Palo Alto, CA
Joined October 2016
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this guideline is ridiculous
it combines every type of hypoxemic respiratory failure and makes a blanket recommendation for all of them together π€‘
we all know that different forms of hypoxemic respiratory failure respond differently (e.g., cardiogenic pulmonary edema vs pneumonia)
this will be cited a bajillion times which is great for the journal's impact factor and the authors' H-indicies, but it's still nonsense
Noninvasive respiratory support for adult patients with acute respiratory failure: An Official American Thoracic Society Clinical Practice Guideline
doi.org/10.1093/ajrccm/aamagβ¦
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Increasing TKV in ADPKD with SGLT2i use
Not a good sign
#KidneyWk
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Holy shit an RCT of dialysis access
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#JClinMicro photo quiz! A 13-year-old boy with a history of frequently relapsing nephrotic syndrome, presented with persistent and progressive eosinophilia, alongside pruritic skin lesions. A parasitological workup was undertaken. What's your diagnosis? asm.social/38z
ALT Routine saline wet-mount microscopy of the stool specimen (image at 10Γ magnification).
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Great opportunity to learn and mingle with authors! #kidneyWeek
Heading to #KidneyWeek? Join our PD Poster Tour! πΆββοΈπ‘
Discover top science in home dialysis, ask questions, and network with leading experts
Don't miss out! π«π
#HomeDialysis #ISPD #Nephrology @ISPD1 @ASNKidney
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Again where is the evidence for this?
For adults with sepsis-inducedΒ hypoperfusion or septic shock, they suggest administering at least 30 mL/kg of IV crystalloid within the first three hours (conditional recommendation), but note the 3 remarks provided!Β #CHEST2026
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At #KidneyWk on Thursday, October 22, the Michelle P. Winn, MD, Endowed Lectureship. Brad Rovin, MD, FASN, will discuss βHow Has the Clinical Trial Landscape in Glomerular Diseases Changed in the Past 5 Years?β
Read more in #ASNKidneyNews: kidney.pub/KN1810-11
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This is one of the funniest things to me. I will often ask someone who tells me that theyβre dry. How is it that they got that way and then thereβs usually a little bit of silence, a mumble about insensible losses, a limited PO intake, despite the 3 L that have been given in the last 48 hours, lol. The reality is that unless you were getting aggressive diuretic therapy or you have severe G.I. losses, your so-called intravascular dry patient likely has a main systemic filling pressure problem and you donβt wanna miss the septic source because you thought they were dry.
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Totally agree, @VincentRK! Center availability for PLEX can vary quite a bit. Weβre fortunate to have PLEX available right away here, and it helps lower FLC levels while we wait for plasma cell-directed therapy to reach its maximum effect. Individualized medicine is key!
Thanks. Yes and I understand the dilemma. But itβs a package. One doesnβt work well without the other based on pathogenesis and how these treatments work. Even a quad like Dara VCd takes a couple weeks to work. So if I have cast nephropathy with a creat of 6, Iβd be quite worried if we are willing to wait 2 weeks to reduce the light chains and give my kidneys a chance a good chance at recovery when there is a way to reduce light chains on day 1. And similarly if we just plex for 5 days and not institute highly effective therapy to shut off the tap we cannot expect plex to change outcomes.
I appreciate this is an area that for a number of years Iβve been going outside of the evidence. But all studies I have seen so far run huge risks of type II error. And the consequences to patients are so huge that I feel compelled to recommend based on the non randomized data we have at Mayo and the pathophysiologic rationale.
πππ₯π©π‘ ππ¨π‘ππ² ππ πππ retweeted
Thanks for your comments. However, I would like to highlight that there are very few patients in practice that receive both Dara and plex - mayo is unique that way.
The target trials were separate and were intended to look at each treatment individually, not together.
π
Being "intravascularly dry" is often suspected when:
1. Furosemide monotherapy for diuresis is used, which produces metabolic alkalosis and hypernatremia irrespective of someone's true volume status.
2. Low MSFP shock due to vasoplegia in conditions like sepsis. The issue isn't about volume, but rather the pressure driving venous return.
3. Oliguria in the ICU. Many cases are 1) not AKI 2) not fluid responsive and 3) congestive
4. The patient has intracavitary gradients or dynamic LVOTo. These patients behave "super dry" . Preload helps temporarily, but afterload, beta blockade etc. accomplishes same goal in more durable fashion.
5. Pancreatitis patients. These patients have third spacing, sure, but actually are often more distributive. They require some fluids, but routine use of 100+ml/hr IV fluids in the absence of objective markers of low stroke volume and fluid responsiveness leads to many of the iatrogenic complications of pancreatitis we see!
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Being "intravascularly dry" in the ICU is way rarer than most clinicians think.
Most of the time its mistaking other conditions/circumstances π
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Plasma Exchange and Daratumumab for Myeloma Cast Nephropathy
-In a multicenter cohort study, neither PLEX nor daratumumab was associated with kidney recovery at 90βdays #mmsm #bmtsm @cshincovich @ShrutiGkidney
onlinelibrary.wiley.com/doi/β¦
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I agree. Adina Turcu has an excellent paper pubmed.ncbi.nlm.nih.gov/3817β¦ on factors that may better predict surgical success. Lots to do in this area but itβs the minority of cases for sure. I agree that with more screening we need to be address this as a field.
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Why do we keep doing this dumb study?
In mechanically ventilated adults with #AcuteHypoxemicRespiratoryFailure, an inhaled sedation strategy using isoflurane with intravenous adjuncts as needed did not reduce hospital mortality vs intravenous sedation. Ventilator-free days, intensive care unitβfree days, hospital-free days, and 3-month quality-of-life and disability scores were also similar between groups.
ja.ma/3TKDpfY
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Pregnancy-Associated TMA: Bringing the Right Experts Together When Every Hour Counts
Masterclass discussion with Cristina Popa
kireportscommunity.org/post/β¦
@ISNkidneycare #TMA #pregnancy
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Well, we won't spoil all the details, but the primary outcome was similar to both CVVH and IDH; the so-called superiority is just a secondary outcome- trial was not powered for it and was interrupted earlier... lots to comment on in a future #nephjc
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We will have a @Rush_Nephrology live renal biopsy conference tomorrow Thursday 10/15 at 1 PM CST. All I can say is this is some bad pathology. Please join us. #RushRenalRules
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Proud to share the publication of the ICRAKI trial in the @NEJM
In critically ill patients with AKI requiring RRT, intermittent hemodialysis was associated with higher mortality than CRRT.
thanks to all participating teams for their outstanding commitment
#ICRAKI #NEJM #AKI
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ASN Kidney News Oct-Nov 2026 Intravenous Bicarbonate for Metabolic Acidosis in the ICU: Improving Outcomes or Just Fixing Numbers?
J. Pedro Teixeira, Lenar Yessayan @luck_urine
@asnpublications
kidneynews.org/view/journalsβ¦
