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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 30/06/2025

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

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Reposted by Srikanth Bathini

myadla.bsky.social @myadla.bsky.social · 05/05/2025

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

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Reposted by Srikanth Bathini

Dr. Suman Behera @drsumanbehera.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Yup… Conservative management failed Neostigmine trial failed Colonoscopic decompression-> improved Colonic dilatation recurred as potassium fell after stopping Spironolactone Repeated aggressive potassium correction and a Colonoscopic decompression Slower weaning of Spironolactone helped

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

That’s amazing! How were the electrolytes ? #ECNeph

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Reposted by Srikanth Bathini

Dr. Suman Behera @drsumanbehera.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Well, these cases are rare. But dealing with this patient’s case helped to diagnose and treat a similar case pretty fast and effectively. The second patient required Spironolactone+IV + Oral KCL Weaned to Spironolactone and Oral KCL over a week Later only oral KCL Now, none… #ECNeph

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

👉 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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Several confounders in this case Investigations will be confusing when the case is evolving Better to hold on to your horses 🐴 and wait till the patient settles #ECNeph

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Hmmm… Ease of availability, low cost and the fact that short term use doesn’t cause too many adverse effects #ECNeph New MRA —> not studied for these though —> But hold that thought ☝🏻

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

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

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Reposted by Srikanth Bathini

Milagros Flores @dramiliflores.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Well, nothing suggestive of a villous adenoma #ECNeph

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

There were liquid stools trickling time to time from the rectum But, colonoscopy LIV decompression showed large volume of liquid stool trapped inside and was drained #ECNeph

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Srikanth Bathini @dakidneydoc.bsky.social · 25/04/2025

Pseudo obstruction can recur in upto 30% of cases Also, hypokalemia recurred in this case, which could have precipitated it #ECNeph

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

🚨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

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Reposted by Srikanth Bathini

ISNkidneycare @theisn.org · 25/04/2025

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...