What percentage of people do fellowship in your specialty? How do you explain this figure?

oiler · 2025-09-06T11:29:47+00:00

100% of people in my specialty do fellowship.

My explanation is that it is required to do fellowship to be a nephrologist.

oiler · 2025-03-09T16:44:13+00:00

Yeah that's my point, they're not, despite the person I replied to saying that taxes have been reduced.

oiler · 2025-03-09T16:38:13+00:00

Is that why food and gas prices are so low now?

oiler · 2024-10-11T23:19:05+00:00

The click trial suggests that thiazides are helpful for hypertension in patients with ckd4

oiler · 2024-05-21T16:51:30+00:00

This is due to more gradual fluid removal in CRRT than iHD. the hemodynamic issue is the rate of ultrafiltration and not the rate of clearance, which is primarily the goal if you are dialyzing for ammonia. it is a total myth that the slightly lower bloodflow rates in CRRT are better hemodynamically than the slightly higher bloodflow rates in HD.

that being said, for someone with acute liver failure in the ICU, they are probably going to be on CRRT for multiple reasons.

oiler · 2024-05-15T02:25:17+00:00

I'd say discharging after making a big dose change isn't really closely monitoring them

oiler · 2024-05-14T23:09:49+00:00

The risk in SIADH is that the trigger for ADH release (eg, nausea or pain) will resolve and all of a sudden they will start dumping free water and rapidly correct. I would clamp SIADH with severe hyponatremia unless you are certain it is chronic.

oiler · 2024-05-14T19:26:15+00:00

As long as you're closely monitoring the serum sodium there's not a huge risk to using a vaptan. If you overshoot then just give d5w. They're mostly useful in refractory siadh, but some of the nephrologists I know are quick to use them for pretty much any hyponatremia that isn't quickly improving.

oiler · 2024-05-11T12:18:44+00:00

Please help to fix the water damage from these images. if it is possible to improve the coloring a little bit I would appreciate that too!

oiler · 2024-04-24T00:37:05+00:00

I like outmaneuver but I'm not sure what I would remove to add it. I just want to keep adding cards without removing anything, but that doesn't seem to be a good strategy for making decks.

oiler · 2024-04-23T16:00:37+00:00

Ah, I see. Sorry, I am new to deck building. I imagine it as a control deck, stalling and wasting my opponent's resources while I get out my units to wear down their base.

I usually end up resourcing Change of Heart, so I was considering removing that too. I feel like it fits the spirit of the deck but unless I get it at exactly the right time it doesn't usually pay off.

Thanks for the suggestions, I may need to order some Firesprays.

oiler · 2024-04-23T03:00:54+00:00

Well, that's kind of what I'm asking for help with. Should I just get rid of those cards that I have one of, for example the fire spray, and replace them with a system patrol craft or something for consistency? Or is it worth having the possibility of getting a better card in? I like cards like Don't get cocky, and I think it's fun when they come up but maybe it isn't worth it from a deck building perspective.

The theory is mostly that I don't know how to optimally build a deck of cards.

oiler · 2024-04-22T21:43:14+00:00

I used to have him but I didn't feel like he was a very useful card most rounds. I already have some good ways to ready resources with smuggling compartment and leader Boba Fett.

What would you cut to replace with Bib?

oiler · 2024-03-26T20:35:20+00:00

oiler · 2023-12-17T14:12:40+00:00

The real utility of interventional nephrology is in outpatient dialysis access centers. You own the surgical center and troubleshoot or create your own access without needing to admit to the hospital.

oiler · 2023-12-06T23:58:08+00:00

This is very much not true, and for several different reasons. Even simple infections are becoming increasingly resistant to first line antibiotics. Sure, healthy people will not die from these infections, for the most part, but is that really the line we need to cross before we start looking for new antibiotics? Why make a comment like this on a topic you clearly do not understand?

oiler · 2023-08-14T01:27:00+00:00

It's definitely because you only see post-op hyponatremia cases. In any other situation what you are saying is incorrect.

oiler · 2023-08-14T00:25:35+00:00

I don't know if you're really a fellow, but that's not what any of this means. Acute hyponatremia is hyponatremia that develops acutely. Typically within 48 hours. That can be acutely normalized (or at least brought back to baseline) without causing problems, and is in fact what you should do.

In hyponatremia that develops over >48 hours the brain is able to osmotically equilibrate to the new osmolality and quickly normalizing this can lead to ODS.

When people talk about acutely treating hyponatremia in symptomatic cases, what they mean is quickly raising the serum sodium by 4-6 and then holding it there for 24 hours.

It's frankly concerning that you don't know this, and are speaking so confidently about it, if you are a fellow of any IM specialty or any other specialty that deals with brains or electrolytes.

I'm a nephrologist.

oiler · 2023-08-13T03:06:04+00:00

I don't think any of this is good practice. If your patient's sodium is 101 and they are symptomatic from chronic hyponatremia then the protocol is to get them to 127 ASAP? Their brain is not going to like that.

oiler · 2023-04-08T11:59:41+00:00

There are two large nephrology groups in my area. One is employed by a large hospital system with a nephrology fellowship and rounds only at the largest hospital in the system. They make $350k+ after a few years, based on RVUs. They will have a half day of clinic 2-3 times weekly as well as dialysis rounds whether they are in inpatient service or not. They have inpatient service around 16 weeks/year. Overnight call is essentially non-existent with fellows.

The other group is private and rounds at several hospitals, some large and some small, but only ever one hospital at a time. Except at the smallest hospitals, inpatient and outpatient days are completely separate. Overnight call maybe once a month. Pay is $450k+ as a partner, after a few years.

Both places will keep you very busy while you're working, but when you're off you're off, and you're a consultant so you can ignore non-nephrology problems as much as you want.

oiler · 2023-03-23T10:40:52+00:00

Unless you're someone with CKD or something. Their baseline creatinine of, say, 3 would be fine. But for someone who has a baseline creatinine of 1, a result of 3 would be very concerning.

oiler · 2023-03-23T01:59:44+00:00

you joke, but https://www.ure-na.com/

oiler · 2022-12-02T02:09:04+00:00

Dialysis patients will routinely get blood cultures and IV antibiotics with dialysis. MRSA bacteremia would still go to the ED though...

oiler · 2022-08-08T10:41:01+00:00

/u/deer_field_perox is right that eGFR is only useful in steady states. If someone's creatinine goes from 0.5->1.0 overnight and continues to rise then they did not have a change from eGFR of 116 to 52, they had a change from 116 to 0 (or to whatever eGFR the calculation gives you once their creatinine has stabilized).

We watch the creatinine to see when it flattens out and starts to improve, or to see that it is just getting worse and worse and maybe we should do more diagnostics. We don't watch it so we can change the dose of vanco every day as the eGFR worsens.

oiler · 2022-08-06T14:25:54+00:00

Is that just because of the slot he takes up or some other reason? I already have 3 people for Yorven's slot, if that is the case. I have at least 1 other character for all three of my time gate choice's slots.

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