Diana Laura Muñoz
@nephrodiana.bsky.social
🇲🇽 Nephrology Resident CMNO
✨ Special interests: GN + Onco nephrology
✈️ Love travel and enjoying small things in life 🌿
💪 Let’s team up and learn together
✨ Special interests: GN + Onco nephrology
✈️ Love travel and enjoying small things in life 🌿
💪 Let’s team up and learn together
✅ Takeaway:
Creatinine is not a static value in pregnancy.
Context matters. Trimester matters.
Let’s push for better, evidence-based reference ranges to improve maternal and fetal outcomes.
#NephTwitter #MedTwitter #PregnancyCare #AKI #CKD
Creatinine is not a static value in pregnancy.
Context matters. Trimester matters.
Let’s push for better, evidence-based reference ranges to improve maternal and fetal outcomes.
#NephTwitter #MedTwitter #PregnancyCare #AKI #CKD
June 6, 2025 at 12:39 AM
✅ Takeaway:
Creatinine is not a static value in pregnancy.
Context matters. Trimester matters.
Let’s push for better, evidence-based reference ranges to improve maternal and fetal outcomes.
#NephTwitter #MedTwitter #PregnancyCare #AKI #CKD
Creatinine is not a static value in pregnancy.
Context matters. Trimester matters.
Let’s push for better, evidence-based reference ranges to improve maternal and fetal outcomes.
#NephTwitter #MedTwitter #PregnancyCare #AKI #CKD
🌍 Further validation in diverse global cohorts is needed to update clinical guidelines and ensure early detection for all.
June 6, 2025 at 12:39 AM
🌍 Further validation in diverse global cohorts is needed to update clinical guidelines and ensure early detection for all.
💡Clinical implication:
We should lower the threshold for investigating abnormal kidney function in pregnancy.
Waiting for creatinine to rise above current “normal” limits could delay diagnosis and treatment.
We should lower the threshold for investigating abnormal kidney function in pregnancy.
Waiting for creatinine to rise above current “normal” limits could delay diagnosis and treatment.
June 6, 2025 at 12:39 AM
💡Clinical implication:
We should lower the threshold for investigating abnormal kidney function in pregnancy.
Waiting for creatinine to rise above current “normal” limits could delay diagnosis and treatment.
We should lower the threshold for investigating abnormal kidney function in pregnancy.
Waiting for creatinine to rise above current “normal” limits could delay diagnosis and treatment.
Even more concerning—pregnant individuals who experience adverse outcomes show different creatinine trajectories, especially a rise in the 3rd trimester.
This deviation might be an early signal of trouble.
This deviation might be an early signal of trouble.
June 6, 2025 at 12:39 AM
Even more concerning—pregnant individuals who experience adverse outcomes show different creatinine trajectories, especially a rise in the 3rd trimester.
This deviation might be an early signal of trouble.
This deviation might be an early signal of trouble.
⚠️ The upper limits of these values are actually lower than current UK thresholds for investigation.
That means kidney dysfunction might be going undetected in pregnant patients.
That means kidney dysfunction might be going undetected in pregnant patients.
June 6, 2025 at 12:39 AM
⚠️ The upper limits of these values are actually lower than current UK thresholds for investigation.
That means kidney dysfunction might be going undetected in pregnant patients.
That means kidney dysfunction might be going undetected in pregnant patients.
In a modern UK cohort of healthy pregnancies, researchers redefined normal serum creatinine levels:
📍 1st trimester: 0.42–0.75 mg/dL
📍 2nd trimester: 0.38–0.71 mg/dL
📍 3rd trimester: 0.39–0.75 mg/dL
📍 1st trimester: 0.42–0.75 mg/dL
📍 2nd trimester: 0.38–0.71 mg/dL
📍 3rd trimester: 0.39–0.75 mg/dL
June 6, 2025 at 12:39 AM
In a modern UK cohort of healthy pregnancies, researchers redefined normal serum creatinine levels:
📍 1st trimester: 0.42–0.75 mg/dL
📍 2nd trimester: 0.38–0.71 mg/dL
📍 3rd trimester: 0.39–0.75 mg/dL
📍 1st trimester: 0.42–0.75 mg/dL
📍 2nd trimester: 0.38–0.71 mg/dL
📍 3rd trimester: 0.39–0.75 mg/dL
However, current reference ranges are based on outdated, limited data.
This means clinicians may miss early signs of:
🚨 Pregnancy-associated AKI
🚨 Chronic kidney disease (CKD)
...leading to worse outcomes.
This means clinicians may miss early signs of:
🚨 Pregnancy-associated AKI
🚨 Chronic kidney disease (CKD)
...leading to worse outcomes.
June 6, 2025 at 12:39 AM
However, current reference ranges are based on outdated, limited data.
This means clinicians may miss early signs of:
🚨 Pregnancy-associated AKI
🚨 Chronic kidney disease (CKD)
...leading to worse outcomes.
This means clinicians may miss early signs of:
🚨 Pregnancy-associated AKI
🚨 Chronic kidney disease (CKD)
...leading to worse outcomes.
Always consider adjusting dose & frequency in CKD patients. 📉🧬
Any other mechanism?
#Nephrology #CKD #Pharmacology #MedEd #RenalDoseAdjustments
Any other mechanism?
#Nephrology #CKD #Pharmacology #MedEd #RenalDoseAdjustments
June 3, 2025 at 1:48 AM
Always consider adjusting dose & frequency in CKD patients. 📉🧬
Any other mechanism?
#Nephrology #CKD #Pharmacology #MedEd #RenalDoseAdjustments
Any other mechanism?
#Nephrology #CKD #Pharmacology #MedEd #RenalDoseAdjustments
🔹 Uremia ↓ protein binding via competitive displacement
🔹 Reduced renal clearance → ↑ drug half-life & toxicity risk
🔹 Reduced renal clearance → ↑ drug half-life & toxicity risk
June 3, 2025 at 1:48 AM
🔹 Uremia ↓ protein binding via competitive displacement
🔹 Reduced renal clearance → ↑ drug half-life & toxicity risk
🔹 Reduced renal clearance → ↑ drug half-life & toxicity risk
🧵Bottom line:
✔️ Use long dwells for loading and maintenance
✔️ Monitor levels in blood & dialysate
✔️ Watch for subtherapeutic levels in fast APD cycles
✔️ Be cautious with antibiotic strategies post-inflammation
doi: 10.1038/ki.2011.322
#Antibiotics #Pharmacokinetics #Nephrology #PeritonealDialysis
✔️ Use long dwells for loading and maintenance
✔️ Monitor levels in blood & dialysate
✔️ Watch for subtherapeutic levels in fast APD cycles
✔️ Be cautious with antibiotic strategies post-inflammation
doi: 10.1038/ki.2011.322
#Antibiotics #Pharmacokinetics #Nephrology #PeritonealDialysis
May 27, 2025 at 3:26 AM
🧵Bottom line:
✔️ Use long dwells for loading and maintenance
✔️ Monitor levels in blood & dialysate
✔️ Watch for subtherapeutic levels in fast APD cycles
✔️ Be cautious with antibiotic strategies post-inflammation
doi: 10.1038/ki.2011.322
#Antibiotics #Pharmacokinetics #Nephrology #PeritonealDialysis
✔️ Use long dwells for loading and maintenance
✔️ Monitor levels in blood & dialysate
✔️ Watch for subtherapeutic levels in fast APD cycles
✔️ Be cautious with antibiotic strategies post-inflammation
doi: 10.1038/ki.2011.322
#Antibiotics #Pharmacokinetics #Nephrology #PeritonealDialysis
🎯 Even better?
Monitor dialysate levels when possible — these may provide more relevant data on local antibiotic concentration.
Monitor dialysate levels when possible — these may provide more relevant data on local antibiotic concentration.
May 27, 2025 at 3:26 AM
🎯 Even better?
Monitor dialysate levels when possible — these may provide more relevant data on local antibiotic concentration.
Monitor dialysate levels when possible — these may provide more relevant data on local antibiotic concentration.
🎯 Therapeutic drug monitoring (TDM) is essential:
👀 Monitor blood levels to avoid under- or overdosing:
• Under in those with residual kidney function
• Increase dose in intense APD schedules
👀 Monitor blood levels to avoid under- or overdosing:
• Under in those with residual kidney function
• Increase dose in intense APD schedules
May 27, 2025 at 3:26 AM
🎯 Therapeutic drug monitoring (TDM) is essential:
👀 Monitor blood levels to avoid under- or overdosing:
• Under in those with residual kidney function
• Increase dose in intense APD schedules
👀 Monitor blood levels to avoid under- or overdosing:
• Under in those with residual kidney function
• Increase dose in intense APD schedules
⚠️ Short dwell times in APD may prevent antibiotics from reaching concentrations above the minimal inhibitory concentration (MIC).
→ Risk of inadequate bacterial killing.
→ Risk of inadequate bacterial killing.
May 27, 2025 at 3:26 AM
⚠️ Short dwell times in APD may prevent antibiotics from reaching concentrations above the minimal inhibitory concentration (MIC).
→ Risk of inadequate bacterial killing.
→ Risk of inadequate bacterial killing.
For intermittent maintenance dosing:
🌙 Use long nighttime dwell in CAPD
☀️ Use long daytime dwell in APD
This maximizes drug exposure in the peritoneal cavity.
🌙 Use long nighttime dwell in CAPD
☀️ Use long daytime dwell in APD
This maximizes drug exposure in the peritoneal cavity.
May 27, 2025 at 3:26 AM
For intermittent maintenance dosing:
🌙 Use long nighttime dwell in CAPD
☀️ Use long daytime dwell in APD
This maximizes drug exposure in the peritoneal cavity.
🌙 Use long nighttime dwell in CAPD
☀️ Use long daytime dwell in APD
This maximizes drug exposure in the peritoneal cavity.
✅ Let’s promote health both prior to and following the donation process.
March 21, 2025 at 12:49 PM
✅ Let’s promote health both prior to and following the donation process.
💡 Among those who were obese and lost weight to donate, 12 out of 14 participants regained a considerable amount of weight post-donation.
🟢 Given that obesity management is lifelong, donors will need to have access to lifelong medical care.
🟢 Given that obesity management is lifelong, donors will need to have access to lifelong medical care.
March 21, 2025 at 12:49 PM
💡 Among those who were obese and lost weight to donate, 12 out of 14 participants regained a considerable amount of weight post-donation.
🟢 Given that obesity management is lifelong, donors will need to have access to lifelong medical care.
🟢 Given that obesity management is lifelong, donors will need to have access to lifelong medical care.