In December 2019, when Chinese authorities alerted the World Health Organization of cases of pneumonia in Wuhan City, for which they were unable to identify a known cause, little did we know that this was just the tip of the iceberg that would leave us with (to quote a Lin-Manuel Miranda song title in “Hamilton”) a “world turned upside down.”
None of us signed up for this. There was a realistic fear of death to health care workers who were already taxed beyond what anyone could imagine. They may have questioned, “Will my patient die because of a bed or
Is the risk of ODS the same at all levels of starting PNa levels? And if not, perhaps we do not need to re-lower the PNa if starting in the mid-120s?
The discussion focused on several points:
The relative change in serum osmolality (and therefore shifting of brain water) is not the same with a 12 meq/L PNa change when you consider, for example, starting at a PNa of 110 vs. 125. Thus, you would not expect the risk of ODS to be the same in those two patients. This is confirmed by the fact that
A woman with type-1 DM who was 31 weeks pregnant presented for the second time in about a month with vomiting and a severe metabolic acidosis. The first time she had a pH of 7.3 with an HCO3 of 10 but an anion gap (AG) of only 12. Her blood glucose (BG) was 171, her betahydroxybutyrate (BHB) was 39 and she was assumed to have diabetic ketoacidosis (DKA), was treated as such and the acidosis resolved. Then 20 days later she developed a similar metabolic acidosis, HCO3 13, AG 16, BHB again elevated at 55, but her BG this time was only 114. She received 3 liters of normal saline (NS) and her acidosis worsened with her [HCO3] dropping to 8.
Introduction and Background A 46 y/o male with history antiphospholipid Abs on apixoban for DVT in 2012 was referred for renal failure and proteinuria. The patient was seen 9/17 with creatinine 1.6 mg/dl (1.1 in 1/16, 1.4 in 1/17), U/A 2+ protein, no blood, urine P/C ratio 146 mg/g. Serologic w/u normal including serum and urine immunofixation and serum free light chains (FLC): kappa FLC 45.6, lambda FLC 51.9 with a K/L FLC ratio of 0.9 (nl 0.37-3.1 in pts with renal insufficiency) https://tinyurl.com/yakoqt9d. A renal biopsy showed a mesangial proliferative GN with only IgG1 lambda by immunofluorescence consistent with “Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits” (PGNMID). The patient we seen by hematology and a bone marrow was nl including flow cytometry, fluorescence in situ hybridization (FISH), chromosomal studies and stains for amyloid.
Richard Glassock, Roger Rodby, and with Zach Cahill, Senior ASN Communities Associate
Increasingly in the 21st century, nephrologists and other physicians are turning to social media (SoMe) and internet-based forums to teach the next generation, treat their patients better, and bolster their knowledge. From blogs to Twitter, there are an overwhelming number of non-traditional learning and teaching resources available to nephrologists (1–3).
For the past two years, ASN Communities has been a vital addition to this space by providing an online venue for nephrologists around the world to have detailed discussions about complex questions, share their knowledge with peers, and create the peer-to-peer relationships that many only find
Roger A Rodby MD FACP FASN and Susan Willner ASN Communities
Three years ago, the ASN developed and released ASN Communities with the objective of creating an international venue to network, collaborate and discuss important issues in a members-only environment. Since the launch:
Members have embraced the Communities for discussion and learning. Recently a conversation on “Lupus with New Proteinuria and Hematuria” provided such valuable real-life case information that it was used in a presentation on “When to do a Kidney Biopsy in Lupus Patients and Understanding Activity and Chronicity Scores” to the New York Academy of Medicine by Dr. Surya Seshan, MBBS, Weill Cornell Medical Center, who reported that attendees “loved the way I brought the ASN online exchange as an introduction to highlight the issue and my talk. I cannot thank you and all our experts enough for making this happen.”