Jason Prosek

“it’s more of a comment than a question” ;)

Is the XTC / Dukes thing otherwise unprecedented in history?

I figured you’d asked for anatomically accurate foot processes

Agree with this approach - increase spiro to enable d/c of drugs that are clearly not “scratching that itch“

“I don’t respond well to BP meds“ (edema, tachycardia on CCBs) for me, increases my suspicion that the patient has PA!

So I remove them in order of greatest side effect, often CCB first

What the heck is the “drug that speeds up dialysis”? This guy seemed less fed up with the “system” than simply fell in to a very bizarre conspiratorial wave of thought.

On some abandoned message board someone referred to them as “penalty tracks” and I thought that person gets it.

“8 glasses”
Yep I can do that 🍷
“of 8 oz”
Still following… ☕️
“of water per day”
Mate, you lost me there. What are you on about?

My fav part of the endo soc guidelines is the incredibly pragmatic and what I call the hospitalist carve out - 1) if you gave fluids and it got worse - prob SIADH. 2) if you fluid restricted and it got better - prob SIADH. In other words - just go for it! If you guess wrong, call me (on hosp day #2)

Same for us with about 30 feet of straight runway from the back door. But she runs right past us. We figure for this pure athlete it’s the sheer joy of being about a pound lighter and untethered.

Also helps to answer the timeless question “I wonder if that was a poop or a pee?

Big Country - In a Big Country
(song gets your foot in the door, but man, what a great album)

Haircut 100 - love plus one meets this criteria. Boy meets girl was song 1 and a hit, but not *the* hit

Don’t forget that 20-30% of patients with RHTN have primary aldosteronism. These patients get extrarenal, BP-independent benefits from MR-blockade. So be sure PA is excluded before reaching for amiloride. #nephsky

Best exchange in Meeting People is Easy -
Reporter: have you been influenced by Genesis, Pink Floyd?
Thom and co. in unison: we *hate* progressive rock!

Hahahaha. Laughable.

I mean, Jonny’s playing an *actual* mellotron thru OK Computer and Kid A.

Don’t let them tell you prog is a 4-letter word!

I’m a prog rock purist by all stretches. Which is to say this sounds to me like the Steve Howe solo album that he *should* have made.

The nostalgia is preserved in the music for me. Lots of Simon’s Quest riffs in early Iron Maiden - hear a Castlevania-y riff and I’m right back in the game. And that’s enough.

Neph version: I thought it was amusing that some Neph divisions went by “division of nephrology *and hypertension*”. I mean, it’s just hypertension. We can all do that.

10 years later - it’s all hypertension mgmt. The kidneys are just where the drugs work. Fully radicalized.

Similar but golf instead

#MedSky… we all need to check on trainees who are here on visas and not expect they function normally under such impossible conditions ❤️‍🩹

We trained her. The kindest, gentlest physician - human, rather - I’ve had the pleasure to meet.

The Different Colors Of Peritoneal Dialysate During a night call in my first year of nephrology fellowship, I was asked a question that I had never heard before: ‘What do I do when I see black effluent d

What does a green PD fluid effluent bag mean?

This and more in this RFN blog piece

www.renalfellow.org/2025/03/12/d...

By @drcoolbeans.bsky.social

#NephSky

What's the highest renin you've ever seen?

An extreme example of a common issue. Severe hyperreninemia secondary to combination ARB+thiazide.

www.ccjm.org/content/91/2... (free)

@amyaimei.bsky.social

#medsky #nephsky

Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline Take this survey powered by surveymonkey.com. Create your own surveys for free.

I joined Endocrine Society to request a copy. Turns out it is an open link to a surveymonkey site. I checked and they said it was ok to share. Please share your thoughts!

www.surveymonkey.com/r/endopacpg

Do you ever play “concave up” vs “concave down” when trending out ATN? “Improvement! Creatinine climbing less quickly! No RRT today.”

This seems to at least be adjacent to the code gas result. As in “hey neph, you are *not* going to believe how bad the electrolytes got when the cardiac output was zero and GFR was nil.”

Core Curriculum by @amyaimei.bsky.social, Sangeetha Murugapandian, Ali W. Rizvi, and Anna Gaddy:

Viral Nephropathies: Core Curriculum 2024

https://bit.ly/413soY9 (FREE)

Second, only to “elevated creatine kinase” when I’m seeing that muscular patient in clinic with a creatinine of 1.3.
Fine, I’ll just call it AKI. Is that what you really want?!

In general, I think DDx presented as list/table could be strengthened by conveying some relative weight/probability of the Dxs.

When we teach it like this, presenting each on par with each other, I think that leads to excessive testing/healthcare expenditures.

Don’t you find you get the same result (gut versus renal K wasting) regardless of which equation you use? Did TTKG ever actually lead you astray?