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Maurice Khayat @peeingredagain.bsky.social · 13h

Yup, and yet CKD is a major risk factor for AKI!

Maurice Khayat @peeingredagain.bsky.social · 1d

True, improving pre-renal can also be clinically hard to tell apart from recovering ATN depending on when they present.

Maurice Khayat @peeingredagain.bsky.social · 1d

This encapsulates my feelings on FeNa reasonably well. It still has some good use-cases, but we need to stop using it indiscriminately for every AKI!

(Ref below, VA markup/emphasis mine)

pmc.ncbi.nlm.nih.gov/articles/PMC...

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Maurice Khayat @peeingredagain.bsky.social · Aug 31

Ha, I did think of that and downgraded my language to "most" :)

Maurice Khayat @peeingredagain.bsky.social · Aug 31

In a lot of ways medicine is like troubleshooting a computer, but not all the parts are replaceable and in most cases "have you tried turning it off and back on again?" isn't useful advice.

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Maurice Khayat @peeingredagain.bsky.social · Mar 29

I wonder if this will result in any changes?

US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...

US House panel launches antitrust probe of medical residency system

A U.S. congressional committee is investigating how medical students are placed in residency training programs, seeking documents from major university hospitals, the American Medical Association and other organizations as part of an antitrust probe.

www.doximity.com

Maurice Khayat @peeingredagain.bsky.social · Feb 28

Hang on let me write this down:
"prescribe more ACEi, fewer snakebites." OK, got it!

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Maurice Khayat @peeingredagain.bsky.social · Feb 25

With the PTH not super elevated I imagine there's less risk for adynamic bone dz with a bisphosphonate. Although, I'm unsure of the target iPTH when using it for 1°HPT. Looks like I'm d/t do some reading. :)

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Maurice Khayat @peeingredagain.bsky.social · Feb 25

Either way would be risk/benefit discussion with the patient about the unclear risk and benefit and make the decision together.

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Maurice Khayat @peeingredagain.bsky.social · Feb 25

My $0.02: your patient doesn't fit neatly into any trials. Benefit unclear but maybe a 24h uCa & see if the hypercalciuria is resolved?

Figure if high bonr turnover...Ca has to go somewhere, right?

If PTH still overly active I'd favour cinacalcet but PO bisphos probably reasonable (& titratable)?

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Maurice Khayat @peeingredagain.bsky.social · Feb 25

What's the weather like up there?

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Reposted by Maurice Khayat

jefferson triozzi @nepherson.bsky.social · Feb 21

Standard metformin practice is:

GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue

But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?

Stephen Jenkins @sjenkinsmd.bsky.social · Feb 21

We often stop metformin when eGFR < 30 (CKD stage 4). In this observational study of 4,278 patients with type 2 diabetes and CKD stage 4, stopping metformin (40.1% of patients) was associated with lower 3-year survival (63.7% vs 70.5%). Time for an RCT? #MedSky #NephSky www.ajkd.org/article/S027...

Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study

Despite a lack of supporting evidence, current guidance recommends against the use of metformin in people with advanced kidney impairment. This observational study compared the outcomes of patients wi...

www.ajkd.org

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Maurice Khayat @peeingredagain.bsky.social · Feb 22

I'm curious if the CKD4 patients had a higher eGFR Cr-Cys C? Would be nice to see new safety data with updated assessment methods!

Maurice Khayat @peeingredagain.bsky.social · Feb 21

Egophony is just sound. I wonder if there's a Doppler equivalent on POCUS?

Maurice Khayat @peeingredagain.bsky.social · Feb 21

Dad jokes are pretty benign.

Maurice Khayat @peeingredagain.bsky.social · Feb 18

I swear the word "spellcheck" was in there somewhere

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Maurice Khayat @peeingredagain.bsky.social · Feb 18

What I can't seem to do is my posts prior to posting them...

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Maurice Khayat @peeingredagain.bsky.social · Feb 18

Getting caught up on my HoP episodes!

On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.

I also can't overstate how helpful poison control is in these situations. Make sure to call them!!

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Maurice Khayat @peeingredagain.bsky.social · Feb 7

It's been a long time comung, but at our lab we just implemented a cystatin C panel. It adds a Cr automatically and outputs a calculated eGFR Cr-Cys C automatically!

Since the Cr is the cheaper test it makes sense to add it on in most cases.

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Maurice Khayat @peeingredagain.bsky.social · Feb 6

When I was younger I just to have cool dreams. Now my dreams are "we need to treat this RPGN patient but no one can find the biopsy results."

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Maurice Khayat @peeingredagain.bsky.social · Jan 26

Done. Let me know your thoughts.

Maurice Khayat @peeingredagain.bsky.social · Jan 26

(6) The authors proposed comparing ABG/BMP might help diagnose equipment errors.

My conclusion: both methods have potential pitfalls For bizarre results, checking against the *other* method might help confirm that it's real (both directions!).

Oh and definitely check an ABG in a lipidemic pt :)

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Maurice Khayat @peeingredagain.bsky.social · Jan 26

(4, cont'd) the agreement between chem panels and ABGs seems to vary by device and lab methods used, but in the quoted study they agreed in ~95% & ~99% for ±2 & ±3 mmol/L (respectively).
(5) Common pre-prep errors were trialed and it didn't seem to effect the results by much.
(6) →

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Maurice Khayat @peeingredagain.bsky.social · Jan 26

(3) This covers the case where there are ↑triglycerides, but doesn't really say which is more accurate in general.

*** many pubmed searches later ***

I came across this article (see excerpt):

academic.oup.com/clinchem/art...

(4) After getting access to the article (finally), I learned this →

Comparison of Measured and Calculated Bicarbonate Values

Patient acid–base status may be assessed by measuring bicarbonate (HCO3−) in serum or plasma from a sample of venous blood. HCO3− values are also frequentl

academic.oup.com

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Maurice Khayat @peeingredagain.bsky.social · Jan 26

@raghumnephdoc.bsky.social please forgive my delayed response. You sent a great article, so I wanted to scrutinize it properly! Here's what I learned:

(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →

Raghunath M @raghumnephdoc.bsky.social · Jan 9

www.ajkd.org/article/S027...
This article in AJKD seems to suggest that POC ABG derived HCo3 is free from interference due to lipids and stuff.

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