First Last. We are doing this as well.