#IM2017 Nephrology Pearls

As you’ve probably noticed from our Twitter feed this week, Knowmedge chief editor Dr Sunir Kumar (@DrSunir) has been delivering real-time updates from the American College of Physicians’ Internal Medicine conference. Using #IM2017, you can view those and other relevant tweets and provide your own dispatches from this year’s gathering.

Below is a compilation of 17  Nephrology pearls so that you can easily refer to this high-yield content as you get closer to your ABIM exam date later this year.

@knowmedge Usually ATN will have FeNa>2%. Myoglobinuric renal failure and contrast nephropathy, FeNa can be less than 1%. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge If a patient has low K, high BP, and low renin and aldosterone, think Liddle Syndrome. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Patiromer is a newer agent that can be used to manage hyperkalemia. Once/day packet and then titrate dose as necessary. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Tolvaptan, which can be used in managing SIADH, is contraindicated in patients with liver disease. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Hyponatremia with neurological symptoms–>do not raise by more than 6-8 meq/L over 24 hours. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge If pt has NAGMA and negative urine anion gap, think GI problem like diarrhea. If NAGMA and + urine anion gap, think RTA. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Uncommon causes of increased anion gap: Propofol or pyroglutamic acid (chronic acetaminophen use). #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge if sterile pyuria, think: treated UTI, TB, interstitial cystitis, interstital nephritis, prostatitis. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge If pt has >1000 mg/day of proteinuria–>probably glomerular disease. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Urine microalbumin of 30-300 mg/24 hours–>think microalbuminuria. If >300 mg/24 hrs–>macroalbuminuria or nephropathy. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge If glucosuria + even if glucose <180 mg/dL, think RTA type II, physiologic in pregnancy, or use or SGLT-2 inhibitors. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge If urine pH>7.0 and has a non anion gap metabolic acidosis (NAGMA), consider the patient has RTA type 1 (distal RTA). #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Remember, in order to establish CKD, the patient's GFR has to be low for at least 3 months. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge No role in measuring Epo level in patients with CKD. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge AV fistula indicated if anticipated dialysis within 6 months or when GFR is 20-25 mL/min/1.73 m^2. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge No real transplant if following–> malignancy, chronic infection, severe heart dz, neuropsych problems, substance abuse. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017

@knowmedge Glomeular hematuria–>RBC casts with co-existing proteinuria. Non-glomerular hematuria–> no RBC casts or proteinuria. #IM2017
— Sunir Kumar (@SunirMD) March 28, 2017