Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Do you recommend patients consume dairy products over taking calcium carbonate with meals if they have recurrent calcium based nephrolithiasis and persistent hyperoxaluria?
I generally consider the decision between dairy and calcium tablets in the context of other medical conditions. For instance, if the patient has surgical or medical short gut syndrome as a cause of hyperoxaluria, I favor using calcium tablets to help compensate for the enteric loss of bicarbonate in...
What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?
Probably NS but if the Na crept up at all, would change to 1/2 NS. I dont see a need here for balanced solutions, but wouldn't argue against them.
Do you try to treat the acidosis resulting from acetazolamide in patients with IIH?
In general, I do not treat the acidosis of acetazolamide use as it occurs in everyone taking the drug. I only treat it if the symptoms of the acidosis interfere with the patient's activities of daily living.
Do you recommend checking 1,25-hydroxy vitamin D levels in patients with recurrent nephrolithiasis who have hypercalciuria of unknown etiology?
No, unless they are hypercalcemic or I suspect renal sarcoidosis. Stephen B Erickson, MD
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
Under what circumstances would you consider obinutuzumab instead of rituximab when treating primary membranous nephropathy?
Obinutuzumab is a Type II fully humanized glycoengineered anti-CD20 monoclonal antibody with marked B-Cell depletion along with greater antibody dependent cytotoxicity when compared to Rituximab.Currently, its use in 'primary' membranous nephropathy is limited to only refractory cases wherein Rituxi...
Would you consider a patient with spina bifida and end stage kidney disease secondary to reflux nephritis with an ileal conduit for a kidney transplant?
In general, patients with ileal conduit and those with neobladder can be considered for kidney transplantation.
Would you recommend transition to hemodialysis for a patient with calciphylaxis, hyperphosphatemia, and ESKD on peritoneal dialysis?
Changing from PD to HD is a tough decision but I would do it for calcemic uremic arteriopathy CUA (calciphylaxis) for two reasons, increase clearance and guarantee IV delivery of sodium thiosulfate (STS). Peritoneal STS has been describedMataic & Bastani, PMID 16771254But I think CUA is life-threate...
Below what platelet count would you avoid using an AV fistula in a patient with ESKD and thrombocytopenia?
Great question & the answer is likely debatable based on personal experience. Review of some case reports show no evidence of prolonged bleeding after AVF cannulation with platelet counts as low as 37,000 (1). Platelet counts can drop by 5- 15% with initiation of HD normally. They fall during the fi...
Would you recommend avoiding PICC line placement in a kidney transplant patient with an estimated GFR of more than 45 ml/min/1.73m2 and no functional AV access?
Great question and of course there is no data to guide decision-making in this scenario. Anecdotally, I would assess the patient as a whole, not just limited to current GFR though that is a great starting point. What is their age and co-morbidities - is this a younger /middle-aged/older patient, is ...