The Curbsiders Internal Medicine Podcast #326 Cardiorenal Syndrome, Biomarkers, Diuretic Resistance (NephMadness 2022)
56:35
Managing Elevated Creatinine in ADHF
- Don't stop a patient's ARBs or SGLT2s solely due to elevated creatinine in acute decompensated heart failure.
- Address volume overload as the primary concern, even if creatinine rises.
Venous Congestion in Cardiorenal Syndrome
- Increased venous pressure, not decreased cardiac index, is the primary driver of worsening kidney function in cardiorenal syndrome.
- This venous congestion slows down perfusion, leading to acute kidney injury.
Restarting Medications Post-ADHF
- Restart ARBs and SGLT2 inhibitors in ADHF patients before discharge if they were stopped during admission.
- Rapidly restarting these medications can prevent future heart failure exacerbations.
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Introduction
00:00 • 2min
Nephrology - I'm a Cardiologist, Epidemiologist, Mother of Two
02:14 • 2min
Nephrology Board Review Courses - Learn How to Prepare for the Boards With Confidence
03:46 • 3min
Green Chef an - The Green Chef Podcast
06:20 • 2min
What Is Cartiorina Sindrome?
07:54 • 2min
Cardio Renal Candromes - What Are the Different Types?
09:36 • 2min
Do You Know What's Happening With Kidney Failure?
11:08 • 3min
Is Blood Pressure Impairing Heart Failure?
13:39 • 2min
Impatient Drugs - Are They Available Where You're at Your Local Cash Lack?
15:42 • 2min
Is There Acute Heart Failure?
17:25 • 2min
How Soon Should I Start My Caratnins?
19:10 • 2min
Do You Know What's Happening to Your Blood Pressure?
20:43 • 2min
Acute Kidney Injury - Do Not Panic
22:26 • 2min
Acute Decomposent Heart Failure in the Hospital
24:16 • 2min
Hypercretaanemia
25:47 • 2min
Kidney Injuries - Is There a Lagging Indicator?
27:19 • 2min
How Do You Assess Volume Status?
28:54 • 2min
Do You Know What the Volume Status Is?
31:09 • 2min
Investing in Blue Chip Art Can Help Diversify Your Portfolio
32:52 • 3min
Is the Troponen a Cause of Cardiovascular Disease?
36:17 • 3min
The Only Right Cat. I Love It.
38:49 • 2min
Diaretic Resistance
40:29 • 2min
Dose Loop Diaretic Versus Bolus Dosing
42:27 • 2min
Dose Response in Kidney Failure
44:29 • 2min
Dose of Ibmedinide in a Patient With Heart Failure
46:04 • 2min
Diaretics
47:57 • 2min
Hypertonic Saline
49:41 • 3min
Acutely Compromised Heart Failure - What Do You Want the Audience to Remember?
52:33 • 2min
Curb Siders Digest - The Curbsiders
54:35 • 3min
Lose your heart to NephMadness 2022! Dr. Joel Topf (@kidney_boy) and Dr. Sadiya Khan (@HeartDocSadiya) tackle the NephMadness 2022 Cardiorenal Syndrome region, leading us through the pathophysiology of cardiorenal syndrome, how to approach the creatinine “bump” with diuresis, managing patients with diuretic resistance, and more. This episode is part of our first ever NephMadness Pod Crawl, so check out the other podcasts, and fill out your NephMadness 2022 brackets!
Credits
- Producer, Writer, Show Notes, Infographics: Malini Gandhi
- Cover Art: Beth Garbitelli
- Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
- Reviewer: Emi Okamoto MD, FACP
- Executive Producer: Beth Garbitelli
- Showrunner: Matthew Watto MD, FACP
- Editor: Clair Morgan of nodderly.com
- Guest: Dr. Joel Topf MD, Dr. Sadiya Khan MD
*Claim free CME for this episode at curbsiders.vcuhealth.org! *Available within 24 hours of release.
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Show Segments
- Intro, disclaimer, guest bios
- Guest one-liners, Introduction to Nephmadness 2022
- Case #1 from Kashlak: acute decompensated heart failure with elevated creatinine
- Definition and pathophysiology of cardiorenal syndrome
- Use of home ACE-is/ARBs and SGLT-2 inhibitors in cardiorenal syndrome
- Case #2 from Kashlak: the creatinine bump with diuresis
- Approach to the creatinine bump with diuresis
- Tips for the volume exam
- Interpreting cardiac biomarkers in patients with chronic kidney disease
- Case #3 from Kashlak: diuretic resistance
- Maximizing loop diuretic efficacy
- Sequential nephron blockade
- Use of hypertonic saline
- Outro
NephMadness 2022 Pod Crawl
- Tues 3/15: The Drs. Washington - Inequities in Nephrology. Listen on Apple or Spotify. Website: https://www.drlatonyawashington.com/drswashingtonpodcast
- Wed 3/16: The Cribsiders - Neonatal AKI. Listen on Apple or Spotify. Website: http://thecurbsiders.com/thecribsiders
- Thurs 3/17: Up My Nursing Game - Hemodialysis. Listen on Apple or Spotify. Website: www.upmynursinggame.com
- Fri 3/18: BS Medicine - #505: Albuminuria, basketball and the Great White North. Listen on Apple or Spotify. Website: https://therapeuticseducation.org/
- Sat 3/19: Freely Filtered - Animal House Region. Listen on Apple or Spotify. Website: http://www.nephjc.com/freelyfiltered
- Twitter: @thecurbsiders @TheCribsiders @NephJC_Podcast @drs_washington @upmynursinggame @medmyths
Sponsor: ACP’s Internal Medicine Board Review
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New registrants will receive 6 months of access to the course recordings. Visit acponline.org/imbr2022 to register or learn more.
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CME Partner: VCU Health CE
The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.