Jaswanth

Kidney Doctor

[Dr. AK 🇮🇳 @docakx]

Mariano Barbacid's whole team at Spanish National Cancer Research Centre (CNIO).

[Jaswanth @jaswanth627]

@Agarwalja_Aiims Congratulations and best wishes

[Jason Gordan @jasongordo626]

@DrNeilStone

[Dr. Glaucomflecken @DGlaucomflecken]

40% of students apply to med school with no intention of practicing clinical medicine? That seems high. Is that a real stat?Physicians are leaving medicine because the government and private corporations sponsored by the government have made our jobs miserable and almost impossible. Fix that first please.

[Medlarge @medlarge]

End of an era at @aiims_newdelhi !
Dr. J.S. Titiyal, Padma Shri awardee and pioneer in live corneal surgery, retires as Chief of the RP Centre for Ophthalmic Sciences.
Faculty members applaud with heartfelt respect, their eyes brimming with tears and honors.
@AIIMSRDA

[Jasmine Sethi @JasmineNephro]

😬🫘Do you discontinue ACEi/ARB in advanced renal failure 🌚

STOP ACEi Trial✍️

Read insights from @isn_india newsletter @KidneyKolumns ✍️Dr Mudit

[Jaswanth @jaswanth627]

@IamGopambuj @vinayrathoremd @aiims_rpr @vinaykumarav Yes I guess. Plss DM me.

[vinay rathore @vinayrathoremd]

2nd Convocation @aiims_rpr . Congratulations to @vinaykumarav and Jaswant Dola who were our first and second DM student, for being awarded, DM Nephrology.
Your contribution to build the Department had been immense. All the best for your Future. May you enjoy Nephrology!

[Jyoti Aggarwal @Agarwalja_Aiims]

First Pediatric cadaveric kidney transplant patient discharged🥳🥳Celebrations at AIIMS-RAIPUR 😇 It is so gratifying to see the kid and happy parents✌️Wishing him and his graft a long healthy life😍🙏🤞

[Sundar Sankaran @sundar_s1955]

Wonderful eulogy on Dr George Bakris legend of hypertension prevention and management
25 years ago in his lecture on ACE Inhibitors he said physicians are scared to use it as this drug may increase creatinine which is a physiological response not a toxic response it's akin to using Beta Blockers in hypertension
When you use Beta Blockers if Hypertension is controlled and Heart rate drops for 80 to 55 will you stop Beta Blockers -No same way ACE Inhibitors increasing creatinine should be accepted
This has been my mantra since then

https://t.co/KhA64tBKM1

[Ross Prager @ross_prager]

@FH_Verbrugge discusses the top 10 diuretic mistakes at #HR24 .

If you prescribe lasix you need to read these key mistakes👇

10 Diuretic mistakes 🧵

#1: Not getting the job finished.. don't stop diuresis too early. If you fail to decongest, outcomes are worse and there is a higher risk of readmission to hospital.

#2: Being distracted by serum Creatinine.. rising Cr does NOT indicate dying kidneys!!

#3: Giving oral loop diuretics for in-hospital pts. with clear fluid overload (instead of IV diuretics)...

When dosing loop diuretics, there is a threshold effect that until above that you get no effect, and then a ceiling effect where any more diuretics don't increase diuresis.

#4: Underdosing (loop) diuretics and compensating with increasing maintenance outpatients doses instead.

Lasix dose = 1-2 times oral maintenance dose only makes sense IF the maintenance dose was appropriate... might not be the best place to start.

Does house of god (book) have it right? Adjust based on GFR. If you have poor kidney function need higher dosing... general gestalt
GFR>45 --> 80 IV lasix
GFR 30-45--> 120 IV lasix
GFR <30 -->120 IV lasix

#5: Too infrequent dosing of loop diuretics
LaSIX --> lasts six hours.
If you dose too infrequently then you get Na resorption in-between diuretic doses.
Start BID or TID with Lasix, not once daily! (sometimes even QID)

#6: Using loop diuretic drips (No lasix infusions!)
Higher plasma-renin activity with diuretic infusions...

#7: Failure to recognize fluid overload when cardiac filling pressures are normal / not terribly elevated

You can be overloaded with normal filling pressures. Volume does NOT equal pressure.

If overload + high filling pressures --> diurese fast

If overload + low filling pressures --> diurese slow

#8: Mistaking one size fits all for diuretic resistance
Steps to treat diuretic resistance:
1. Maximize Loop Diuretic
2. Add thiazide like diuretic (e.g Metolazone)
3. Add other nephro segment blocker (Acetazolamide, Spiro, Empagliflozin, Amiloride)
4. Consider hyperdiuresis (3% saline with diuretics)
5. Consider diuresis

#9: Don't be afraid of combination diuretic therapy
ADVOR trial: acetazolamide added to loop diuretic improved decongestion. We need to start thinking about multi-modal diuresis!

#10: Don't mistake decongestion for dehydration
Decongestion is about removing sodium.

Positive sodium balance with net fluid loss still portends worse survival (Hodson et al 2019).

#echofirst #Cardiology #medtwitter #foamed #foamcc #pocus #physiology

The key is in the pee
Check urine sodium concentration 1-2 hours post diuretic ... want a urine Na > 100 ideally (<80 is diuretic resistance)

[JanaSena Party @JanaSenaParty]

జరిగిందంతా "జగన్" నాటకం - జరగబోయేది రాక్షస సంహారం!

#YCPLosingBig | #APVotesForAlliance

[Dr Benil @hafeeq_benil]

Hot Topics in Glomerulonephritis: Online Symposium from the Indian Socie... https://t.co/lbmKqFgfyp via @YouTube

[vinay rathore @vinayrathoremd]

@aiims_rpr conducted its fourth Deceased Donor Organ Donation and its fifth Deceased Donor Renal Transplantation. A salute to the family members of the Deceased who at difficult times have donated organ&amp; tissues saving six lives.@NottoIndia @DghsIndia @PMOIndia @mansukhmandviya

[AIIMS, Raipur, CG @aiims_rpr]

#aiims_rpr has successfully transplanted 21 kidneys in the last year, and more than 50 patients are in waiting list. Experts in AIIMS say that some districts in CG and nearby areas in Odisha are posing a challenge for kidney patients.
#Chhattisgarh
#MoHFW_INDIA

[Iqraa Kidney Care @iqraakidneycare]

kidney allograft biopsy performed between January 2004 and March 2016 displaying dnTMA. Ninety-two patients were included. The median time of occurrence was 166 (IQR 25-811) days. The majority (82.6 %) had TMA localized only in the graft.

[Sahil Bloom @SahilBloom]

I can't stop thinking about this question:

Are you willing to sprint when the distance is unknown?

In 2021, Georgia Tech strength coach Lewis Caralla delivered this epic speech to the football team.

If it doesn't get you motivated, you may need to check your pulse...

He opens with a few harsh truths:

• Winning isn't loyal to you
• Winning doesn't care about you
• Winning doesn't care how sore you are
• Winning doesn't care how hard you work
• Winning doesn't care how much sleep you get

But it's his question that stuck with me:

Are you willing to sprint when the distance is unknown?

The willingness to sprint with no clear view of the finish line is rare.

It requires two things:

1. A deep belief in one's self
2. A deep belief in the mission

If you have 1 but not 2, you won't be able to do it.

If you have 2 but not 1, you won't be able to do it.

You need both.

In my observation, the greatest things in life are accomplished when you're willing to sprint when the distance is unknown:

The sprint to care for your loved ones in their time of need.

The sprint to build something meaningful.

The sprint to serve others and create positive ripples in the world.

Goal: Find those rare things in life that you're willing to sprint for when the distance is unknown.

That, to me, is the definition of winning.

"And why chase winning? Because the only thing that's guaranteed in life if you don't chase it is losing."

[Jaswanth @jaswanth627]

@JasmineNephro Genetic tests: Initial steroid-resistance with: (i) onset during infancy; (ii) family history of steroid-resistance, (iii) extrarenal features, (iv) non-response to calcineurin inhibitors, (v) prior to transplantation

ISPN 2021 guidelines they don't advise in all SRNS madam.

[Jithu Kurian🇮🇳 @Jithukurian6]

🤔🤔 Dr Bholu, a recently passed out Nephrologist has so many doubts ❓❓

🛫 He has booked his tickets for the biggest nephrological academic feast , the ISNCON 2023 , Kolkata 📚

🔥He is also determined to make his learning complete by attending ‘ Nephrology beyond classrooms’ conference organised by MKF

🎙️🎙️ Are you attending it ?

📆 13 th December 2023, 1: 30 pm onwards

📍 Kolkata

👍👍If yes then fill this up

https://t.co/QmmlU6YWWS

@Ubkhanna @BeheraVineet @Nikhilb5887 @happiedoc @priti899 @AnandhUrmila @varunkumarbandi @DrPallaviPrasad @nephronisha @SKhushboo09

[vinay rathore @vinayrathoremd]

AIIMS Raipur conducted its 2nd second deceased donor Multiorgan donation, fourth of the state ⁦and second deceased donor renal transplant.
@NottoIndia @IndiaSoTx @cghealth_
@DghsIndia @mansukhmandviya