Endocrinology

Nephrology

Questions discussed in this category

How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?

1 Answer available

What treatment options would you consider for a young patient with limited mobility, low bone mass and multiple vertebral compression fractures who is on dialysis for advanced kidney disease?

1 Answer available

Would you order a repeat DEXA scan 1 year later for a kidney transplant patient who had an initial DEXA scan within the first 6 months post-transplant showing osteopenia but no history of fractures, and who has been stable on glucocorticoid-free immunosuppressive therapy?

1 Answer available

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

1 Answer available

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

1 Answer available

Do you recommend non-bypass bariatric surgeries over intestinal bypass procedures for kidney transplant-eligible candidates to prevent oxalate nephropathy, given the higher risk of kidney oxalate deposition with intestinal bypass?

2 Answers available

Should all kidney transplant patients be started on statin therapy post operatively given their increased risk of CVD?

At what doses do you start? and how do you titrate therapy?

1 Answer available

Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?

4 Answers available

Do you taper steroids more aggressively to decrease the risk of developing new-onset diabetes after transplantation in kidney transplant recipients who had pretransplant impaired fasting glucose?

2 Answers available

Does vitamin D supplementation in primary hyperparathyroidism increase the risk of kidney stones?

Is this seen more with high dose vitamin D supplementation?

1 Answer available

Are recurrent UTIs a contraindication to SGLT2i use?

4 Answers available

Do you recommend parathyroid adenoma resection or ablation for patients with primary hyperparathyroidism and recurrent nephrolithiasis who are found to have a single gland adenoma on parathyroid ultrasound and nuclear medicine imaging?

1 Answer available

How does contralateral suppression of more than 50% with cosyntropin during adrenal venous sampling influence your decision to recommend adrenalectomy in patients with primary aldosteronism?

Okubo et al., PMID 38442744

1 Answer available

Would you recommend cinacalcet for patients with recurrent nephrolithiasis who have hypercalciuria despite thiazide diuretic use and who also have an elevated PTH level without localizing parathyroid adenoma on imaging?

1 Answer available

How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?

1 Answer available

Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?

3 Answers available

Do you recommend stopping a SGLT2i indefinitely if a patient with chronic kidney disease and diabetes develops euglycemic diabetic ketoacidosis?

1 Answer available

Do you recommend parathyroid imaging testing for patients with recurrent nephrolithiasis who are incidentally found to have an elevated PTH but who do not have hypercalciuria, hypercalcemia, hypovitaminosis D, or chronic kidney disease?

2 Answers available

What is your approach to managing patients with recurrent nephrolithiasis and nephrocalcinosis in the setting of hypoparathyroidism?

1 Answer available

For a patient with idiopathic hypercalciuria and a history of calcium kidney stones who has not normalized 24-hr urine calcium level on thiazide diuretic, is there evidence for targeting a certain urine calcium level for decreased future risk of nephrolithiasis and osteoporosis?

2 Answers available

Given the risk of hypocalcemia in dialysis dependent patients treated with denosumab, what is the best method of treatment for osteoporosis for these patients, and should we be transitioning to a different agent?

2 Answers available

Should GLP1 R agonists be used as first line glucose lowering agents in patients with ESKD and DM2?

1 Answer available

Are you offering GLP-1 agonists to patients with CKD and diabetes mellitus?

4 Answers available

Do you recommend obtaining a DEXA scan for patients with recurrent nephrolithiasis and hypercalciuria of unknown etiology?

2 Answers available

What is your approach to differentiating primary from secondary hyperparathyroidism in recurrent kidney stone formers who also have chronic kidney disease, an elevated PTH, and hypercalcemia?

1 Answer available

What is your approach to differentiating diabetes insipidus from primary polydipsia in the outpatient setting?

1 Answer available

In patients with hypertension and suspected primary aldosteronism who have undergone negative confirmatory testing, what follow-up and monitoring strategies would you recommend to ensure early detection of potential aldosteronism?

1 Answer available

Do you routinely check a TSH level in patients with recurrent kidney stones who have hypercalciuria of unknown cause?

1 Answer available

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., NEJM

5 Answers available

What is your approach to managing osteoporosis in patients with end stage kidney disease?

1 Answer available

Is there a role for cinacalcet suppression testing when evaluating patients for suspected primary hyperparathyroidism who also have recurrent calcium containing kidney stone disease?

1 Answer available

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

3 Answers available

How do you distinguish between primary and tertiary hyperparathyroidism in a patient with ESRD?

1 Answer available

What is your daily correction goal for those patients being treated for hypernatremia?

2 Answers available

Would you recommend switching a diabetic CKD patient on oral semaglutide to the subcutaneous form since the benefits in CKD have primarily been reported in studies using subcutaneous GLP-1 receptor agonists?

1 Answer available

How long do you wait before reassessing a 24 hour urine calcium level in patients with recurrent nephrolithiasis, hypercalciuria, and osteoporosis who are initiated on bisphosphonate therapy?

3 Answers available

How do you approach a patient with biochemical evidence of primary hyperparathyroidism, but normal parathyroid scan?

4 Answers available

What is your approach to using bisphosphonates in those with severe hypercalcemia and chronic kidney disease?

1 Answer available

Do you recommend continuing SGLT2 inhibitors in patients with diabetic kidney disease and congestive heart failure who have been taking the medication for several years and later develop end stage kidney disease?

3 Answers available

Which medications do you deem necessary to stop prior to measuring plasma renin and plasma aldosterone when evaluating a patient for possible primary aldosteronism?

1 Answer available

What is the next best anti-hypertensive medication to start after mineralocorticoid receptor antagonists in patients with primary aldosteronism?

1 Answer available

What is your preferred method for confirming the diagnosis of primary aldosteronism in a patient with an elevated plasma aldosterone to renin ratio?

1 Answer available

Does your goal rate of correction in patients with chronic hypoosmolar hyponatremia differ based on the degree of hypoosmolarity?

4 Answers available

Do you recommend stopping Vitamin D supplementation in a patient with hypercalcemia and a low 25(OH)D level?

1 Answer available

How would you manage a patient with osteoporosis on denosumab who develops significant renal insufficiency where it is difficult to continue denosumab due to increased risk of hypocalcemia (i.e. eGFR in the low 20’s)?

1 Answer available

In which patients with chronic kidney disease and low 25-OH vitamin D levels do you prefer weekly ergocalciferol to daily cholecalciferol supplementation?

1 Answer available

Do you treat low 25-OH vitamin D levels in those with end stage kidney disease?

1 Answer available

What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?

1 Answer available

How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?

1 Answer available

How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?

1 Answer available

Papers discussed in this category

Semin Dial, 2010 May 10

Why dialysis patients need combination therapy with both cholecalciferol and a calcitriol analogs.

The Journal of clinical endocrinology and metabolism, 2016-05

The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

Clinical journal of the American Society of Nephrology : CJASN, 2019-05-07

Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients.

Curr Opin Cell Biol, 1995 Aug

Cell volume regulated transporters of compatible osmolytes.

The New England journal of medicine, 2015 Sep 17

Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.

The New England journal of medicine, 2020 Sep 24

Dapagliflozin in Patients with Chronic Kidney Disease.

The American journal of medicine, 2016-05

Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion.

Clinical journal of the American Society of Nephrology : CJASN, 2018-07-06

Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.

Journal of critical care, 2023 May 13

Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes.

The Journal of urology, 1992-06

Functional obstructive uropathy: a significant factor in the hyponatremia of psychogenic polydipsia?

Kidney international, 2022 Nov

Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023 Jan 18

The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease.

Cardiovascular diabetology, 2024 Feb 08

Cardiorenal effectiveness of empagliflozin vs. glucagon-like peptide-1 receptor agonists: final-year results from the EMPRISE study.

The New England journal of medicine, 2024 May 24

Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.

Clinical journal of the American Society of Nephrology : CJASN, 2017-08-07

Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones.

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-04

Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia.

N Engl J Med, 2023 Mar 02

Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence.

The New England journal of medicine, 1980-02-21

The importance of circulating 1,25-dihydroxyvitamin D in the pathogenesis of hypercalciuria and renal-stone formation in primary hyperparathyroidism.

The New England journal of medicine, 2018 Sep 13

Primary Hyperparathyroidism.

Annals of surgery, 2008-10

A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.

Kidney360, 2022 Aug 25

Bariatric Surgery Decreases Barriers for Kidney Transplant: Are There Other Weight-Loss Options?

Circulation, 2019-06-18

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

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