Mark GN

Diagnostic and Interventional Nephrology, Interest in AKI and extracorporeal support therapies… 🍷,☕️,📚, ✈️ & 🎥. …….🏥🟰🫁🔄🫘

[Mark GN @MarkOO7S]

Feliz día de Starwars: May the 4th be with you

[Nefropildoras: Conocimiento en dosis precisas! @nefropildoras]

Qué es el índice de estasis venosa renal (IEVR) y para qué sirve medirlo? 🤔

[NephroPOCUS @NephroP]

Hepatic vein Doppler waveform components explained.
#POCUS #VExUS #Nephpearls
🔗https://t.co/hgFLH8VM39

[NephroPOCUS @NephroP]

The 60/60 sign is a cardiac #POCUS finding used to support the bedside diagnosis of acute pulmonary embolism. It refers to the simultaneous presence of two measurements, both involving the number 60.

RV outflow tract (RVOT) acceleration time ≤60 ms - This is the time from the onset of blood flow through the pulmonary valve to its peak velocity. In acute PE, the sudden obstruction causes blood to accelerate and decelerate abnormally fast, producing a "truncated" or shortened flow profile.

Pulmonary artery systolic pressure (PASP) ≤60 mmHg (but >30 mmHg) - estimated via the tricuspid regurgitation jet.

In acute PE, the thin-walled right ventricle cannot generate very high pressures because it has not had time to adapt. A PASP above 60 mmHg suggests a chronic process (e.g., chronic pulmonary hypertension) where the RV has hypertrophied over time

[NephroPOCUS @NephroP]

#POCUS #echofirst #Nephpearls
RVOT pulse-wave Doppler can provide useful clues about pulmonary vascular resistance.
In normal individuals (A), the waveform has a smooth, dome-shaped appearance, with peak velocity occurring in mid-systole, reflecting a compliant, low-resistance pulmonary circulation.
As RV afterload increases, the waveform gradually becomes more triangular. The RVOT acceleration time shortens, and the peak velocity shifts earlier into systole (B).
With further increases in pulmonary vascular impedance and reduced arterial compliance, a characteristic mid-systolic notch may appear (C), creating the classic "W sign."
In advanced pulmonary hypertension with RV failure, the Doppler envelope becomes smaller and more abbreviated, with a very short and steep AccT (D). This reflects rapid equilibration of RVOT and proximal pulmonary artery pressures due to severe afterload elevation.
Like most POCUS findings, RVOT Doppler should be interpreted in the context of the overall echocardiographic picture rather than in isolation.

[NephroPOCUS @NephroP]

#POCUS #Nephpearls #FOAMed

The RV should normally appear smaller than the LV in the apical 4-chamber view and should not exceed about two-thirds of the LV size. If the RV appears equal to or larger than the LV, significant RV dilation should be suspected.

Another helpful visual clue is when the RV becomes the apex-forming ventricle instead of LV. While this finding has not been formally validated with quantitative thresholds, it generally suggests at least moderate RV dilation.

If you remember just one measurement, remember this: the upper limit of normal RV basal diameter is 4.2 cm, measured at end-diastole in an RV-focused apical 4-chamber view.
Also assess RV wall thickness. An RV end-diastolic free wall thickness >5 mm (typically measured in the subcostal view) indicates RV hypertrophy, which often accompanies chronic pressure overload and RV dilation.

Finally, don’t forget to look for interventricular septal flattening on the parasternal short-axis view. Septal flattening (“D-shaped” LV) is another important clue to RV pressure and/or volume overload.

[Mark GN @MarkOO7S]

@brian_rifkin @eric_weinhandl Very true, we are still searching for the holy grail of vascular access; however, for now, it remains an Achilles' heel in nephrology.🦵⏭️🦿

[Mark GN @MarkOO7S]

12/
📚 Editorial:
“CRRT and ECMO: one love or separate lives?”
Schmidt M, Rimmelé T, Kashani KB.
Intensive Care Medicine (2026)
#ECMO #CRRT #AKI #CriticalCare #Nephrology #IntensiveCare #ExtracorporealSupport #NephrologyTwitter #FOAMed #ECMOlife

[Mark GN @MarkOO7S]

🧵 CRRT and ECMO: one love or separate lives?

[Mark GN @MarkOO7S]

11/
En la era del soporte multiorgánico extracorpóreo, ECMO y CRRT ya no pueden entenderse como terapias aisladas.
La integración entre pulmón 🫁🔄🫘 riñón y soporte circulatorio redefine el manejo del paciente crítico moderno.

[Srinivas Mahesh Prasad Nephrologist @NephPrasad]

RENAL BIOPSY
Sample Size and Needle Gauge

#Nephtwitter #MedTwittee #Nephrology