𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
@rmohty.bsky.social
@KUInternalMed @sonostache @StanfordNeph @glomcon @StanfordCCM
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Dual-Antigen Membranous Nephropathy
doi.org/10.1016/j.kint.2025.10.006
#NephSky #MedSky #membranousnephropathy @mayoclinicpath.bsky.social @arkanalabs.bsky.social @lynncornell.bsky.social @aaronstorey.bsky.social
doi.org/10.1016/j.kint.2025.10.006
#NephSky #MedSky #membranousnephropathy @mayoclinicpath.bsky.social @arkanalabs.bsky.social @lynncornell.bsky.social @aaronstorey.bsky.social
November 4, 2025 at 10:16 PM
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
🔬for the diagnosis of glowmrulonephritis, searching for urinary acanthocytes only using bright field illumination is clearly suboptimal compared to utilizing dark field illumination or phase contrast microscopy. #UrinarySediment #UrineMicroscopy karger.com/gdz/article/...
October 25, 2025 at 12:31 AM
🔬for the diagnosis of glowmrulonephritis, searching for urinary acanthocytes only using bright field illumination is clearly suboptimal compared to utilizing dark field illumination or phase contrast microscopy. #UrinarySediment #UrineMicroscopy karger.com/gdz/article/...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
The urine in glomerulonephritis really glows ✨
#urinarySediment
#urinarySediment
🔬for the diagnosis of glowmrulonephritis, searching for urinary acanthocytes only using bright field illumination is clearly suboptimal compared to utilizing dark field illumination or phase contrast microscopy. #UrinarySediment #UrineMicroscopy karger.com/gdz/article/...
October 27, 2025 at 10:38 AM
The urine in glomerulonephritis really glows ✨
#urinarySediment
#urinarySediment
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Thanks @amyaimei.bsky.social for giving an excuse to share some #UrinarySediment pics. See below for context 👇🏼
October 30, 2025 at 4:20 AM
Thanks @amyaimei.bsky.social for giving an excuse to share some #UrinarySediment pics. See below for context 👇🏼
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Not hugely practice-changing, as many folks are already using bicarb to reduce dialysis risk based on BICAR-ICU-1
Lack of mortality impact is unsurprising given how difficult it is to prove in ICU (discussed: emcrit.org/pulmcrit/mor...)
Reduced dialysis & bacteremia are important pt-centered wins
Lack of mortality impact is unsurprising given how difficult it is to prove in ICU (discussed: emcrit.org/pulmcrit/mor...)
Reduced dialysis & bacteremia are important pt-centered wins
a baby is crying while being held by a woman in a crowd .
ALT: a baby is crying while being held by a woman in a crowd .
media.tenor.com
October 29, 2025 at 2:59 PM
Not hugely practice-changing, as many folks are already using bicarb to reduce dialysis risk based on BICAR-ICU-1
Lack of mortality impact is unsurprising given how difficult it is to prove in ICU (discussed: emcrit.org/pulmcrit/mor...)
Reduced dialysis & bacteremia are important pt-centered wins
Lack of mortality impact is unsurprising given how difficult it is to prove in ICU (discussed: emcrit.org/pulmcrit/mor...)
Reduced dialysis & bacteremia are important pt-centered wins
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Renal tubular epithelial cell cast (Sternheimer-Malbin stain) under 1000x bright field. Pt with nephrotic range proteinuria, suspected GN. Note small lipid droplets on most inferior cell in the cast.
November 1, 2025 at 6:42 PM
Renal tubular epithelial cell cast (Sternheimer-Malbin stain) under 1000x bright field. Pt with nephrotic range proteinuria, suspected GN. Note small lipid droplets on most inferior cell in the cast.
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
This is great! Renal biopsy by the nephrologists!
Real-time ultrasound-guided kidney biopsy performance, simulation lab at Ochsner Nephrology #NephSky #KidneyBiopsyAcademy workshop available at @kidneycon.bsky.social
November 3, 2025 at 5:26 AM
This is great! Renal biopsy by the nephrologists!
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Interesting case from the Skeleton Key Group which just keeps pumping out the #FOAMed
www.renalfellow.org/2025/09/28/s...
www.renalfellow.org/2025/09/28/s...
Skeleton Key Group Case #40: Cosmetic Calcium
Author: Nikitha (Niki) Cherayil, MD A. The Stem A middle-aged woman with chronic kidney disease stage 3 in the setting of hypertension and recurrent kidney st
www.renalfellow.org
September 29, 2025 at 3:09 AM
Interesting case from the Skeleton Key Group which just keeps pumping out the #FOAMed
www.renalfellow.org/2025/09/28/s...
www.renalfellow.org/2025/09/28/s...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Silva et al: Safety of Peripherally Administered 23.4% Sodium Chloride
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Link: link.springer.com/ar...
@neurocritical #neurocritcare
Safety of Peripherally Administered 23.4% Sodium Chloride
Neurocritical Care - For patients with increased intracranial pressure, prompt initiation of hyperosmolar therapy with 23.4% sodium chloride may minimize permanent neurological damage and prevent...
link.springer.com
October 28, 2025 at 5:38 PM
Largest ever study of peripheral 23.4% NaCl with 863 administrations 😀
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Some extravasation did occur, but it *didn't* lead to any major problems (tissue necrosis etc)
If someone is having an ICP crisis, you should worry about their BRAIN and not their ARM - their arm will be fine #EMIMCC
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Mixed cellular containing RBCs, WBCs (blue) and RTECs (fuchsia) in the #UrinarySediment from a patient with suspected IgA nephropathy 🔬bright field (500x) and oblique illumination (1000x) #UrineMicroscopy #OchsnerNephrology
October 25, 2025 at 12:19 AM
Mixed cellular containing RBCs, WBCs (blue) and RTECs (fuchsia) in the #UrinarySediment from a patient with suspected IgA nephropathy 🔬bright field (500x) and oblique illumination (1000x) #UrineMicroscopy #OchsnerNephrology
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
I was just reminded that I once made an autoportrait of my distal LAD flow in 3D (and got it published!) #echosky #cardiosky pubmed.ncbi.nlm.nih.gov/29993929/
October 22, 2025 at 4:51 PM
I was just reminded that I once made an autoportrait of my distal LAD flow in 3D (and got it published!) #echosky #cardiosky pubmed.ncbi.nlm.nih.gov/29993929/
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Following #KidneyWk I’ll be flying to Santiago, Chile, for a #UrinarySediment Microscopy conference 🔬 citem.cl/congreso-int...
October 19, 2025 at 5:08 PM
Following #KidneyWk I’ll be flying to Santiago, Chile, for a #UrinarySediment Microscopy conference 🔬 citem.cl/congreso-int...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Key point from my invasive CO talk the other day #CHEST2025
October 21, 2025 at 1:25 PM
Key point from my invasive CO talk the other day #CHEST2025
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
A famous nephrologist getting ready to go see the most famous guy who plays a nephrologist @glaucomflecken.bsky.social @stanforddeptmed.bsky.social Grand Rounds!
September 5, 2025 at 4:27 PM
A famous nephrologist getting ready to go see the most famous guy who plays a nephrologist @glaucomflecken.bsky.social @stanforddeptmed.bsky.social Grand Rounds!
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 .
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
https://med.stanford.edu/hypertension/e…
September 25, 2025 at 8:02 AM
We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 .
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
We are thrilled to announce that we have generously received funding for a one-year hypertension fellowship, and we are recruiting now for a candidate to start fellowship July 1, 2026 .
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
med.stanford.edu/hypertension/e…
-Jehan Zahid Bahrainwala
HTN Fellowship Program Director
https://med.stanford.edu/hypertension/e…
September 25, 2025 at 9:37 PM
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Secondly, loop diuretics act as venodilators, which means if you look at vena cava shortly after a diuretic dose, vena cava (and RAP/CVP for that matter) may suggest normovolemia even if the patient is still volume overloaded. www.ahajournals.org/doi/10.1161/...
Direct Vascular Effects of Furosemide in Humans | Circulation
Background In humans, hemodynamic changes observed within minutes after systemic administration
of furosemide are often referred to as direct vasoactivity. However, these immediate
changes do not per ...
www.ahajournals.org
September 16, 2025 at 1:48 PM
Secondly, loop diuretics act as venodilators, which means if you look at vena cava shortly after a diuretic dose, vena cava (and RAP/CVP for that matter) may suggest normovolemia even if the patient is still volume overloaded. www.ahajournals.org/doi/10.1161/...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
First of all, I think it’s well overdue that we abandon the use of vena cava size (or at least downgrade it). It’s the poorest parameter! Vena cava circularity/sphericity is much better! pubmed.ncbi.nlm.nih.gov/28065586/
Estimation of Central Venous Pressure Using the Ratio of Short to Long Diameter from Cross-Sectional Images of the Inferior Vena Cava - PubMed
S/L of an IVC cross-section measured using three-dimensional echocardiography may be a reliable parameter to estimate CVP compared with standard grading by 2DE.
pubmed.ncbi.nlm.nih.gov
September 16, 2025 at 1:48 PM
First of all, I think it’s well overdue that we abandon the use of vena cava size (or at least downgrade it). It’s the poorest parameter! Vena cava circularity/sphericity is much better! pubmed.ncbi.nlm.nih.gov/28065586/
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky
La veine cave inférieure n'est pas un bon examen pour décider de remplir un malade ? En toute logique, elle n'est pas meilleure pour guider la vidange...
www.jacc.org/doi/10.1016/...
www.jacc.org/doi/10.1016/...
Inferior Vena Cava Ultrasound to Guide Decongestion in Acute Decompensated Heart Failure: A Randomized Controlled Trial
www.jacc.org
September 16, 2025 at 1:48 PM
Some thoughts on this study on using vena cava to guide in-patient treatment of deconpensated heart failure and why it will not change the way I diurese (I use vena cava wisely). #emimcc #cardiosky
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
☝️DIGIT trial shows benefit from digitoxin in HFrEF (even in context of reasonable GDMT)
numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations)
digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC
www.medscape.com/viewarticle/...
numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations)
digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC
www.medscape.com/viewarticle/...
Five Big Messages From the DIGIT-HF Trial
Will reassuring safety data and a good efficacy signal increase use of digoxin in heart failure? John Mandrola MD reviews the DIGIT- HF trial from the 2025 European Society of Cardiology congress.
www.medscape.com
September 1, 2025 at 12:46 PM
☝️DIGIT trial shows benefit from digitoxin in HFrEF (even in context of reasonable GDMT)
numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations)
digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC
www.medscape.com/viewarticle/...
numerous limitations but consistent w/ the seminal DIG trial (👇 hospitalizations)
digitoxin is hepatically metabolized making dosing easier (not available in USA) #1/2 #EMIMCC
www.medscape.com/viewarticle/...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
for those of you worried about the safety of PPIs among critically ill patients:
this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and...
...absolutely nothing happened. #EMIMCC
journals.lww.com/ccmjournal/f...
this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and...
...absolutely nothing happened. #EMIMCC
journals.lww.com/ccmjournal/f...
August 21, 2025 at 3:59 PM
for those of you worried about the safety of PPIs among critically ill patients:
this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and...
...absolutely nothing happened. #EMIMCC
journals.lww.com/ccmjournal/f...
this RCT evaluated the effect of using insanely ridiculously ginormous mega-doses of esomeprazole in septic patients and...
...absolutely nothing happened. #EMIMCC
journals.lww.com/ccmjournal/f...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Case in point: vasopressin is probably only a wise choice if EF is supranormal pubmed.ncbi.nlm.nih.gov/37030157/
Echocardiographic profiles and hemodynamic response after vasopressin initiation in septic shock: A cross-sectional study - PubMed
Pre-drug echocardiographic profiles differed in hemodynamic responders after vasopressin initiation versus non-responders.
pubmed.ncbi.nlm.nih.gov
August 17, 2025 at 7:10 PM
Case in point: vasopressin is probably only a wise choice if EF is supranormal pubmed.ncbi.nlm.nih.gov/37030157/
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...
August 17, 2025 at 8:24 PM
Extremely striking difference in utilisation of Impella in the US vs UK and Canada. #cardiosky #cccsky #emimcc jamanetwork.com/journals/jam...
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
P-values are fraught with hazard, but SO IS BAYESIAN STATISTICS
the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily)
The pre-test probability is often too high
This inflates the final posterior probability
🧵 #1/4 #EMIMCC
the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily)
The pre-test probability is often too high
This inflates the final posterior probability
🧵 #1/4 #EMIMCC
August 14, 2025 at 12:10 PM
P-values are fraught with hazard, but SO IS BAYESIAN STATISTICS
the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily)
The pre-test probability is often too high
This inflates the final posterior probability
🧵 #1/4 #EMIMCC
the Achilles heel of Bayesian stats is that someone determines a pre-test probability distribution (usually arbitrarily)
The pre-test probability is often too high
This inflates the final posterior probability
🧵 #1/4 #EMIMCC
Reposted by 𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇
assessing the severity of methemoglobinemia:
people get too hung up on % methemoglobin
*functional hemoglobin level* is more important
30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL
same idea as O2 saturation vs. O2 carrying capacity 👇
#EMIMCC
people get too hung up on % methemoglobin
*functional hemoglobin level* is more important
30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL
same idea as O2 saturation vs. O2 carrying capacity 👇
#EMIMCC
August 13, 2025 at 2:42 PM
assessing the severity of methemoglobinemia:
people get too hung up on % methemoglobin
*functional hemoglobin level* is more important
30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL
same idea as O2 saturation vs. O2 carrying capacity 👇
#EMIMCC
people get too hung up on % methemoglobin
*functional hemoglobin level* is more important
30% MeHb is OK if total hemoglobin is 15 mg/dL, but a big problem if total hemoglobin is 7 mg/dL
same idea as O2 saturation vs. O2 carrying capacity 👇
#EMIMCC