𝗜𝗦𝗡 𝗩𝗜𝗗𝗘𝗢 𝗔𝗕𝗦𝗧𝗥𝗔𝗖𝗧 𝗦𝗘𝗥𝗜𝗘𝗦: APOL1 genotype and HIV infection: 20 year outcomes for CKD, CVD and hypertension. 2025 from @kireports.bsky.social‬ www.kireports.org/ar... #VideoAbstract by ‪@drsumanbehera.bsky.social‬ & @dakidneydoc.bsky.social‬

Friends ! Check this survey on Pregnancy AKI Available in 20 languages Do share in your groups qualtrics.kcl.ac.uk/jfe/form/SV_... @dramiliflores.bsky.social @hswapnil.medsky.social @divyaveerssneph.bsky.social @kajareeg.bsky.social @dakidneydoc.bsky.social

Hypoelectrolytemia. Low K, Mg Ca, Na and P. Did you have to use more than the conservative measures for management?

Sounds like pseudoobstruction... seen in patients with Ogilvie syndrome. Can also cause severe electrolyte dysfunction. But quite rare.. mostly diagnosed by GI before the nephrologists get to see them

A big thanks to @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social Thanks to the wonderful #NephSky community for tuning in! #ECNeph

A glimpse at the causes of an Acquired Bartter Defect too! #ECNeph @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social

How do we manage Ogilvie’s syndrome? @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

❓ What is this Acute Pseudo colonic Obstruction (Ogilvie’s syndrome)? 👉 Several theories have been proposed @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

👉 In vitro studies suggest that colonic Maxi – K channels are upregulated 👉 These are the same channels upregulated in CKD, enhancing gut excretion of potassium 👉 In ESRD, the colonic excretion of Potassium is 3-fold that of normal individuals #ECNeph @myadla.bsky.social @dramiliflores.bsky.social

Here are some of the case reports describing hypokalemia in Ogilvie’s syndrome @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

Can there be any other cause for hypokalemia in this case? There are several case reports of Ogilvie’s syndrome being associated with severe hypokalemia @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

Here’s an infographic describing the various mechanisms of hypokalemia Highlighted in brown = Present in this case Shout out to @dana_m_larsen , my Nephrologist colleague from UCSF for the amazing infographic #ECNeph @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social

What do you do when there is a fluctuating acid base disorder in hypokalemia? Keep Calm … #ECNeph @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social

🧠 worth considering — especially if we have renal potassium-wasting, in the set of GI loss #ECNeph

Here’s a review of the initial clinical course: Note that there was a fluctuating acid base balance -> look at the case summary #ECNeph @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social

The story doesn’t end here! @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

The patient was treated with 50 mg of Spironolactone and Oral Potassium of 70 mmol per day and maintained normokalemia and normal bowel movements. @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

Now that we know that there is a chloride, Potassium and Calcium loss disorder…. @myadla.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org @nephroseeker.medsky.social #ECNeph

28/n what next #ECNeph? Peel another banana? @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

34/ 🧪 What nephron segment could be acting out? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

36/n What’s your working diagnosis now? Time to zoom in! #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

33/n 📊 So… if it’s not the aldosterone, who’s stealing the K+? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

22/n 🧐 How would YOU approach this case? What’s the unifying diagnosis? What test or clue are we still missing? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

32/n 🕵️ What’s behind the potassium leak? need more lab rouns? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

26/n 🧪 88 mmol/day of urinary K+… Are the kidneys holding back? Clues are leaking! #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

23/n 🕵️‍♂️ Ready to solve the mystery? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

Amazing picture Welcome @ferarceamare.bsky.social #ECNeph

24/n 🔄 The potassium pendulum swings again—what’s sabotaging K⁺ retention? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

25/🔬 ↓ K+, ↓ Mg2+ and alkalosis joins the plot 🧪 We’ve seen this trio before... but where? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

MUDPILES! #ECNeph

21/n 🧠 The Potassium Puzzle: Still unsolved? 🕵️ This slide’s got suspects—can you spot the culprit? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

20/n 😳 Still hypokalemic after all that? What’s so peculiar? ⚠️ Potassium wasting? GI sequestration? Something rarer? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

🚨The potassium climb: what a wild ride on this case!!! Colonic decompression - large potassium supplementation #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

Do you agree with the diagnosis? any other ideas? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

#ECNeph Great discussion going on Glad to join @dakidneydoc.bsky.social @dramiliflores.bsky.social

13/ How does hypokalemia affect the colon? ⚠️ ⚠️ In hypokalemia, increased activity of ENaC & BK channels may paradoxically worsen K⁺ loss → Vicious cycle of K-wasting #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social pmc.ncbi.nlm.nih.gov...

When in doubt, take a step back and observe Your everyday cases may sometimes not be what residency prepares you for! #ECNeph

11/n 🧠 Something’s not adding up… Time to take a step back. #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

12/n 🤔 What’s the link between gut, lungs, and electrolytes? Keep following—#ECNeph👇 @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

10/n 🔍 CT Time! 🌀 Obstruction? Paralytic ileus? Something more ominous? Take a closer look 👀 #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

paralytic ileus? #ECNeph

9/n The acid-base alarm is ringing 🔔 So… what’s causing the gap? Any more clues? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

8/n 💉 ChemMystery! 🤕 That’s severe hypokalemia, mild AKI, and possible sepsis brewing. Electrolytes don’t lie❗ But what’s the why? Any more clues? #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

7/n Could this be driven by an inflammatory or infectious process? Time to think about the broader approach—and consider the possibilities. #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social pubmed.ncbi.nlm.nih....

6/n 🩸What do you see here? CBC = Chaos? 🧪 Mild transaminitis 🤔 What could tie this together? #ECNeph #MedSky #NephSky @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

5/n 🔍 At admission Sounds like more than just GI discomfort, right? Any thoughts ⬇️ #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

1/n 🚨#ECNeph returns! Time to meet our next patient... A 50-year-old lady walks into your nephrology radar. What would you be looking for next? Clues ahead… 👀🔍 #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

2/n 🔍 Let’s add some spice! She now presents with: 🌀 Repeated vomiting 🌡️ Intermittent fever🪠 Abd distension what's your diagnostic clue? 🧩 #ECNeph @dakidneydoc.bsky.social @dramiliflores.bsky.social @myadla.bsky.social @dilushiwijay.bsky.social

Hello! I’m Fernanda Arce joining today’s #ECNeph from Mexico City, land of the jacarandas 💜

Where’s the potassium going? 🕵️‍♂️ Any culprits?⚡ Renal losses or ⚡ GI losses — any difference? 💥 Bring your K⁺ game to the table! @dakidneydoc.bsky.social @dramiliflores.bsky.social @dilushiwijay.bsky.social @kajareeg.bsky.social @theisn.org #ECNeph #NephSky #MedSky