Andrew Bland

I think AI with the right prompting is pretty effective at answering clinical questions while reducing hallucinations. I’ve been playing with it quite a bit. Excited to see you using it as an educational multiplier. Submitted this to HiMSS as a proposal

This highlights the importance of stakeholder involvement and the impact of disease prevalence when evaluating AI tool effectiveness.

#EuropeanRadiology #RadSky #MedSky

🔗 https://buff.ly/4aMWy4G

Hypertensive nephropathy: revisiting the causal link between hypertension and kidney disease Rajiv Agarwal; Hypertensive nephropathy: revisiting the causal link between hypertension and kidney disease, Nephrology Dialysis Transplantation, , gfaf014

Contrary to popular- (ahem, cardiology bias)- opinion, it is unlikely that hypertension is causal of chronic kidney disease: academic.oup.com/ndt/advance-... #openaccess
Classic editorial this week from the #NephSky expert, Dr. Agarwal!!, 👀🤓🙏💛

Artifactually elevated serum bicarbonate results caused by elevated serum lactate dehydrogenase concentrations - Mohamed Saleem, Goce Dimeski, Les Bourne, Penelope Coates, 2013 Background An accurate estimation of serum bicarbonate concentration (HCO) is essential to the diagnosis and treatment of acid-base disorders and electrolyte di...

I just had a patient who had a BMP CO2 of 40 and an ABG bicarb of 20. VBG showed bicarb of 20. Turned out LDH can also artificially raise BMP CO2. Anion gap was negative 15. journals.sagepub.com/doi/full/10....

Great piece, this is what stuck with me: "The care I provided in the delivery room to ensure that this baby survived: 1.94 RVUs (code 99464)... Elsewhere in the hospital, if my physician colleagues perform 30 minutes of hair removal by electrolysis: 264.87 RVUs (code 17380)."

Proposed age-adjusted eGFR thresholds for CKD 👇
#Nephpearls #NephSky

eGFR 75 for ages <40 years
eGFR 60 for 40-65 years
eGFR 45 for >65 years

👉 link.springer.com/book/10.1007...
👉 pubmed.ncbi.nlm.nih.gov/31506289/

Endothelin receptor antagonists in chronic kidney disease - Nature Reviews Nephrology Endothelin-1 (ET-1) is a potent vasoactive peptide that is produced by various cell types of the kidney and regulates a variety of physiological processes. This Review describes the role of ET-1 in th...

Endothelin receptor antagonists in chronic kidney disease | Nature Reviews Nephrology - goo.gl/alerts/D9gxoY #GoogleAlerts

Penn Medicine partners with Mark Cuban’s Cost Plus Drugs Penn Medicine has partnered with Mark Cuban's Cost Plus Drug Company through its innovative Cost Plus Marketplace in a strategic alliance that will allow Penn Medicine to secure the top 100 most frequ...

Not every day a leading US academic health system partners with @costplusdrugs.com, bypassing PBMs, to save drug costs for their patients
@pennmedicine.bsky.social + @mcuban.bsky.social
www.pennmedicine.org/news/news-re... a 1st-of-its-kind deal

Renal Physiology for the Clinician Series
#Nephpearls

👉 journals.lww.com/cjasn/pages/...

I have a Trovan pen that I love

I spoke at a couple of RN education sessions and hospitalist mgts and the nurses, on their own, selected this as their quality improvement project for 2025.

I agree. The journey is long but worthy. The nurses accept that all of my patients are now “allergic” to IV anti hypertensive meds. We are working on ensuring pain and agitation are managed. I have had to do a few standardized seated average of 3 BPs but found a few ETOH withdrawals

We have started this journey. Most accept the truth but fear medical legal consequences of either not calling a doctor or “Dr notified no orders received”

Little discussed fact: Choosing to not “treat” high blood pressure makes you look like a wacko to the nurses and CRNAs/anesthesiologists in the real world where I practice

It requires lots of time, explanation, being present, and even documentation of your rationale

a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom ALT: a man in a plaid shirt sits at a picnic table with the words " settle down " on the bottom

Skytorial: Five pearls on olanzapine 😁

Between agitation and nausea/vomiting, olanzapine has a wide range of use.

Olanzapine is generally not a front-line agent (e.g., haloperidol or ondansetron often are). But sometimes, it really comes in clutch....

FDA Recalls CKD Drug Cinacalcet | Docwire News The FDA issued a recall of a batch of Dr. Reddy’s Cinacalcet Tablets. Cinacalcet is a treatment for chronic kidney disease (CKD) and other conditions.

ICYMI: A batch of the #CKD drug #cinacalcet has been recalled by the FDA. #drugrecall #kidneydisease

Association of Kidney Function with Sodium-Glucose... : Clinical Journal of the American Society of Nephrology LT2i discontinuation in patients with CKD may limit the cardiokidney benefits of SGLT2i in real-world practice. Background The effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on cardi...

journals.lww.com/cjasn/fullte...

Large sample , real world data .
Would want to know reasons for discontinuation . In our practice CKD3b,CKD4 patients hitting the panic button after GFR drop 3-4 ml even though they were counseled about a likely drop in the first three months or more.

The water intake trial: www.nephjc.com/news/waterin... on #NephJC

Read the whole #Skytorial from @fperrywilson.bsky.social ⏬

1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.

And yet, it isn't.

Let's examine why.

This is very consistent with what I’m seeing when patients in GDMT (complete RAASi) come in septic. It suggests we need suck day education in when to hold RAASi meds

The renin–angiotensin–aldosterone-system in sepsis and its clinical modulation with exogenous angiotensin II - Critical Care Dysregulation of the renin–angiotensin–aldosterone-system (RAAS) in sepsis is a complex and early phenomenon with a likely significant contribution to organ failure and patient outcomes. A better unde...

'A better understanding of the pathophysiology and intricacies of the RAAS in septic vasodilatory shock has led to using exogenous angiotensin II as a new drug to treat sepsis. The use of angiotensin II may improve outcomes' #critcaresky #emimcc #RAAS #renin
ccforum.biomedcentral.com/articles/10....

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

Honey, stop what you're doing, new hyponatremia research just dropped!

What's it say?

It looks like slow correction is associated with worse outcomes, like death and length of stay!

Was it just a small study?

No, it was a meta-analysis of almost 12,000 patients!

jamanetwork.com/journals/jam...

I'm a big fan of sequential nephron blockade, including diamox, which I have used successfully many times. But as a reminder, the VAST majority of patients w/ADHF can be successfully decongested with adequate loop diuretic doses and adding thiazides when necessary #medsky #cardiosky

📖 KI #ISNFridaySelection: "Effects of dialysate K concentration of 3.0mEq/l with sodium zirconium cyclosilicate on dialysis-free days vs dialysate K concentration of 2.0mEq/l alone on rates of cardiac arrhythmias in HD pts w/hyperkalemia", presented @ #KidneyWk: www.kidney-internati... #NephSky

No blood in, no urine out