Kidney function improved after 12 F drain placed under CT guidance!!

Page kidney: Patient s/p kidney biopsy, complicated by subcapsular hematoma. He became more hypertensive and Serum creatinine went up from 2s to 8 within days.

Pictures are worth a thousand words! What happened to the kidney function?

ICU Mini-Stories:

Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:

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Yes, already did!

Same here, I was contacted about a federal grant!!

Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass VASOPLEGIC SHOCK (VS) is a form of vasodilatory shock characterized by normal-to-increased cardiac output and reduced systemic vascular resistance (SVR) occurring with cardiopulmonary bypass (CPB).1,2...

Hi, check this study from Cleveland Clinic, looks like favors hydroxy cobalamin www.jcvaonline.com/article/S105....

I do that vice versa, start on 2 k and then go to 1 for the last hour as you still have a high gradient with the 2, but hopefully a smooth shift.

Really well done! I love the math behind!

You've probably heard that Bicarbonate has to turn into CO2 to raise the pH.

“Don’t give bicarb if you can’t increase ventilation.” But why?!

How much CO2 is there in an amp of sodium bicarbonate? Hos much does it raise pH? And how long does it last?

A 🧵 all about our ICU frenemy NaHCO3

1/

Fascinating, thank you🙏💪! Unrelated to the topic, but it reminded me about pseudo hyperchloremia with a negative anion gap!!! Bromide and iodide belong to the same group (as chloride) in the periodic table with 7 electrons, and can interfere with some assays measuring chloride!

Hi, not yet. I have tried the iQ+. The iQ3 appears to have a smaller footprint, glad it has better cardiac images.

So far workup is in progress with concern for Mycobacterium species,pending cultures.

...an ascending colon mass-like thickening suspicious for active malignancy. Colonoscopy + for 2 malignant-appearing friable masses, but pathology returned negative for malignancy and revealed prominent granulomatous inflammation with focal crypt abscesses, no AFB or fungal organisms identified.

While the Initial workup for fungal infections, TB, and sarcoidosis was negative, she received zoledronic acid and ketoconazole instead of prednisone due to concern about underlying infectious processes. Then PET CT showed..

How satisfying is the workup and management of Hypercalcemia!!?
62 YO F who presented with abdominal pain, and decreased PO intake, was found to have liver cirrhosis with a small amount of ascites. Neph consulted for HRS,,, but noted high Ca, driving polyuria... Workup showed an elevated 1:25 Vit D.

Almost twins!!

Yes!

Since Swifties have moved en masse, I’d like to re-present one of my favorite threads 😍

Inspired by beautiful #urinemicroscopy pictures posted elsewhere... I present to you
⭐️Taylor Swift as #urinarysediment 🔬⭐️ findings...

1/ Bilirubin pigmented RTEC (renal epithelial cell cast)
🧵 #NephSky #MedSky

30 yo male, hypotensive on the floor, aki, hyponatremia! More fluids??! Less fluids!!! #Nephrology #POCUS

In the 140s-150s, despite being hypovolemic with multiple drains!

This was taken with Clarius convex scanner. It works pretty well for abdominal imaging, a little challenging on the cardiac imaging.

Our patient with a single kidney underwent CT-guided drainage but it appeared to be an organized hematoma. In addition, there was partial ureteral obstruction due to extensive collections/adhesion post multiple surgeries.

PAGE Kidney: Subcapsular hematoma causing compression of the parenchyma and hypoperfusion-> activation of RAAS-> HTN and in some cases reduced renal function.

SGLT2 inhibitors - Key points

• hold for 72 h before elective surgery (5 half-lives)

• multidisciplinary input for procedures w dietary alterations and in poorly controlled DM or cardiac/renal disease

• ketone monitoring in emergency surgery

#AnSky #MedSky 🧪

https://buff.ly/3O6qa2C

New AKI consult... Interesting POCUS finding at bedside! Can you guess what is wrong? #Nephrology #POCUS

Thank you so much for making the transition easier!!