The Curbsiders Internal Medicine Podcast REBOOT: #454 Kidney Boy on Managing Diabetes and Hypertension in CKD
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Jul 24, 2025 
Dr. Joel Topf, a passionate nephrologist and clinical assistant professor, shares his expertise on managing diabetes and hypertension in chronic kidney disease. He emphasizes the interplay between these conditions and kidney health, providing invaluable insights into blood pressure control and the importance of effective communication in patient care. The discussion also highlights the significance of cystatin C over creatinine as a marker for kidney health and advises on personalized treatment strategies to improve patient outcomes. Prepare to laugh while learning!
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Sometimes Medicine Works
- Medicine sometimes works and sometimes it doesn't, similar to the ritualistic aspects of care.
- Patients often don't fully understand what treatments are doing or if they will succeed.
CKD Risk Requires Albuminuria
- CKD prognosis depends greatly on albuminuria, not just GFR.
- The Kidney Failure Risk Equation provides practical risk percentages that help communicate prognosis to patients.
Use Cystatin C for GFR Accuracy
- Use cystatin C to better estimate kidney function, especially for patients with unusual muscle mass or race-related concerns.
- Cystatin C avoids biases of creatinine and provides more reliable GFR assessment.