Nephrology
Clinical discussions on kidney disease management, dialysis, transplantation, and electrolyte disorders.
Recent Discussions
Under what conditions do you perform a post-procedural kidney ultrasound in patients who recently underwent a kidney biopsy?
The most important complication of renal biopsy is bleeding. Ultrasound helps in the detection and monitoring of an enlarging hematoma. In some practices, the patient is discharged after 6-8 hours after a biopsy. Ultrasound is done at 1 hour (which detects only 20% of bleeding) and then at the time ...
Do you advise patients to limit physical exertion including lifting heavy objects following a kidney biopsy?
I don’t think there is data on this, who would do a trial, but for an uncomplicated biopsy I tell them to take it easy for 3 days, usually over the weekend, a reason I like to do them on a Friday. No sports no working out no heavy lifting. I also tell them not to just lay around because if they are ...
Which patients do you recommend referral to interventional radiology to perform a kidney biopsy?
There are a few instances when I would refer to an IR to perform a kidney biopsy: Obese patients when the kidney is deep Biopsy of target lesions within the kidney Transjugular kidney biopsy
How frequently do you obtain 24 hour urine stone risk profiles in your patients with kidney stone disease who pass less than one stone per year?
When I do 24h urine collections in patients, I repeat the collection in order to see if the goal of therapy was achieved. Whether that was fluids, dietary changes, or medications, I usually want to see if we were successful. After that, I'm less interested in repeating the study especially if the st...
In which patients do you obtain genetic testing for further evaluation of kidney stone disease?
First stone as a pre-adolescent, stone complicated by kidney failure, history of growth retardation, family history of stones or nephrocalcinosis or unexplained kidney failure, hearing impairment, ocular crystals High stone burden on imaging or nephrocalcinosis Concomitant low molecular weight prot...
How do you advise your kidney stone patients about optimal daily fluid intake?
Measuring urine is better than counting liters of intake and shoot for 2-3 liters/day. If they aren’t getting up most nights to urinate they probably aren’t drinking enough water. When they get tired of drinking and urinating I tell them to remember the pain associated with their stone.
What is your approach to the medical management of struvite kidney stones?
It is difficult to separate medical and surgical management of struvite stones, since these stones are typically the consequence of persistent or recurring infections. Surgically, risk factors for infection need to be addressed, which may include efforts to remove any retained stone material, follow...
What dietary advice do you provide your patients with calcium oxalate nephrolithiasis?
High water intake (at least 2.5L of urine volume per day) Low sodium and low animal protein intake (high dietary sodium and high animal protein correlate with higher urine calcium) Normal dietary calcium balance around 1000mg per day (maintain bone health and ensure adequate dietary calcium to bin...
Do you use 24 hour urine stone risk profiles for purposes other than managing nephrolithiasis?
In patients with enteric risk factors for hyperoxaluria and kidney disease without a clear cause or in those with confirmed calcium oxalate deposition on kidney biopsy (even in the absence of history of kidney stones), I check 24-hour urine supersaturation. The data helps guide treatment approach to...
Would you consider clearing a patient with essential thrombocytosis for a kidney donation?
For brevity, I am assuming that the patient is already medically approved for surgery and organ donation, and I will focus on the clinical significance of the essential thrombocytosis (ET) with regard to both. I am also going to assume that the patient actually has ET, and not masked polycythemia ve...