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Nephrology

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Questions discussed in this category

Do you routinely continue dual antibiotic coverage or de-escalate to monotherapy based on peritoneal fluid culture sensitivities in patients with relapsing pseudomonas aeruginosa peritoneal dialysis peritonitis after peritoneal catheter removal?
1 Answer available
Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?
2 Answers available
How would you manage hemodialysis for an ESKD patient who presents with a phosphorus of 1.6 mg/dl and potassium of 6.5 mEq/L without ECG changes?
2 Answers available
Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?
2 Answers available
How long do you wait before arranging AVF placement in patients with AKI who remain dialysis dependent?
2 Answers available
What would be your approach to managing severe ANCA-associated vasculitis in a patient who is also septic from a bacterial infection?
1 Answer available
Are there instances when you recommend initiation of dialysis in patients with advanced chronic kidney disease who are scheduled for a major surgery but do not currently have any indications for renal replacement therapy?
4 Answers available
How do you manage hemodialysis for an ESKD patient presenting with severe hyponatremia and a serum sodium more than 10 mEq/L below the lowest available dialysate sodium concentration?
2 Answers available
How frequently do you check serum electrolytes for patients on CRRT?
1 Answer available
What factors influence your decision to start salt tablets, urea, or a vaptan first in the management of a patient diagnosed with SIADH?
3 Answers available
Is there a serum ammonium level for which you recommend initiation of dialysis in a patient with hepatic encephalopathy?
2 Answers available
What is your calcium level threshold for initiating targeted calcium lowering therapies for patients with an acute kidney injury believed secondary to renal vasoconstriction and volume depletion?
1 Answer available
Would you consider treating hypercalcemia with CRRT and regional citrate anticoagulation for a dialysis dependent patient who does not respond to bisphosphonate therapy and low calcium dialysate bath?
2 Answers available
Would you recommend desmopressin for a patient with ESKD receiving thrice weekly hemodialysis who is hospitalized for a persistent gastrointestinal bleed not amenable to usual interventional treatment strategies?
1 Answer available
For outpatients undergoing a kidney biopsy, do you routinely recommend an overnight admission for continued hemoglobin monitoring?
8 Answers available
Is there a serum phosphorus level you would consider too low to safely perform hemodialysis?
3 Answers 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
Are there instances when you do not recommend tunneled dialysis catheter exchange in patients on hemodialysis who are found to have bacteremia?
4 Answers available
Do you recommend any CRRT prescription changes for optimal clearance for patients with AKI who are on a reduced blood flow rate due to concurrent regional citrate anticoagulation?
2 Answers available
What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?
1 Answer available
Would you recommend administering IV amino acids prior to cardiac surgery with cardiopulmonary bypass, given recent trial findings of improved AKI rates but no significant difference in kidney-replacement therapy with IV amino acids?
Landoni et al., PMID 38865168
1 Answer available
In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
3 Answers available
Have you considered priming CRRT machines with renal replacement solutions during the current crystalloid solution shortage?
2 Answers available
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
For example, is captopril dialyzable? 
1 Answer available
Are there instances where you may transiently transition a perioperative ESKD on PD inpatient from peritoneal dialysis to hemodialysis if they are likely to receive a large volume of fluid?
Invited Professor Series Video: Volume Management and Access Troubleshooting in Peritoneal Dialysis - Claretha Lyas, MD
2 Answers available
How would you manage a patient with CKD4 due to lupus nephritis of unknown class who develops AKI requiring hemodialysis and nephrotic range proteinuria and is found to have atrophic kidneys on imaging?
3 Answers available
What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?
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 avoid performing urine microscopy in patients with AKI who have COVID-19 given concern for potential aerosolization?
2 Answers available
Are there any instances when you would not perform 3 consecutive daily dialysis sessions when initiating a patient on hemodialysis?
2 Answers available
How often do you recommend basic metabolic panel checks in a hospitalized ESKD patient on thrice weekly hemodialysis and for whom hyperkalemia is not of major concern?
2 Answers available
Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?
1 Answer available
What is your approach to weaning dialysis in a patient with AKI on CKD and CHF who now has resolved AKI but a history of recurrent episodes of decompensated heart failure?
1 Answer available
What is your daily correction goal for those patients being treated for hyponatremia?
1 Answer available
What factors influence your decision between guidewire exchange versus removal and replacement through a new tunnel tract for patients with tunneled hemodialysis catheter mechanical failure?
Lazarus, et al., PMID: 38913437
1 Answer available
In which clinical scenarios do you use prolonged intermittent renal replacement therapy (PIRRT)?
2 Answers available
Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?
1 Answer available
Do you recommend prophylactic post-operative use of an intravenous calcium infusion for patients with ESKD who undergo subtotal parathyroidectomy for secondary hyperparathyroidism?
1 Answer available
Do you administer calcium to patients with K > 6.5 without EKG changes?
3 Answers available
What is your approach to interpreting urine studies in patients hospitalized for hyponatremia who have recently received intravenous fluids containing sodium chloride?
1 Answer available
Do you recommend fluid restriction in addition to other management strategies for patients with hyponatremia due to SIADH?
5 Answers available
Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?
ACORN Randomized Clinical Trial 
1 Answer available
Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?
2 Answers available
How frequently do you recommend flushing a peritoneal dialysis catheter for patients with ESKD who are hospitalized and are not currently undergoing peritoneal dialysis?
6 Answers available
Would you recommend normal saline for pre- and post-LHC hydration in patients with CKD stage III to IV with reduced LV systolic function, and if so, what is a reasonable amount of volume?
2 Answers available
Do you use terlipressin for patients with hepatorenal syndrome who also have elevated blood pressures?
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
In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD? How frequently do you monitor osmolarity?
1 Answer available
Do you hospitalize patients with newly diagnosed lupus nephritis and nephrotic syndrome if you are able to provide pulse steroids outpatient and follow them closely?
 When do you decide to hospitalize?
1 Answer available
What is your preferred fill volume, dialysis solution, and dwell time for patients with suspected peritoneal dialysis associated peritonitis who arrive to the hospital with a dry abdomen?
2 Answers available
Do you perform a kidney ultrasound in patients following a kidney biopsy to evaluate for post-procedural complications?
2 Answers available
Would you consider reducing the dialysate sodium concentration to 135 meq/L as a strategy to decrease interdialytic weight gain in a hypervolemic ESKD patient?
Miskulin, et al., PMID 38349776
1 Answer available
Do you use a phosphate binder to manage inpatient hyperphosphatemia in patients with AKI who have no history of CKD?
5 Answers available
Would you recommend a TIPS procedure in the management of hepatorenal syndrome for a patient with no history of hepatic encephalopathy?
1 Answer available
Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?
2 Answers available
What is your approach to anticoagulation in a patient with AKI and cirrhosis who has frequent filter clotting on CRRT?
2 Answers available
Do you start patients on a B complex multivitamin if they are on CRRT and have not previous been on renal replacement therapy?
1 Answer available
How do you choose between eculizumab and ravulizumab for patients with acute kidney injury from complement mediated thrombotic microangiopathy?
1 Answer available
Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?
2 Answers available
What is your approach to safely performing hemodialysis in a patient with a fistula who is hospitalized for altered mental status and unable to remain still?
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
How do you approach the decision to use terlipressin in a patient with hepatorenal syndrome type 1, AKI, and a history of heart failure given its potential cardiovascular effects?
1 Answer available
Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?
3 Answers available
Do you recommend giving IV albumin with furosemide to augment diuresis in a patient with hypoalbuminemia and volume overload?
1 Answer available
What are your management strategies for acute kidney injury attributed to pembrolizumab in patients with a kidney biopsy showing predominately acute tubular injury?
2 Answers available
Do you increase the frequency of hemodialysis for patients with calciphylaxis?
3 Answers available
What considerations do you take when managing a patient with end stage kidney disease on peritoneal dialysis who is planning on undergoing PEG tube placement?
1 Answer available
For patients on CRRT with worsening hyperkalemia despite high replacement fluid rate using a 0 mEq/L potassium bath, do recommend using an additional CRRT machine with separate dialysis access for improved clearance?
3 Answers available
What is your approach to monitoring for recovery in a patient with non-oliguric AKI requiring dialysis?
4 Answers available
What is your daily correction goal for those patients being treated for hypernatremia?
2 Answers available
Between mean arterial pressure (MAP) and blood pressure (BP), which do you use when prescribing hemodialysis to instruct a hold on additional ultrafiltration should the value become too low?
1 Answer available
Do you intensify the dialysis prescription for patients with end stage kidney disease who develop uremic pericarditis despite regular dialysis sessions?
3 Answers available
Is there benefit to performing CVVH instead of intermittent hemodialysis for a patient with AKI secondary to rhabdomyolysis who requires renal replacement therapy?
1 Answer available
How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?
2 Answers available
In patients with intrinsic acute kidney injury of unknown etiology and with pending kidney biopsy results, are there instances when you would recommend a trial of glucocorticoids?
1 Answer available
How long would you wait for outflow to improve before consulting surgery in a peritoneal dialysis patient with an outflow obstruction who is prescribed laxatives for catheter migration?
Invited Professor Series Video: Volume Management and Access Troubleshooting in Peritoneal Dialysis - Claretha Lyas, MD
1 Answer available
What are some considerations to make when managing a patient on peritoneal dialysis who develops acute pancreatitis?
1 Answer available
What is your approach to achieving hypernatremia in a patient on CRRT for whom increasing the rate of a post-filter 3% sodium chloride infusion is insufficient?
2 Answers available
Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?
1 Answer available
Is there a platelet count threshold when you would avoid performing a kidney biopsy in patients with thrombocytopenia?
1 Answer available
Do you use mannitol when initiating patients on intermittent hemodialysis?
1 Answer available
Are there instances when you use erythropoietin stimulating agents in patients with acute kidney injury requiring dialysis?
2 Answers available
Would you perform dialysis on a patient with altered mental status in the setting of an elevated blood urea nitrogen level attributed to a tube feeding diet?
1 Answer available
Do you hold CRRT for a period of time before performing a diuretic challenge in a patient with whom you are assessing for the ability to wean off of continuous dialysis?
2 Answers available
Would you consider adding an SGLT2 inhibitor to augment diuresis in patients with worsening renal function presenting with acute decompensated heart failure and AKI on CKD?
1 Answer available
What adjustments do you make to a hemodialysis prescription for a patient with a recent stroke?
3 Answers available
Do you recommend using dextrose based solutions to induce osmotic diuresis for euvolemic patients with acute kidney injury in the setting of a hemolytic condition?
1 Answer available
What is your approach to inpatient immunosuppression for a kidney transplant patient on home tacrolimus, prednisone, and mycophenolic acid who cannot tolerate anything by mouth?
2 Answers available
Have you encountered acute kidney injury after starting eltrombopag for aplastic anemia as part of triple immunosuppressive regimen with ATG and cyclosporine?
1 Answer available
Would you recommend initiating RRT in a patient with tumor lysis syndrome and a phosphorus of 9 mg/dl or more who does not have symptomatic hypocalcemia or other indications for dialysis?
1 Answer available
Would you add an SGLT2 inhibitor to augment diuresis during a hospitalization in a patient with nephrotic syndrome, an eGFR above 30 mL/min/1.73m2, and refractory hypervolemia on an intravenous loop diuretic?
1 Answer available
Do you use tolvaptan for management of hyponatremia related to heart failure given the side effect profile and lack of mortality benefit seen in a previous trial?
The EVEREST Outcome trial (Konstam et al., PMID 17384437)
1 Answer available
What is your approach to the use of desmopressin prior to performing a kidney biopsy to potentially prevent procedural associated bleeding?
1 Answer available
What is your approach to the use of intravenous sodium thiosulfate for the management of calciphylaxis in a patient with end stage kidney disease and on hemodialysis?
1 Answer available
Do you recommend testing for G6PD deficiency in those with whom rasburicase for tumor lysis syndrome is indicated?
2 Answers available
Do you proceed with outpatient hemodialysis for an asymptomatic ESKD patient who has missed the last three hemodialysis sessions?
1 Answer available
Do you prefer that hospitalized peritoneal dialysis patients use their own home dialysis equipment during the admission?
2 Answers available
Under what conditions do you perform a post-procedural kidney ultrasound in patients who recently underwent a kidney biopsy?
1 Answer available
Do you require patients who undergo a kidney biopsy to be admitted to the hospital for observation?
1 Answer available
What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?
1 Answer available
How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?
1 Answer available
How do you approach the use of endothelin receptor antagonists in patients with scleroderma renal crisis and hypertension refractory to maximum ACE inhibition and calcium channel blockers?
1 Answer available


Papers discussed in this category

N Engl J Med, 2020 Feb 13
Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis.
QJM, 2013 May 21
Targeting the endothelin axis in scleroderma renal crisis: rationale and feasibility.
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.
Journal of vascular and interventional radiology : JVIR, 2012 Apr 17
Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2009-08
The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys.
POCUS J, 2022 Feb 01
Point of Care Ultrasound in Monitoring of Post-Renal Biopsy Bleeding.
Hemodialysis international. International Symposium on Home Hemodialysis, 2013 Oct
Changing the hemodialysis prescription for hemodialysis patients with subdural and intracranial hemorrhage.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2017 Mar-Apr
Biopsy of small kidneys: A safe and a useful guide to potentially treatable kidney disease.
Clinical journal of the American Society of Nephrology : CJASN, 2017 May 04
Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis.
Kidney international, 1997 Oct
Mannitol therapy revisited (1940-1997).
Critical care medicine, 2009-09
Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study.
Journal of critical care, 2019-08
The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study.
BMC nephrology, 2022 Mar 13
Erythropoietin in Acute Kidney Injury (EAKI): a pragmatic randomized clinical trial.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2019 Apr 27
Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A Randomized Controlled Trial.
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?
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2009-07-01
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2010 May-Jun
Acute pancreatitis in peritoneal dialysis patients: diagnosis in the icodextrin era.
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.
Journal of the American Society of Nephrology : JASN, 2004-01
Timing of complications in percutaneous renal biopsy.
The Journal of surgical research, 2019-12
Safety of Laparoscopic Gastrostomy in Children Receiving Peritoneal Dialysis.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2011 May-Jun
Adult peritoneal dialysis patient with Tenckhoff and percutaneous endoscopic gastrostomy catheters.
The International journal of artificial organs, 2022 Jan 17
Is percutaneous gastrostomy tube insertion contraindicated in adult peritoneal dialysis patients? A single-centre experience of three successful cases: It is time to revisit.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2024 Jan 24
Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review.
Current opinion in critical care, 2021 Aug 01
Nutrients and micronutrients at risk during renal replacement therapy: a scoping review.
Journal of immunological methods, 2020 Dec 13
Monitoring Ravulizumab effect on complement assays.
Kidney international reports, 2021 Mar 24
Long-Term Efficacy and Safety of the Long-Acting Complement C5 Inhibitor Ravulizumab for the Treatment of Atypical Hemolytic Uremic Syndrome in Adults.
Kidney international, 2020 Mar 06
The long-acting C5 inhibitor, Ravulizumab, is effective and safe in adult patients with atypical hemolytic uremic syndrome naïve to complement inhibitor treatment.
Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2023 Jan-Dec
Regional Citrate Anticoagulation or Heparin Anticoagulation for Renal Replacement Therapy in Patients With Liver Failure: A Systematic Review and Meta-Analysis.
JAMA internal medicine, 2024 May 13
Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime.
The Annals of thoracic surgery, 2003 Mar
Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery.
Nephron, 2017 Apr 22
Effect of Prophylactic Dialysis on Morbidity and Mortality in Non-Dialysis-Dependent Patients after Coronary Artery Bypass Grafting: A Pilot Study.
Coronary artery disease, 2022 Jan 01
Prophylactic dialysis improves short-term clinical outcome in patients with non-dialysis-dependent chronic kidney disease undergoing cardiac surgery: a meta-analysis of randomized controlled trials.
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2019
Creating and Maintaining Optimal Peritoneal Dialysis Access in the Adult Patient: 2019 Update.
Perit Dial Int, 2022 Mar
ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment.
Lancet (London, England), 2014-05-24
Haemodynamic-guided fluid administration for the prevention of contrast-induced acute kidney injury: the POSEIDON randomised controlled trial.
The New England journal of medicine, 2021 Mar 04
Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome.
Blood purification, 2020 Jan 15
Report of Dialysis-Induced Hypophosphatemia Leading to Reversible Encephalopathy Prevented by Adding Phosphorus to the Dialysate.
Clinical journal of the American Society of Nephrology : CJASN, 2024 Jun 24
Replacement Strategies for Tunneled Hemodialysis Catheters with Complications: A Nationwide Cohort Study.
American journal of infection control, 2020 Jun 02
Cautious handling of urine from moderate to severe COVID-19 patients.
Osong public health and research perspectives, 2020 Feb
Identification of Coronavirus Isolated from a Patient in Korea with COVID-19.
The New England journal of medicine, 2024 Jun 12
A Randomized Trial of Intravenous Amino Acids for Kidney Protection.
The New England journal of medicine, 2003 Oct 02
The prevention of radiocontrast-agent-induced nephropathy by hemofiltration.
Clinical journal of the American Society of Nephrology : CJASN, 2023 Oct 17
How We Treat Hyperammonemia in Acute Liver Failure.
Kidney Med, 2020 Jan-Feb
Equivalent Efficacy and Decreased Rate of Overcorrection in Patients With Syndrome of Inappropriate Secretion of Antidiuretic Hormone Given Very Low-Dose Tolvaptan.

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