Sanjay Kothari

Nephro

[Deepak Kumar Panigrahi @deepak_dr_2020]

Urology for Nephrologist by Stalwarts of Urology #drrajeevkumar, #dranantkumar

[Shreshta Tripathi @ShreshtaT]

HF + CKD = treat by EF + eGFR 🎯

✅HFrEF:
<15 → β-blocker + nitrates
15–29 → + SGLT2i (>20) ± vericiguat
30–59 → + ARNI/ACEi/ARB + MRA
≥60 → full GDMT

✅HFpEF:
SGLT2i backbone; add nsMRA (>25), ARNI if EF ~50%
@goKDIGO

https://t.co/JnSDa6Mq6x

[Sanjay Kothari @sanjay_nephro]

@arkanalabs Podocytopathy, would present with nephrotic range proteinuria and nephrotic syndrome.

[Sanjay Kothari @sanjay_nephro]

@arkanalabs Primary Pauci immune RPGN/ANCA Vasculitis Associated Cresentic GN.

[Sanjay Kothari @sanjay_nephro]

@CuriousClinPod How might Ca change resting and threshold potential? @tony_breu

[Sanjay Kothari @sanjay_nephro]

@JasmineNephro Why is Urine Ca/Cr ratio increased in distal RTA only? 🤔

[Sanjay Kothari @sanjay_nephro]

#askrenal 👇

[Sanjay Kothari @sanjay_nephro]

@arkanalabs How to differentiate if it is Mesangial Hypercellularity or Endocappilaey Hypercellularity?

[Sanjay Kothari @sanjay_nephro]

My understanding is that with endocapillary proliferation the capillary lumen will be closed and it will be open in case of Mesangial Hypercellularity. But I am not so sure and it still seems confusing.

[Arkana Laboratories @arkanalabs]

@Sanjayshkothari Paging Dr.@Tiff_Caza to answer this question!

[Sanjay Kothari @sanjay_nephro]

@arkanalabs How to differentiate if it is Mesangial Hypercellularity or Endocappilaey Hypercellularity?

[Sanjay Kothari @sanjay_nephro]

@arkanalabs Which stain is used here? 🤔

[Sanjay Kothari @sanjay_nephro]

@BrownJHM @drkeithsiau Polycystic Kidneys?

[Sanjay Kothari @sanjay_nephro]

@mendesthiagob Hypervolemic HyperNa, as with bicarb or hypertonic saline infusion.

[Roger Rodby @NephRodby]

15) Ethanol also ⬆️ osmolal gap! MW ethanol is 46 so you divide 97 by 4.6 = 21. The remaining osmolal gap is now 31-21=10, essentially nl. UpToDate suggests you use 3.7 because ethanol in blood acts as lower MW 37 and 97/3.7=26 and now remaining osmolal gap is nl 5. No methanol?

[Roger Rodby @NephRodby]

6) DD of HAGMA: Many options here, I like GOLDMARK. G=glycols ethylene (antifreeze) propylene (vehicle in IV drips eg lorazepam) and diethylene (brake fluid). O=oxoproline L=l-lactate, D=D-lactate (GI bacterial overgrowth in blind loop), M=methanol, A=aspirin, R=renal, K=ketones

[Sanjay Kothari @sanjay_nephro]

@PBryniarski @rahulsai1990 @kidney_boy @ASNKidney @NephRodby I'm not sure if loop diuretics may cause Hyperphosphatemia.
And yes, it's PPI that may cause hypoMg which leads to HypoPTH and causing Hypocalcemia and Hyperphosphatemia

[Sanjay Kothari @sanjay_nephro]

@rahulsai1990 @kidney_boy @ASNKidney @NephRodby Can you please post an explanation to this?

[Sanjay Kothari @sanjay_nephro]

@hswapnil @BrownJHM Hypertension won't be there in Gitelman syndrome

[Conrad Fischer @SeeFisch]

Renal Osteodystrophy (Two types)
*High PTH/High Alk Phos (high turnover)= Osteitis Fibrosis Cystica. Use Phosphate binders, Vit D, Cinacalcet

*Low PTH/Low Alk Phos = Adynamic bone disease. Bone just not grow! Stop Vitamin D. Non-calcium phosphate binder (sevelamer, lanthanum)

[Roger Rodby @NephRodby]

55 y/o found unresponsive at train stop. 911 to ED, he wakes up a bit, slumps over and says he lost vision in one of his eyes. Follow the case with me. Some of this is very simple, some not so (all values in mg/dl, mmol/l etc). @RushIMChiefs @RushTweetorials @RushDOIM.

[Roger Rodby @NephRodby]

9) Na always has an anion with it so osmolality from it is NaX2. Neither urea or glucose are charged molecules so so we divide by 18 for BG? BC MW of glucose is 180 (BG in mg/dl) 180/10=18. Why 2.8 for BUN? We are measuring nitrogen (not urea) N2 = 28.