Podcasts about renal

Vertebrate organ that filters blood and produces urine

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Latest podcast episodes about renal

Mehlman Medical
HY USMLE Q #561 – Renal

Mehlman Medical

Play Episode Listen Later Sep 23, 2022 4:56


Video for this podcast: https://mehlmanmedical.com/audio-qbank-hy-usmle-q-561 Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this podcast episode, I discuss glimepiride pharmacology, adverse effects, hypoglycemia symptoms, and drug interactions. CYP2C9 is an important enzyme in the breakdown of glimepiride. I discuss a few drugs that can cause interactions via this enzyme. Renal function is important to consider with glimepiride. The active metabolites are cleared by the kidney and can accumulate in CKD. Hypoglycemia and weight gain are problematic adverse effects of this medication and are the primary reasons it has fallen out of favor.

The Rx Bricks Podcast
Renal Laboratory Tests and Imaging

The Rx Bricks Podcast

Play Episode Listen Later Sep 20, 2022 27:45


Looking for more information on this topic? Check out the Renal Laboratory Tests and Urinalysis brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Twitter: https://twitter.com/mesage_hub Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including over 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

The Medbullets Step 2 & 3 Podcast
Renal | Urethral Injury

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Sep 19, 2022 6:46


In this episode, we review the high-yield topic of Urethral Injury from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Renal | Epididymitis

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Sep 18, 2022 7:45


In this episode, we review the high-yield topic of Epididymitis from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Renal | Prostatitis

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Sep 17, 2022 7:40


In this episode, we review the high-yield topic of Prostatitis from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

The Medbullets Step 2 & 3 Podcast
Renal | Dialysis Indications

The Medbullets Step 2 & 3 Podcast

Play Episode Listen Later Sep 16, 2022 6:54


In this episode, we review the high-yield topic of Dialysis Indications from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

MEM Cast
Episode 131: Cardio-renal syndrome (CRS)

MEM Cast

Play Episode Listen Later Sep 16, 2022 21:38


This week we are happy to welcome Dr Matthew Graham-Brown Consultant Nephrologist in Leicester (Glenfield and Leicester General Hospital). Dr Graham-Brown is going to discuss Cardio-Renal Syndrome (CRS) with us, we all in medicine encounter the clinical conundrum of a patient that is fluid overloaded and might have acute or chronic kidney or heart failure.  Listen to this excellent talk for tips on how to manage this clinical situation. 

I Think, Therefore I.M.
Journal Club: Vanc + Zosyn and Renal Function

I Think, Therefore I.M.

Play Episode Listen Later Sep 15, 2022 11:10


Join us for a brief review of the recently published article "Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study". Published in Intensive Care Med in Aug 2022

The Uromigos
Episode 196: The COSMIC-313 Trial cabo/ipi/nivo in 1st line renal cancer

The Uromigos

Play Episode Listen Later Sep 14, 2022 32:22


Toni Choueiri describes the study.

Addiction in Emergency Medicine and Acute Care
BONUS EPISODE - The Non-Opioid Management of Renal Colic

Addiction in Emergency Medicine and Acute Care

Play Episode Listen Later Sep 13, 2022 18:17


A bonus episode! This isn't really on the topic of addiction...but it does involve opioid sparing and alternative to opioid treatment protocols (and avoiding a new start of opioids may prevent someone from developing opioid dependence or opioid use disorder). I put together a lecture on the non-opioid management of renal colic a few months back. I thought the topic was really useful, so I presented it to the docs that I work with where I practice as a part of our monthly physician education. I literally just recorded my presentation with my iPad while I was giving the lecture to my group (thus the lousy audio...my apologies). In any case - I hope you find this lecture helpful. I review non opioid pain management of renal colic in detail, including NSAIDs, lidocaine infusions, antispasmodics, and tamsulosin.

San Lucas Al Día
Dr. Gilberto Ruiz Deyá: Raro aneurisma renal

San Lucas Al Día

Play Episode Listen Later Sep 12, 2022 30:59


Dr. Gilberto Ruiz Deyá, urólogo: Raro aneurisma renal

Keeping Current CME
The Renal Denervation Durability Question Put to Rest

Keeping Current CME

Play Episode Listen Later Sep 12, 2022 16:05


Renal denervation has been shown to effectively lower BP, but for how long? Listen as our experts discuss the newest data.     Credit available for this activity expires: [09/09/23] Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/[980286]?src=mkm_podcast_addon_[980286]

The Uromigos
ESMO 2022: Pegylated il-2 + nivolumab in renal cancer

The Uromigos

Play Episode Listen Later Sep 12, 2022 24:35


Nizar Tannir describes this randomised phase 3 study presented at ESMO. 

GU Cast
Radiation for renal cancer??!! Really??!!

GU Cast

Play Episode Listen Later Sep 8, 2022 35:17


It wasn't that long ago that we would have scoffed at the idea of using radiation therapy to treat primary kidney cancer. Not any more!! We are joined by two top experts in kidney cancer, and leaders of ongoing research in this field, to discuss the expanding role for radiation therapy in managing primary renal cancer. Dr Rana McKay, GU Medical Oncologist at the University of California, San Diego, and Associate Professor Shankar Siva, Radiation Oncologist at Peter MacCallum Cancer Centre in Melbourne, take us through the relatively recent history of radiation for renal cancer and highlight some ongoing trials in this area. A fantastic overview for anyone interested in renal cancer. Plus our intrepid social media watcher, Dr Aoife McVey, pops in to tell us what has caught her eye on Twitter this week. You can watch us broadcasting from our studio here on Youtube. Links:Twitter - Dr Rana McKay Twitter - A/Prof Shankar Siva Twitter - Dr Aoife McVeyTwitter - CheatUrologyTwitter - GoumasUrologiahttps://urologycheatsheets.org/ 

Global Medical Office Dialogues
Precision Medicine: Drug Resistant Infections - Miriam Huntley, PhD.

Global Medical Office Dialogues

Play Episode Listen Later Sep 7, 2022 28:15


The escalating incidence of infections caused by drug-resistant bacteria contributes to a reported 700,000 deaths annually, that number is expected to soar to over 10 million by 2050.  Timely, actionable information is necessary to provide effective treatments quickly to drug-resistant infections. Dr. Miriam Huntley, the Chief Technology Officer for Day Zero Diagnostics, talks about their efforts to improve infectious disease diagnosis and treatment with genomic sequencing and machine learning to solve antibiotic resistance.

Podcasts do Portal Deviante
Doença Renal Crônica e o Transplante Renal (SBN #50)

Podcasts do Portal Deviante

Play Episode Listen Later Sep 7, 2022 39:19


Queridos ouvintes, sejam bem-vindos ao quinquagésimo episódio do podcast da Sociedade Brasileira de Nefrologia em parceria com o Portal Deviante. O que é Doença renal crônica? Como se chega nesse diagnóstico? Como a doença renal crônica pode levar à necessidade de um transplante renal? Quais critérios para um transplante renal? Como ele acontece e o porquê? Lembre-se: Beba água e dose sua creatinina!

Scicast
Doença Renal Crônica e o Transplante Renal (SBN #50)

Scicast

Play Episode Listen Later Sep 7, 2022 39:19


Queridos ouvintes, sejam bem-vindos ao quinquagésimo episódio do podcast da Sociedade Brasileira de Nefrologia em parceria com o Portal Deviante. O que é Doença renal crônica? Como se chega nesse diagnóstico? Como a doença renal crônica pode levar à necessidade de um transplante renal? Quais critérios para um transplante renal? Como ele acontece e o porquê? Lembre-se: Beba água e dose sua creatinina!

The Rx Bricks Podcast
Renal Stones

The Rx Bricks Podcast

Play Episode Listen Later Sep 6, 2022 34:47


Looking for more information on this topic? Check out the Secondary Hypertension brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

The Journey Continues
Recipe for Success

The Journey Continues

Play Episode Listen Later Sep 6, 2022 25:33


Figuring out what to eat in each stage of kidney disease can be frustrating and confusing. Renal dietitian Kelly Nemec joins Dr. Melissa Prest to talk all things kidney diet – including tips for setting yourself up for a successful transplant. 

AIM4PG
CLINICAL CASE PRESENTATION OF RENAL / KIDNEY STONE WITH NOTES

AIM4PG

Play Episode Listen Later Sep 4, 2022 15:37


CLINICAL CASE OF RENAL STONE WITH NOTES https://youtu.be/OVarJLIFAmg INSTAGRAM www.Instagram.com/aim4pgmed FACEBOOK www.facebook.com/aim4pg EVERY WEEK VIDEO/GUIDE TO USMLE/PLAB LECTURES WILL BE UPLOADED HERE www.youtube.com/aim4pgmed Download this video lecture notes in AIM4PG PREMIUM Group only. More video lectures notes, past paper of INICET, UPSC-CMS, NEETPG, FMGE, 1ST 2ND 3RD 4TH YEAR MBBS PAPER, all disease diet plans will only be available in AIM4PG PREMIUM Group link https://bit.ly/AIM4PG --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/aim4pg/message

Casenotes
Ep.6 - Past & Present - Renal

Casenotes

Play Episode Listen Later Sep 2, 2022 27:03


Casenotes Past & Present is a Royal College of Physicians of Edinburgh podcast. In this episode we explore the history of renal medicine, examining how difficult it was to uncover what was happening inside the body before medical advances in the 1800s. Theories around how the kidney worked, and what to do when it failed, are uncovered – alongside some very strange attempts at treatment. We also talk to Professor Neil Turner about what it is like to work as a nephrologist today. And we finish by exploring the first successful example of kidney dialysis – which trialled on a Nazi collaborator. A full transcript of this podcast episode can be downloaded here: https://www.rcpe.ac.uk/heritage/talks/past-present-renal Website: https://www.rcpe.ac.uk/heritage Twitter: https://twitter.com/RCPEHeritage

Physician Assistant in a Flash
Surgery: Urology and Renal Topics (Ep 8)

Physician Assistant in a Flash

Play Episode Listen Later Aug 25, 2022 17:54


Urology and renal topics comprise 5% of the General Surgery End of Rotation Exam and 5-10% of the PANCE (including the genitourinary system). Review common renal and urologic surgical topics including nephrolithiasis, chronic kidney disease, cancers, and more!

The Rx Bricks Podcast
Hemostasis

The Rx Bricks Podcast

Play Episode Listen Later Aug 23, 2022 15:10


Looking for more information on this topic? Check out the Congenital Disorders of the Urinary System brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

The PathPod Podcast
Around The Scope - Renal Pathology

The PathPod Podcast

Play Episode Listen Later Aug 19, 2022 43:54


In this series, PathPod gathers pathologists Around The Scope to discuss their work in depth. Today, we learn about renal pathology. Our host, Dr. Sara Jiang (@Sara_Jiang) speaks with Dr. Mei Lin Bissonnette (@BCRenalPath), Director of the British Columbia Provincial Renal Pathology Laboratory, Dr. Carla Ellis (@theglasspusher), Director of Renal Pathology in the Department of Pathology at Northwestern University, Dr. Alcino Gama (@AlcinoGama), PGY2 at Northwestern Pathology, and Dr. Vighnesh Walavalkar (@vighnesh_w), Director of Histology at the University of California San Francisco.  What is new and exciting in the field of renal pathology? How is the Renal Pathology Society supporting DEI efforts? What is two-handed fly fishing? Learn about these questions as well as about our expert guests!   Renal pathology society: https://www.renalpathsoc.org/ https://www.renalpathsoc.org/Diversity-Equity-and-Inclusion https://www.facebook.com/renalpathologysociety Twitter: @Renalpathsoc   Public domain music: Main Stem by US Army Blues

Oncotarget
Press Release: Kinase Activity in RCC, Renal Tissue and in Response to TKI

Oncotarget

Play Episode Listen Later Aug 17, 2022 4:12


A new research paper was published in Oncotarget on August 4, 2022, entitled, “Kinase activity profiling in renal cell carcinoma, benign renal tissue and in response to four different tyrosine kinase inhibitors.” Kinase activity is frequently altered in renal cell carcinoma (RCC), and tyrosine kinase inhibitors (TKIs) are part of the standard treatment strategy in patients with metastatic disease. However, there are still no established biomarkers to predict clinical benefits of a specific TKI. “Despite a number of new treatment options improving RCC patients' disease control rates and survival, the lack of useful biomarkers remains a major clinical concern.” In the current study, researchers Andliena Tahiri, Katarina Puco, Faris Naji, Vessela N. Kristensen, Glenny Cecilie Alfsen, Lorant Farkas, Frode S. Nilsen, Stig Müller, Jan Oldenburg, and Jürgen Geisler, from University of Oslo, Oslo University Hospital, Akershus University Hospital, and Pamgene International BV, performed protein tyrosine kinase (PTK) profiling using PamChip® technology. “The aim of this study was to identify differences in PTK activity between normal and malignant kidney tissue obtained from the same patient, and to investigate the inhibitory effects of TKIs frequently used in the clinics: sunitinib, pazopanib, cabozantinib and tivozanib.” The results showed that 36 kinase substrates differ (FDR < 0.05) between normal and cancer kidney tissue, where members of the Src family kinases and the phosphoinositide-3-kinase (PI3K) pathway exhibit high activity in renal cancer. Furthermore, ex vivo treatment of clear cell RCC with TKIs revealed that pathways such as Rap1, Ras and PI3K pathways were strongly inhibited, whereas the neurotrophin pathway had increased activity upon TKI addition. Their assay showed that tivozanib and cabozantinib exhibited greater inhibitory effects on PTK activity compared to sunitinib and pazopanib, implying they might be better suitable as TKIs for selected RCC patients. “The results of our study contribute to better understanding of the changes in kinase activity in RCC tumor cells involved in fundamental oncogenic cellular processes and the ex vivo effect of TKIs. We found tivozanib and cabozantinib to be more potent TKIs in RCC samples than sunitinib or pazopanib. The next step will be to correlate the efficacy and toxicity in individual patients with their respective kinase activity of normal and malignant kidney tissue.” DOI: https://doi.org/10.18632/oncotarget.28257 Correspondence to: Jürgen Geisler – Email: juergen.geisler@medisin.uio.no Keywords: kidney cancer, kinase activity, tyrosine kinase inhibitors, renal cell carcinoma, tyrosine kinase About Oncotarget: Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, visit Oncotarget.com and connect with us on social media: Twitter – https://twitter.com/Oncotarget Facebook – https://www.facebook.com/Oncotarget YouTube – www.youtube.com/c/OncotargetYouTube Instagram – https://www.instagram.com/oncotargetjrnl/ LinkedIn – https://www.linkedin.com/company/oncotarget/ Pinterest – https://www.pinterest.com/oncotarget/ LabTube – https://www.labtube.tv/channel/MTY5OA SoundCloud – https://soundcloud.com/oncotarget For media inquiries, please contact: media@impactjournals.com.

FLCCC Alliance
Q&A#68 Can patients use ivermectin with dialysis or with renal transplantation

FLCCC Alliance

Play Episode Listen Later Aug 17, 2022 1:40


Dr. Iglesias explains the issues with using ivermectin with renal transplantation. He notes that the drug-drug interaction is the main concern and recommends speaking with your doctor. View the full webinar here: https://odysee.com/@FrontlineCovid19CriticalCareAlliance:c/weekly_webinar_August03:a Formed by leading critical care specialists in March 2020, the Front Line COVID-19 Critical Care Alliance (FLCCC) has developed highly effective treatment protocols that aim to prevent and treat COVID-19 at all stages of the disease. We are a 100% donor-supported 501(c)(3) non-profit organization — our work would not be possible without you. Your gifts help us expand our reach and share the latest research available, for the health and well-being of all. To donate online, click here: https://covid19criticalcare.com/network-support/support-our-work/ To follow FLCCC, click here: https://covid19criticalcare.com/follow-flccc-2/ To learn more about our protocols, click here: https://covid19criticalcare.com/covid-19-protocols/ To register for weekly webinars, click here: https://geni.us/FLCCC_Webinar_Register To buy FLCCC gear, click here: https://supportflccc.store/ Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

KidneyTalk - An Online Radio Show By Renal Support Network

For Molly Reehl, CDN, working as a technician was the first step in a career in dialysis. She loved caring for patients and felt valued by them, and she wanted to provide them with more care. To fulfill her dream to become a dialysis nurse, Molly worked full-time while attending school and raising a family. She remains passionate about providing care for patients, and her future has no limits. Listen in to hear Mollys inspiring story. We are so grateful for her dedication.

ACEP Frontline - Emergency Medicine
Being a Huge Pain - Managing Renal Colic in the ED - KYSOS

ACEP Frontline - Emergency Medicine

Play Episode Listen Later Aug 16, 2022 62:02


This episode is a special from the Kentucky Statewide Opioid Stewardship program where Dr. Stanton presents on behalf of KYSOS and is joined by Dr. Casey Grover with their pain management algorithm. We talk about effectively managing the pain as well as harm reduction. ACEP22 Discount Code - A481646

Yale Cancer Center Answers
Surgical Innovations for Prostate Cancer Treatment

Yale Cancer Center Answers

Play Episode Listen Later Aug 14, 2022 29:00


Surgical Innovations for Prostate Cancer Treatment with guest Dr. Isaac Kim August 14, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Cancer Interviews
077: Patrick Owen - Renal Cancer Survivor - Salem, Oregon, USA

Cancer Interviews

Play Episode Listen Later Aug 13, 2022 20:04


Patrick Owen quickly realized he had some form of cancer when the seemingly harmless act of slipping into a ski boot resulted in a split femur. This is the story of how he survived a diagnosis of renal cancer through immunotherapy and faith.

The EMJ Podcast: Insights For Healthcare Professionals
Episode 109: Renal Expertise on Rare Disease

The EMJ Podcast: Insights For Healthcare Professionals

Play Episode Listen Later Aug 12, 2022 43:53


This week, Smeeta Sinha, Consultant Nephrologist at the Salford Royal Hospital, Manchester, UK and Visiting Professor at Manchester Metropolitan University, UK, joins Jonathan to explore renal healthcare. In this episode, the pair discuss Prof Sinha's fascinating career, including her role in the research of calciphylaxis treatment and management. A range of pertinent topics are discussed, including the importance of patient awareness of diabetic kidney disease, and how simple innovative strategies can have a hugely positive impact on patients.

Circulation on the Run
Circulation August 9, 2022 Issue

Circulation on the Run

Play Episode Listen Later Aug 9, 2022 30:06 Very Popular


This week, please join authors John McMurray and David Cherney, editorialist Kausik Umanath, as well as Associate Editors Ian Neeland and Brendan Everett as they discuss the original research articles "Initial Decline (Dip) in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights from DAPA-HF" and "Renal and Vascular Effects of Combined SGLT2 and Angiotensin-Converting Enzyme Inhibition" and editorial ""Dip" in eGFR: Stay the Course With SGLT-2 Inhibition." Dr. Carolyn Lam: Welcome to Circulation On the Run, your weekly podcast summary and backstage pass to the Journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, Associate Editor from the National Heart Centre and Duke National University of Singapore. Dr. Greg Hundley: I'm Dr. Greg Hundley, Associate Editor and director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr. Carolyn Lam: Greg, it's the season of double features. Except this time, we're having a forum discussion of two related articles and an editorial that discusses both. What is it on? SGLT2 inhibitors. In the first paper, an analysis from the DAPA-HF trial, looking specifically at that initial dip in GFR that follows initiation of dapagliflozin in patients with HFrEF. Then we will discuss further, in a mechanistic way, the renal and vascular effects of combining SGLT2 inhibition on top of ACE inhibition. Lots and lots of good learning and insights, but let's go on first to the other papers in today's issue. Shall we? Dr. Greg Hundley: You bet, Carolyn, and I'm going to grab a cup of coffee. Carolyn, in this issue, wow, so many exciting original articles. In fact, there are two more articles that were going to pair together, both clinical and pertaining to TAVR procedures. In the first one, it was a group of authors led by Dr. Duk-Woo Park from the Asan Medical Center at the University of Ulsan College of Medicine. They conducted a multicenter, open-label randomized trial comparing edoxaban with dual antiplatelet therapy or DAPT, aspirin plus clopidogrel, in patients who had undergone successful TAVR and did not have an indication for anticoagulation. Now in this study, Carolyn, the primary endpoint was an incidence of leaflet thrombosis on four-dimensional computed tomography, CT, performed at six months after the TAVR procedure. Key secondary endpoints were the number and volume of new cerebral lesions on brain magnetic resonance imaging or MRI and the serial changes of neurological and neurocognitive function between six months and that time immediately post the TAVR procedure. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. In patients without an indication for long-term anticoagulation after successful TAVR, the incidence of leaflet thrombosis was numerically lower with edoxaban than with dual antiplatelet therapy, but this was not statistically significant. The effect on new cerebral thromboembolism and neurological or neurocognitive function were also not different between the two groups. Now because the study was underpowered, the results should be considered really as hypothesis generating, but do highlight the need for further research. Dr. Greg Hundley: Carolyn, there's a second paper pertaining to transcatheter aortic valve prosthesis. It's led by a group directed by Dr. Paul Sorajja from the Minneapolis Heart Institute Foundation and Abbott Northwestern Hospital. Carolyn, these authors prospectively examined 565 patients with cardiac CT screening for HALT, or what we would define as hypoattenuating leaflet thickening, at 30 days following balloon-expandable and self-expanding TAVR. Now, deformation of the TAVR prosthesis, asymmetric prosthesis leaflet expansion, prosthesis sinus volumes, and commissural alignment were analyzed on the post-procedural CT. For descriptive purposes, an index of prosthesis deformation was calculated, with values greater than 1 representing relative midsegment underexpansion. A time-to-event model was also performed to evaluate the association of HALT with the clinical outcomes. Dr. Carolyn Lam: Oh, interesting. What did they find? Dr. Greg Hundley: Right, Carolyn. Nonuniform expansion of TAVR prosthesis resulting in frame deformation, asymmetric leaflet, and smaller neosinus volume was related to the occurrence of HALT in patients who underwent TAVR. What's the take home here, Carolyn? These data may have implications for both prosthesis valve design and deployment techniques to improve clinical outcomes in these patients. Now, Carolyn, both of these articles are accompanied by an editorial from Dr. Raj Makkar from the Smidt Heart Institute at Cedars-Sinai's Medical Center. It's a very lovely piece entitled Missing Pieces of the TAVR Subclinical Leaflet Thrombosis Puzzle. Well, how about we check what else is in this issue? My goodness, this was a packed issue. First, Carolyn, there are three letters to the editor from Professors Ennezat, Dweck, and then a response from Dr. Banovic pertaining to a follow-up from a previously published study, the AVATAR study, in evaluating valve replacement in asymptomatic aortic stenosis. There's also a Perspective piece from Dr. Wells entitled “Treatment of Chronic Hypertension in Pregnancy: Is It Time For A Change?” There's a Global Rounds piece from Professor Berwanger entitled “Cardiovascular Care in Brazil: Current Status, Challenges, and Opportunities.” Then there's also a Research Letter from Professor Eikelboom entitled “Rivaroxaban 2.5 mg Twice Daily Plus Aspirin Reduces Venous Thromboembolism in Patients With Chronic Atherosclerosis.” Dr. Carolyn Lam: There's another Research letter by Dr. Borlaug on longitudinal evolution of cardiac dysfunction in heart failure with normal natriuretic peptide levels. There's also a beautiful Cardiology News piece by Bridget Kuehn on the post-COVID return to play guidelines and how they're evolving. Well, that was a great summary of today's issue. Let's hop on to our feature forum. Shall we? Dr. Greg Hundley: You bet, Carolyn. Can't wait. Dr. Carolyn Lam: Today's feature discussion is actually a forum because we have two feature papers in today's issue. They all surround the cardiorenal interaction, should I say, of the SGLT2 inhibitors. For the first paper, discussing that initial decline or that dip in the GFR following initiation of dapagliflozin would be Dr. John McMurray, who's the corresponding author of this paper from DAPA-HF. Dr. John McMurray's from the University of Glasgow. Now next, we have also the corresponding author of another paper, really going into the mechanistic insights of the renal and vascular effects of combined SGLT2 and ACE inhibition. Dr. David Cherney is from Toronto General Hospital, University of Toronto. Dr. Carolyn Lam: We have the editorial list of these two wonderful papers, Dr. Kausik Umanath from Henry Ford Health in Michigan. Finally, our beloved associate editors, Dr. Ian Neeland from Case Western Reserve and Dr. Brendan Everett from Brigham and Women's Hospital, Harvard Medical School. Thank you, gentlemen. Now with all of that, what an exciting forum we have in front of us. Could I start by asking, of course, the respective authors to talk a little bit about your papers? I think a good place to start would be with Dr. McMurray. John, please. Dr. John McMurray: Thanks, Carolyn. I think our paper had three key messages. The early dip in eGFR that we saw was, on average, very small in patients with heart failure, about 3 mLs/min or about 5%. Very few patients had a large reduction in the eGFR. It was around 3%. Dapagliflozin-treated patients had a 30% or greater decline compared to about 1% of placebo patients. Finally, very few of those patients had a decline in the eGFR below a critical threshold, which for cardiologists might be around 20 mLs/min. We saw that in only five patients; that's 0.2% of the dapagliflozin-treated patients. Second message was that that early decline partially reverses. The nadir in our study was about 14 days. But by 60 days, on average, eGFR had increased again. Hold your nerve if you see an early decline in eGFR.   Dr. John McMurray: Maybe the most important message was that that decline in the eGFR is not associated with worse cardiovascular or renal outcomes. In fact, if anything, the opposite. If you look at the patients in the dapagliflozin group with a 10% or greater decline in eGFR, then compare it to patients who didn't have that decline, these individuals were about 27% less likely to experience the primary composite outcome of worsening heart failure and cardiovascular death. If you look at the placebo group, we saw exactly the opposite. Amongst those who had a greater than 10% decline in eGFR compared to those who didn't, those people with the early decline in eGFR were 45% more likely to experience the primary composite endpoint. The same is true for other cardiovascular outcomes for worsening kidney function. In the dapagliflozin group, decline in eGFR was not associated with more adverse events, not associated with more treatment discontinuation. That small decline in the eGFR is not a bad prognostic sign. If anything, it might be the opposite. Dr. Carolyn Lam: Thank you so much. That was really clear. David, are you going to tell us why this decline occurs? Dr. David Cherney: Yeah. Perhaps the paper that we published gives some insights into the mechanisms that are responsible for some of those changes in GFR that are thought to be acute hemodynamic effects. In the between trial, which is the trial that we published examining the effect of ACE inhibition followed by SGLT2 inhibition in patients with type 1 diabetes, we also saw that there was an expected effect of adding SGLT2 inhibition on top of an ACE inhibitor in people with uncomplicated type 1 diabetes. This acute dip in GFR was seen in this cohort of patients. We included only 30 patients in this small mechanistic study. At the same time, along with that dip in GFR, we also saw an increase in measures of proximal natriuresis. That proximal sodium loss is linked with changes in sodium handling in the kidney, which then causes changes in both probably afferent and efferent tone, which causes this dip in GFR primarily through natriuresis in this phenomenon called tubuloglomerular feedback. That was one major observation that gives insight into what we see in larger trials around the dip in GFR. Dr. David Cherney: In our mechanistic study, we also saw an additive effect on blood pressure. Blood pressure went down further with the addition of empagliflozin on top of an ACE inhibitor. In terms of the mechanisms that are responsible for the reduction in blood pressure, natriuresis certainly may be in part responsible, but we also saw a novel observation whereby there was a reduction in peripheral vascular resistance using noninvasive measures. There are likely several mechanisms that are responsible for the reduction in blood pressure. Then finally, we also saw reductions in markers of oxidative stress, which may also account for some of the effects that we see in blood pressure, as well as potentially some of the anti-inflammatory and anti-fibrotic effects that we see at least in experimental models that may have some clinical translatability to humans as well around the clinical benefits. I think the blood pressure, the renal hemodynamic effects, and some of the neurohormonal mechanisms are the major observations that we saw that may in part explain some of the really nice changes that were seen in Dr. McMurray's study. Dr. Carolyn Lam: Right. Thanks, David. But these were patients with type 1 diabetes and no heart failure. John, do you have any reflections or questions about how that may apply? By the way, what a beautiful study. Thank you, David. Dr. David Cherney: Pleasure. Thank you. Dr. John McMurray: Yes, David. I really enjoyed your study. In fact, I think, Carolyn, it does shed some insights perhaps to what's going on. As David pointed out, the reduction in peripheral arterial resistance, reduction in blood pressure, that may play some role in that early dip in eGFR as well as autoregulation in the kidney. Then the other interesting thing is that the distal nephron seems to adapt to that effect in the proximal tubule. Again, that may account for some of that recovery in eGFR, that reversal in the early dip that I spoke about, and which I think is very clinically important because, of course, physicians should make sure that they recheck eGFR if they see that early dip. Because they may find that few weeks later that that dip is much smaller and of much less concern. Dr. Carolyn Lam: Thank you, John. In fact, you're saying, stay the course, right- Dr. John McMurray: I have. Dr. Carolyn Lam: ... with the SGLT2 inhibitors. I'm actually stealing the words of the title of the editorial, a beautiful editorial by Kausik. I love that. Stay the course. Kausik, please, could you frame both papers and then with an important clinical take home message for our audience? Dr. Kausik Umanath: Sure. I think the analysis by John and his group was really relevant with the large sample size. What's impressive? Similar to a lot of these other SGLT2 studies that have come out, both in heart failure and in kidney disease progression and so on, it's remarkable how the other analysis, like the analysis of EMPA-REG and CREDENCE and so on, of similar dips. All show more or less the same magnitude, the same relative proportions of this GFR trajectory. I think the mechanistic study only highlights that though it's working with a slightly different population of type 1 patients and much earlier in their course in terms of where their GFRs are. Dr. Kausik Umanath: The other piece is that ultimately we need to understand this dip and know to monitor for it and so on. But I think the general clinician should really understand that a dip of greater than 10% really occurs in less than half the population that takes these agents. That dip, if it occurs, certainly doesn't do any harm. That said, if they see a bigger dip in the 30% range, monitor more closely and consider making sure that there aren't any other renal issues out there for that patient because they are a much smaller proportion of patients in these large trials that generate that level of dip. They should be monitored. Dr. Kausik Umanath: The other thought that we had, and thinking through this in a practical sense, is because you expect this dip, many of our cardiologists or even the nephrologists when we titrate these drugs, they're on a suite of other drugs. It's probably best to not adjust their Lasix or their loop diuretic, or their RAAS inhibitor at the same time as you're adjusting the SGLT2 inhibitor or starting it because then you may just introduce more noise into the GFR changes that you see over the next several weeks. It may be a sequential piece or at least holding those other agents constant while this gets titrated and introduced is a prudent course of action, so you don't misattribute changes. Dr. Carolyn Lam: Thanks so much. What clinically relevant points. In fact, that point about the diuretic especially applies in our heart failure world. You see the dip. Well, first, make sure the patient's not overdiuresed. Remember, there's more that the patient's taking. Thank you. That was a really great point. Brendan and Ian, I have to get you guys to share your views and questions right now. But before that, can I take a pause with you and just say, aren't you just so proud to be AEs of Circulation when we see papers like these and we just realize how incredible the data are and the clinical implications are? I just really had to say that. All right. But with that, please, what are your thoughts, Brendan? Dr. Brendan Everett: Yeah, sure. Thank you, Carolyn. Hats off to all three of our authors today for doing some amazing science. Thank you for sending it to Circulation. I think, in particular, I handled David's paper. I'm not a nephrologist and I'm probably the furthest thing from a nephrologist. Had to do my best to try and understand these concepts that I'm not sure I ever even was exposed to in medical school many years ago. I think it shows the breadth of the interest in our readership. The fact that these changes in eGFR have become a primary focus for our cardiovascular patients and that the clinical implications are really important. I guess my question, David, is... In your paper, you talked a little bit about this hypothesis of hyperfiltration and the role that hyperfiltration plays in setting patients with diabetes up for kidney disease. Is that playing a role in John's observation or not? Again, as a non-nephrologist, I have trouble connecting the dots in terms of that hypothesis and John's observation of the clinical benefit for patients that have a reduction in eGFR as opposed to no change. Dr. David Cherney: Yeah. It's a great question. It's very difficult to know with certainty in a human cohort because we can't measure the critical parameter, which is intraglomerular pressure, which we think these changes in GFR are a surrogate for. But if we go along with that train of thought, along reductions in glomerular hypertension, it very much makes sense that the patients who dip are those who have the... They're taking their medication, number one. Number two, they respond physiologically in the way that you expect them to, which is that their GFR dips at least transiently and then goes back up again through some of the compensatory mechanisms that John mentioned earlier. As was mentioned not only in this paper, but also in previous analyses from CREDENCE and previous analyses from VERTIS CV and others have shown that indeed that dip in GFR is linked with longer term renal benefits, at least. That is reflected in a reduction in the loss of kidney function over time. Dr. David Cherney: The patients who are on an SGLT2 inhibitor and those who dip by around 10% or less, those patients tend to do the best over time in terms of preserving GFR, not losing kidney function compared to patients who are on an SGLT2 inhibitor but do not dip, or those patients who actually have an increase in GFR. That is consistent with this idea that there may be a reduction in glomerular pressure, which is protective over the long term. That ties back into your question around hyperfiltration that this may indeed be due to a reduction in glomerular pressure, which is linked with risk over the long term. Dr. Carolyn Lam: Ian? Dr. Ian Neeland: I wanted to echo Brendan's comments about the excellent science. When I read these papers, it really speaks to the existential struggle that cardiologists have between kidney function and these medications that we know have cardiovascular benefits. How do we manage that practically? It's so clinically relevant, both the observation that John's paper made about the dip in the DAPA-HF trial as well as, David, your mechanistic insights. Dr. Ian Neeland: I wanted to ask John potentially about the most fascinating aspect to me of this paper was that patients with a dip of 10% or more actually ended up doing better in terms of cardiovascular outcomes, specifically hospital heart failure and hospitalizations than people on placebo with a greater than 10% dip. It speaks to the fact that... Is the physiology going on here different between those individuals whose GFR went down on placebo versus those who are on SGLT2 inhibitors? All the mechanistic insight that David's paper had in terms of blood pressure and intraglomerular pressure, how does that feedback and speak to why heart failure is strongly linked to this mechanism? We see this not just with SGLT2 inhibitors, but there are other medications now coming out showing that there's a relationship between this dip in GFR and heart failure. Can you speak to why this heart failure-kidney connection is so important and becoming greater and greater in terms of our understanding? Dr. John McMurray: Well, thank you for asking me the hardest question and one that I truly don't think I have a good answer to. I think it's obvious to all of us that the kidney is central in heart failure and perhaps cardiologists have neglected that fact, focusing more on the other organ. But by definition, almost the fluid retention that characterizes heart failure in terms of signs, and probably is the primary cause of symptoms, that clearly is a renally-mediated phenomenon. The kidney must be central to all of this. I think David right. I think the decline in eGFR that you see with this drug is simply a marker that the drug is having its physiological effect or effects. Whatever those are, they're beneficial. Clearly, patients who have an eGFR decline on placebo are different and they reflect, again, the patients that we see all the time. As our patients with heart failure deteriorate, one of the things that we commonly see, in fact becomes one of the biggest problems that we have to deal with, is that their kidney function declines. As their symptoms get worse, as their cardiac function gets worse, their kidney function also declines. Dr. John McMurray: I think you're seeing two contrasting effects here. One is the background change in eGFR, which is the placebo patients, and we've always known that that's a bad thing. Then we're seeing that early within 14 days marker of the pharmacological or physiological action of the drug. I hope you don't ask me how SGLT2 inhibitors work in heart failure. That's the other most difficult question I can think of, but I think this is just a marker of the fact that they are working. Dr. David Cherney: Yeah. Just to add to that briefly, there is this difficulty in sorting out the mechanisms that are relevant around the acute effects in the kidney that the dip in GFR reflects natriuresis that could keep patients out of heart failure; that the reduction in glomerular pressure reduces albuminuria. Albuminuria reduction is linked with kidney protection. It's linked with heart failure and ASCVD protection. Then there's also this concept of if you dip and then you stay stable afterwards, your GFR stays stable afterwards, those patients with stable kidney function that's not declining, the dippers in other words, those patients are probably able to maintain salt and water homeostasis better than someone who's declining more rapidly. All these things probably tie together in order to reflect, of course, there's a renal protective effect, but that some of those mechanisms may also tie into the heart failure mechanisms that John was mentioning. Dr. John McMurray: But, David, it's hard to imagine if we don't protect the kidney, we won't protect patients with heart failure given how fundamental, as I said, the kidney is, and how fundamentally important worsening kidney function is. Not only because it is a marker of things going badly, but also because it often results in discontinuation or reduction in dose of other life-saving treatments. To Kausik's point, it was very important about the risk of changing background life-saving disease modifying therapy. Actually, we didn't see that in DAPA-HF, which was very intriguing. There was no reduction in use of renin-angiotensin system blockers or mineralocorticoid receptor antagonists. Dr. Carolyn Lam: Thank you so much, gentlemen. Unfortunately, we are running out of time, but I would really like to ask one last question to the guests, if possible. Where do you think the field is heading? What next? What's the next most important thing we need to know? David, do you want to start? Then John, then Kausik. Dr. David Cherney: I think one of the aspects that we need to know in the future is where else can we extend these therapies into novel indications and extend the boundaries of where we currently work with these therapies. People with type 1 diabetes, for example, with either heart failure or with significant kidney disease, patients with kidney transplantation, is there a renal or cardiovascular protective effect? Then another high risk cohorts who have not been included in trials, those on immunosuppressants, for example, who were excluded from the trials. I think those are some of the areas that we need to extend into now that we understand how these therapies work in even very sick patients and that we also know that they likely have at least some benefit through suppressing inflammation, and possibly reducing infectious risks. That would provide a rationale for extending into some of these new areas. I think that's certainly, hopefully on the horizon for us. Dr. Carolyn Lam: John? Dr. John McMurray: Carolyn, obviously I think looking at post myocardial infarction population, that's an obvious place to go. There are a couple of trials there. I suppose the trial that I would love to see, and which I think would address the core question that we've been discussing today, which is: Is this all about the effect in the kidney and how important is the diuretic and natriuretic action of these drugs in heart failure? I think the key study that would address this would be doing a study in patients on dialysis. Because in those patients we could, I think, separate the issue of natriuresis, diuresis, and maybe even the dip in EGR that we've been talking about. If these drugs prove to be effective in end-stage kidney disease, patients on dialysis, that would be really fascinating. Dr. Carolyn Lam: Kausik? Dr. Kausik Umanath: That is a very interesting point. I don't know that we know necessarily outcomes, but I think from working with the DAPA-CKD, we do have a little bit of the safety data because we did continue it. I was the US MLI for that study and we did continue the SGLT2 passed into renal failure. There is a little bit of safety data there. But I don't think once you've declared an outcome, you're not collecting outcomes data after that point. That's a very interesting area to look into. Dr. Kausik Umanath: I also think the other place where this field's heading is trying to better tier and layer the multitude of agents. I think we've been waiting for about 20 to 30 years, at least in the kidney field, for something new to affect the progression of kidney disease after the ACE/ARB trials and so on. This one we've got SGLT2 inhibitors. We've got the new MRA, finerenone, and so on, which also have very beneficial cardiovascular effects. The question becomes: How do we layer these therapies? Which sequence to go in? Some of the others that are in pipeline as well that are out there that have very beneficial cardiovascular effects that may indeed also help kidney function and diabetes control, which do you go with first and so on? Dr. Carolyn Lam: Wow! Thank you so much. We really could go on forever on this topic, but it has been tremendous. Thank you once again. On behalf of Brendan, Ian, Greg, thank you so much for joining us today in the audience. You've been listening to Circulation On the Run. Don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright of the American Heart Association 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

Tales from the Tubules
Two Truths and a Lie: Xenotransplantation

Tales from the Tubules

Play Episode Listen Later Aug 9, 2022 33:17


Cast:Priya YenebereZac CerraChristel Wekon-KemeniMo IbrahimReferencesCooper, DKC. “A Brief History of Cross-Species Organ Transplantation.” Proceedings - Baylor University. Medical Center 25.1 (2012): 49–57. Web. DOI:10.1080/08998280.2012.11928783Roux FA, Saï P, Deschamps JY. Xenotransfusions, past and present. Xenotransplantation. 2007;14(3):208-216. DOI:10.1111/j.1399-3089.2007.00404.xDenner J. Porcine endogenous retroviruses (PERVs) and xenotransplantation: screening for transmission in several clinical trials and in experimental models using non-human primates. Ann Transplant. 2003;8(3):39-48. https://doi.org/10.1186/s12977-018-0411-8Wijkstrom M, Iwase H, Paris W, Hara H, Ezzelarab M, Cooper DK. Renal xenotransplantation: experimental progress and clinical prospects. Kidney Int. 2017;91(4):790-796. DOI: 10.1016/j.kint.2016.08.035Soin B, Smith KG, Zaidi A, et al. Physiological aspects of pig-to-primate renal xenotransplantation. Kidney Int. 2001;60(4):1592-1597. DOI: 10.1046/j.1523-1755.2001.00973.xIwase H, Liu H, Wijkstrom M, et al. Pig kidney graft survival in a baboon for 136 days: longest life-supporting organ graft survival to date. Xenotransplantation. 2015;22(4):302-309. DOI: 10.1111/xen.12174Cooper DKC, Wijkstrom M, Hariharan S, et al. Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation. Transplantation. 2017;101(7):1551-1558. DOI: 10.1097/TP.0000000000001582Fishman JA. Infectious disease risks in xenotransplantation. Am J Transplant. 2018;18(8):1857-1864. DOI:10.1111/ajt.14725Rosner F. Pig organs for transplantation into humans: a Jewish view. Mt Sinai J Med. 1999;66(5-6):314-319.Mansour T. Azhar issues fatwa allowing transplant of pigs' kidneys. The New Arab. https://english.alaraby.co.uk/news/azhar-issues-fatwa-allowing-transplant-pigs-kidneys. Accessed July 3, 2022. Lu T, Yang B, Wang R, Qin C. Xenotransplantation: Current Status in Preclinical Research. Front Immunol. 2020;10:3060. Published 2020 Jan 23. DOI:10.3389/fimmu.2019.03060Carrier AN, Verma A, Mohiuddin M, et al. Xenotransplantation: A New Era. Front Immunol. 2022;13:900594. Published 2022 Jun 9. DOI:10.3389/fimmu.2022.900594

Reorg Ruminations
Americas Core Credit: U.S. Renal Care, Bed Bath & Beyond, Revlon and Voyager Digital.

Reorg Ruminations

Play Episode Listen Later Aug 8, 2022 7:52


This week we take a look at U.S. Renal Care, Bed Bath & Beyond, Revlon and Voyager Digital. We'll be taking a brief break from our Deep Dive segment this week but will be back soon with more premium content. Reorg is always looking for feedback to help us improve the podcast experience! Please take a moment to complete this short survey and let us know how we're doing. https://www.research.net/r/Reorg_podcast_survey

Blood, Sweat and Smears - A Machaon Diagnostics Podcast
Renal transplants and the roles of testing around it

Blood, Sweat and Smears - A Machaon Diagnostics Podcast

Play Episode Listen Later Aug 8, 2022 25:32


In this podcast, our Medical Director, Brad Lewis, talks with Dr. Christina Klein, a transplant nephrologist and the head of the transplant program at Piedmont Transplant Institute in Atlanta, GA. Dr. Lewis and Dr. Klein discuss renal transplants and the different roles of testing around renal transplants (i.e. gene sequencing and soluble MAC). They also discuss the functions of genetic testing for aHUS and complement activation in patients who are coming in for transplant evaluation.Don't forget... Machaon offers aHUS testing with a turnaround time of 24 hours. 

Yale Cancer Center Answers
Tailoring Breast Cancer Treatment in 2022

Yale Cancer Center Answers

Play Episode Listen Later Aug 7, 2022 29:00


Tailoring Breast Cancer Treatment in 2022 with guest Dr. Eric Winer August 7, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Rio Bravo qWeek
Renal Cell Carcinoma

Rio Bravo qWeek

Play Episode Listen Later Aug 5, 2022 24:06


Episode 105: Renal Cell Carcinoma. Manpreet and Jon-Ade explain how to diagnose renal cell carcinoma. Introduction about age and kidney transplant by Dr. Arreaza and Dr. Yomi. Introduction: Too old for a new kidney?By Hector Arreaza, MD. Discussed with  Timiiye Yomi, MD.Today we will be talking about the kidneys, those precious bean-shaped organs that detoxify your blood 24/7. Amazingly, we can live normal lives with one kidney, but when the kidney function is not good enough to meet the body's demands, patients need to start kidney replacement therapy. Modern medicine has made a lot of advances with dialysis, but the perfection of a kidney has not been outperformed by any machine yet. That's why kidney transplant is the hope for many of our patients with end-stage kidney disease.The need for a kidney transplant is growing, likely due to increasing chronic diseases such as diabetes and hypertension, and also because of an increase in elderly population. About 22% of patients on the kidney transplant waiting list are over age 65. A cut-off age to receive kidney transplant has not been established across the globe. Different countries use different criteria for the maximum age for transplant. The American Society of Transplantation's guidelines states “There should be no absolute upper age limit for excluding patients whose overall health and life situation suggest that transplantation will be beneficial.” So, if your patient is older than 65 and needs a kidney, they may qualify for a transplant, and age should not be an absolute contraindication to receive it. Actually, older patients may have lower risk of rejection due to a theoretically weaker immune system. A live donor is likely to be a better option for elderly patients. A condition that would make your elderly patient a poor candidate for kidney transplant would be frailty. Common contraindications to kidney transplant include active infections or malignancy, uncontrolled mental illness, ongoing addiction to substances, reversible kidney failure, and documented active and ongoing treatment nonadherence.So, remember to take these factors into consideration when deciding if you need to refer your elderly patients for a kidney transplant, there is no such thing as being too old for a new kidney if your patient meets all the criteria for a transplant.This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. Renal Cell Carcinoma. By Manpreet Singh, MS3, Ross University School of Medicine, and Jon-Ade Holter, MS3 Ross University School of Medicine. Moderated by Hector Arreaza, MD. Definition:Renal cell carcinoma is a primary neoplasm arising form the renal cortex. 80-85 percent of renal tumors are renal cell carcinomas followed closely by transitional cell renal cancer and Wilms tumor.  Epidemiology: In 2022, 79,000 new cases of kidney cancer were diagnosed with almost 14,000 mortalities. There is a 2:1 male to female ratio and the average age is 64 and normally 65-74. African Americans and American Indians have a higher prevalence rate compared to other racial groups. The lifetime risk for developing kidney cancer in men is about 1 in 46 (2.02%) and 1 in 80 (1.03%) in women.  Risk Factors associated with RCC: Anything that causes assault to the kidneys and affects its function would cause increased demand, injury, and inflammation. This assault can lead to cell derangement and lead to cancer. The risk factors that have been associated with RCC are smoking, obesity, HTN, family history of kidney cancer, Trichloroethylene (a metal degreaser used in large manufacturing factories), acetaminophen, and patients with advanced kidney disease needing dialysis. Patients with syndromes that cause multiple types of tumors: VHL (von Hippel-Lindau) deficiency, a tumor suppressor, gives rise to clear cell renal cell carcinoma. Familial inheritance of VHL deficiency is mostly found in patients that have RCC at a very young age, before 40 y/o. Other tumors can be found in the eye, brain, spinal cord, pancreas, and pheochromocytomas.Hereditary leiomyoma-renal cell carcinoma due to FH gene mutations causing women who have leiomyomas to have a higher risk of developing papillary RCC.Birt-Hogg-Dube (BHD) syndrome mutation in FLCN gene who develop various skin and renal tumors.Cowden syndrome is a mutation in the PTEN gene giving rise to cancers associated with breast, thyroid , and kidney cancers.Tuberous sclerosis causes benign tumors of the skin, brain, lungs, eyes, kidneys, and heart. Although kidney tumors are most often benign, occasionally they can be clear cell RCC. Screening For RCC:Screening is unnecessary because of the low prevalence of this cancer in the general population, though certain groups require annual repeat imaging via US, CT, or MRI. Inherited conditions that are associated with RCC such as VHL syndrome or Tuberous SclerosisESRD patients who have been on dialysis for 3-5 yearsFamily history of RCCPrior kidney irradiation Clinical Picture: Most patients with RCC are asymptomatic until cancer grows large enough to cause disruption of local organs, such as the kidney, bladder, or renal vein, and dysregulates other organs via metastasis. Therefore, it's important to look at other signs and symptoms caused by RCC.  The patient most likely will be an older male who presents with the classic triad of: Flank pain: caused by rapid expansion and stretching of the renal capsule.Hematuria: occurs from the invasion of the neoplasm into the collecting duct.Palpable abdominal mass: mass tends to be homogenous and mobile with respirations. Though this presents only in 9% of patients during the presentation, having physical symptoms is a sign of advanced disease and 25% of patients with these signs tend to have distant metastasis.  Anemia: normally associated with anemia of chronic disease. It precedes the disease by at least 8 months to 1 year. Males can develop varicoceles because of decreased emptying due to neoplasm obstruction. Patients normally develop varicoceles on the left due to the spermatic vein emptying in the higher resistance left renal vein, which causes backup of the blood in the pemphigus plexus. Though a right-sided varicocele should raise a higher suspicion of obstruction due to the spermatic vein draining directly into the IVC which is lower in resistance. A right-sided varicocele is seen in approximately 11 percent of patients. The paraneoplastic syndrome can also arise from RCCEpo: Erythrocytosis with symptoms of weakness, fatigue, headache, and joint pain.PTHrP: PTH-related peptide acts like PTH which gives rise to hypercalcemia with the prevalent symptoms of arthritis, osteolytic lesions, confusions, tetany, ventricular tachycardia, shortened QTc, and nausea and vomiting.Renin: overproduction from the juxtaglomerular cells can cause disarrangement of the RAAS system causing hypertension.Others also like ACTH and beta-HCG. Other disorders present include hepatic dysfunction, cachexia, secondary amyloidosis, and thrombocytosis. Workup If a patient comes in with painless hematuria, then the first test should be abdominal CT or abdominal ultrasound. A CT is more sensitive than the US but it can quickly indicate if the abdominal mass felt can be a cyst or a solid tumor.  US of kidneys should show if it's a simple cyst:-The cyst is round and sharply demarcated with smooth walls- It's anechoic – appears solid black-There is a strong posterior wall echo-Use the Bosniak classification to classify mass  Bosniak I: benign simple cyst with thin wall less than equal to 2mm, no septa or calcifications. No future workup is needed. Bosniak II: benign cyst, 3 cm diameter, requires f/u with US/CT/MRI at 6 months, 12 months, and annually for the next 5 years. Chance of malignancy: 5%.  Bosniak III: indeterminate cystic mass with thick, irregular or smooth walls. This requires nephrectomy or radiofrequency ablation. Chance of malignancy: 55%  Bosniak IV: Clearly a malignancy its grade III with enhancing soft tissue components that its independent from the wall or septum. Requires total or partial nephrectomy. Chance of malignancy 100%.  CT of the kidneys for a neoplasm should show:-Thickened irregular walls or septa -Enhancement after contrast injection are suggestive of malignancy-CT can also help detect invasion in local tissue areas such as renal vein and perinephric organs  MRI is used if the patient cannot use contrast or kidney function is poor. MRI can also evaluate the growth of the cancer. Other imaging studies:Other imaging studies that may be useful for assessing for distant metastases include bone scan, CT of the chest, magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT. Treatment and staging Nephrectomy, partial or total, will be used as the initial tissue collection for pathology. If the patient is not a surgical candidate, you can also obtain a percutaneous biopsy. The nephrectomy is preferred because first, it serves as a definitive treatment option, but also it allows for definitive staging of the cancer with tumor and nodal staging. Regardless of the size, any solid mass may indicate malignancy and point towards RCC, requiring resection.   TNM staging Stage I: Tumor is 7cm across or smaller and only in the kidney with no lymph nodes or distant mets. T1N0M0 Stage IIa: Tumor size is larger than 7cm but still in the kidney but no invasion of lymph node or mets. T2N0M0 Stage IIb: Tumor is growing into the renal vein or IVC, but not into neighboring organs such as adrenals or Gerota's fascia and still lacks lymph node invasion and mets. T3N0M0.  Stage III: Tumor can be any size but has not invaded outside structures such as adrenals, though nearby lymph node invasion is present but not distant. There is no distant mets. T3N1M0. Stage IV:  The main tumor is beyond the Gerota's fascia and may grow into the adrenal gland . It may or may not spread to the lymph nodes or may not have distant mets. Stage IV also consists of any cancer that has any number of distant mets. T4 Adjuvant therapy can be done with immune therapy. Conclusion: Now we conclude our episode number 105 “Renal cell carcinoma.” This type of cancer may be asymptomatic until it is large enough to cause symptoms. Keep it on your list of differentials on patients with hematuria, flank pain, weight loss, and abnormal imaging. Keep in mind the features of simple kidney cysts vs complex cysts when assessing kidney ultrasounds. Your patient will be grateful for an early diagnosis of RCC and a prompt treatment. Even without trying, every night you go to bed being a little wiser.This week we thank Hector Arreaza, Timiiye Yomi, Manpreet Singh, Jon-Ade Holter. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. Audio edition: Suraj Amrutia. See you next week!  Bibliography: Is There a Cut Off Age for Kidney Transplant?, Mayo Clinic Connect, Jul 18, 2017, https://connect.mayoclinic.org/blog/transplant/newsfeed-post/is-there-a-cut-off-age-for-kidney-transplant/ Atkins, Michael. “Clinical Manifestations, Evaluation, and Staging of Renal Cell Carcinoma.” UpToDate, January 21. https://www.uptodate.com/contents/clinical-manifestations-evaluation-and-staging-of-renal-cell-carcinoma American Cancer Society. “Key Statistics About Kidney Cancer”. Cancer.Org, 2022, https://www.cancer.org/cancer/kidney-cancer/about/key-statistics.html. Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, Grünwald V, Gillessen S, Horwich A; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019 May 1;30(5):706-720. doi: 10.1093/annonc/mdz056. PMID: 30788497. https://pubmed.ncbi.nlm.nih.gov/30788497/. Gaillard, F., Bell, D. Bosniak classification system of renal cystic masses. Reference article, Radiopaedia.org. (accessed on 20 May 2022) https://doi.org/10.53347/rID-1006. Kopel J, Sharma P, Warriach I, Swarup S. Polycythemia with Renal Cell Carcinoma and Normal Erythropoietin Level. Case Rep Urol. 2019 Dec 11;2019:3792514. doi: 10.1155/2019/3792514. PMID: 31934488; PMCID: PMC6942735. https://pubmed.ncbi.nlm.nih.gov/31934488/. Leslie SW, Sajjad H, Siref LE. Varicocele. [Updated 2022 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448113/. Maguire, Claire. “Understanding Endoscopic Ultrasound and Fine Needle Aspiration.” Educational Dimension, Educational Dimensions, 1 Jan. 2007, educationaldimensions.com/eLearn/aspirationandbiopsy/eusterm.php. Maller, V., Hagir, M. Renal cell carcinoma (TNM staging). Reference article, Radiopaedia.org. (accessed on 20 May 2022) https://doi.org/10.53347/rID-4699. Palapattu GS, Kristo B, Rajfer J. Paraneoplastic syndromes in urologic malignancy: the many faces of renal cell carcinoma. Rev Urol. 2002 Fall;4(4):163-70. PMID: 16985675; PMCID: PMC1475999. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1475999/.

Occupy Health
Reversing cardiovascular and Renal Disease

Occupy Health

Play Episode Listen Later Aug 5, 2022 49:58


The primary demand on our health system is the management of chronic diseases. Many of these chronic diseases involve the vasculature or blood vessels such as heart disease, strokes, kidney failure, diabetes, kidney failure, etc. Renal failure is increasing in its prevalence. While filtration rate should be 100 %, the current system does not mark kidney function as poor until it drops below 60 %. We won't have symptoms of renal difficulties until are filtration rate is 30 %. We can urinate regularly even when in phase 5 of kidney failure Glycocalyx are hair like elements that line our blood vessels. The role of these hairs is to protect the blood vessel lining, serve as a gate keeper for oxygen, and to facilitate the release of nitric oxide which results in blood vessel dilation. They are the first site of damage in vessel disease. Studies have shown that improving the health of these vessels, can minimize spike protein damage, improve atherosclerosis and improve kidney function. This earliest damage to our blood vessels can be measured and effective approaches to reversing this damage are presented.

Mehlman Medical
HY USMLE Q #550 – Renal / Pediatrics

Mehlman Medical

Play Episode Listen Later Aug 3, 2022 5:30


Video for this podcast: https://mehlmanmedical.com/audio-qbank-hy-usmle-q-550-renal-pediatrics Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

The Rx Bricks Podcast
Nephritic Syndrome

The Rx Bricks Podcast

Play Episode Listen Later Aug 2, 2022 25:36


Looking for more information on this topic? Check out the Nephritic Syndrome brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

If Your Meds Could Talk with Dr. Michele White
If Your Meds Could Talk - Episode 9: Urinary Tract System: Kidneys (Renal) System

If Your Meds Could Talk with Dr. Michele White

Play Episode Listen Later Aug 1, 2022 23:50


Our kidneys are always busy.  Besides filtering the blood and balancing fluids every second during the day, the kidneys constantly react to hormones that the brain sends to the kidneys.  In today's episode we will discuss one of the other most important vital organs, our kidneys.

Better Edge : A Northwestern Medicine podcast for physicians
Improving the Diagnosis and Management of Renal Masses and Localized Renal Cancer

Better Edge : A Northwestern Medicine podcast for physicians

Play Episode Listen Later Aug 1, 2022


Hiten D. Patel, MD, MPH, assistant professor of Urology at Northwestern Medicine, discusses promising novel diagnostic approaches for small renal masses and treatment options for localized renal masses suspicious for cancer. These approaches and treatments include active surveillance, thermal ablation, radical or partial nephrectomy, and tumor enucleation. “If biopsy is not going to change our ultimate management decision, why would we use it? What we want is a diagnostic approach that adds something to the decision-making process and something that can increase our certainty in making a benign tumor diagnosis,” says Dr. Patel. “Some of my recent research efforts focus on how to use novel imaging or unique aspects for our traditional imaging to augment biopsy so, maybe together, we can better identify these benign tumors.”

Yale Cancer Center Answers
Role of Surgical Pathology

Yale Cancer Center Answers

Play Episode Listen Later Jul 31, 2022 29:00


Role of Surgical Pathology with guest Dr. Marie Robert July 31, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Real Life Pharmacology - Pharmacology Education for Health Care Professionals

On this episode, I discuss desvenlafaxine pharmacology, adverse effects, pharmacokinetics, and drug interactions. Desvenlafaxine is a serotonin and norepinephrine reuptake inhibitor that can be used for depression. Renal elimination is an important method of deactivation of desvenlafaxine. Dose adjustments may be recommended as renal function drops below 50 mls/min. Withdrawal syndrome due is a risk with desvenlafaxine as it has a significantly short half-life.

Primary Care Update
Episode 107: TENS for renal colic, secondary HTN in kids, and evaluating chest pain

Primary Care Update

Play Episode Listen Later Jul 20, 2022 21:49


This week, Kate, Mark and Henry will discuss secondary hypertension in children, TENS for persons with renal colic, and CTA vs angiography in persons with suspected stable CAD.

AJR Podcast Series
Validation of Clear Cell Likelihood Score for Characterization of cT1 Solid Renal Masses

AJR Podcast Series

Play Episode Listen Later Jul 13, 2022 8:49


Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.22.27378  Wenhui Zhou, MD, PhD reviews a recent AJR article examining the performance and interreader agreement of clear cell likelihood score (ccLS) for noninvasive, imaging assessment of renal mass. This validation study bolsters the value of multiparametric MRI to predict pathologic diagnosis of incidentally detected renal cell carcinoma.

The Medbullets Step 1 Podcast
Renal | Acute Interstitial Nephritis

The Medbullets Step 1 Podcast

Play Episode Listen Later Jul 11, 2022 12:49


In this episode, we review the high-yield topic of Acute Interstitial Nephritis from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

The Medbullets Step 1 Podcast
Renal | Liddle Syndrome

The Medbullets Step 1 Podcast

Play Episode Listen Later Jul 10, 2022 6:47


In this episode, we review the high-yield topic of Liddle Syndrome from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

The Rx Bricks Podcast
Metabolic Acidosis

The Rx Bricks Podcast

Play Episode Listen Later Jul 5, 2022 31:27


Looking for more information on this topic? Check out the Metabolic Acidosis and Alkalosis brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/ from our Musculoskeletal, Skin, and Connective Tissue collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.