Vancouver IM LMR

Dr. Farah Wehbe, illustrious nephrology fellow, presented on nephrology questions that general internists working in the inpatient setting often run into. This was a great overview of common nephrology topics for our Internal Medicine residents.

Please see the slide deck here.

Key takeaway points:

• Acute kidney injury
  • Defined as increase in creatinine OR oliguria
  • In severe AKI (e.g. when the patient is oligoanuric), the assumption should be that GFR is < 10 ml/min when urine output is minimal
  • Consult nephrology early if there is diagnostic uncertainty or patient is developing indications for dialysis despite medical management
• Chronic kidney disease
  • Cause, current eGFR, albuminuria, age are biggest predictors of progression of CKD
  • Can use the Kidney Failure Risk Equation to predict risk of end stage renal disease in 2 and 5 years
  • Avoid PICC lines in CKD patients who are likely to require AVF creation in the next 2-3 years 🡪 use a
    Groshong line instead
• Hemodialysis
• Peritoneal Dialysis
  • Diagnosis of PD peritonitis requires 2/3 of:
    • Symptoms/Signs of Peritoneal inflammation
    • Demonstration of bacteria in PD fluid
    • WBC > 100 in PD fluid with >50% PMN’s
  • Most common reason for PD catheter dysfunction is constipation
• Contrast associated nephropathy
  • Advanced CKD (eGFR <30) is a risk factor for contrast associated nephropathy
    • However, contrast associated nephropathy rarely results in need for dialysis, and should not delay medically necessary diagnostic tests
  • In higher risk patients (e.g. GFR < 30, GFR 30-44 with other risk factors for CIN, ongoing episode of AKI, or hypovolemia), consider:
    • Lower dose contrast
    • Avoidance of volume depletion and nephrotoxins
    • IV NS at 1cc/kg/h x 6-12 hours pre and post scan
  • Gadolinium based contrast can be used in CKD