Kidney doctor. Founder of Dharma Kidney Care. Adjunct associate professor at Apollo Hospitals,BG Road, Bangalore. Making life easier for kidney patients.
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We live in an age of too much noise and few signals. We were better at managing edema before so many tests became available. There's no signal that's more useful than a patient who feels better with decreasing weight and diuresis.
One of the common criticisms of NephroCheck and other biomarkers of AKI is that since we don't have a treatment for AKI, checking these do not change what we do.
But I think this view isn't thoughtful.
Given that most of the contrast associated nephropathy we see after cardiac cath has been shown to be meaningless hemodynamic changes in creatinine and not actual tubular damage, we could have avoided scaring a generation of doctors in to believing in contrast nephropathy had we evolved from creatinine to biomarkers.
Similarly, how many heart failure patients have gotten inadequate diuresis because of panic over a bump in creatinine? I suspect, had we transitioned to biomarkers of kidney injury, cardiologists and nephrologists would have been more confident in pressing forward with needed diuresis.
Better diagnosis would allow better management despite not having an AKI pill (yet).
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This was a patient with FSGS that we managed two years ago. 10 kgs over recent weight and e
uncomfortable because of edema. Usual measures plus high diuretic doses -- 240 mg Lasix IV, metolazone 10mg and spiro 100mg with albumin didn't move the needle over 5-6 days. Over the next