Blood, Sweat and Smears – Episode Summary

Episode: ASN - Kidney Week, 1 Question to Physicians
Host: Dr. Brad Lewis (via guest host Bjorn), Machaon Diagnostics
Date: November 16, 2024

Episode Overview

This special edition of Blood, Sweat and Smears takes listeners to the floor of the American Society of Nephrology's Kidney Week. Instead of a traditional interview or roundtable, guest host Bjorn asks a single question to a diverse group of nephrologists visiting the Machaon Diagnostics booth:

"What is the most critical test you order for your patients?"

Their candid responses underscore the key laboratory priorities and diagnostic tools of contemporary nephrology, with a special emphasis on both classic and advanced tests in patient management. The episode offers a rapid-fire, insightful snapshot into the minds of front-line kidney specialists.

Key Discussion Points & Insights

1. The Importance of Basic Chemistry and Electrolyte Testing

• Potassium:

  • Nourasa Shoubaki: Highlights potassium as her “most critical lab,” showing the fundamental importance of electrolyte monitoring in nephrology.
    • Quote: “The most critical lab I order that gets me excited is potassium.” (01:50)

• Creatinine and eGFR:

  • Kalyani Chandra: Prioritizes kidney function via creatinine with estimated glomerular filtration rate (eGFR).
    • Quote: “Creatinine with gfr.” (02:02)

• BMP & Chem7:

  • Aldo Torres and Anna (Yale) favor initial panels like BMP (Basic Metabolic Panel) and Chem7, covering kidney function, electrolytes, and guiding clinical urgency.
    • Quote (Aldo Torres): “That’s because it tells us very important initial information such as the kidney function, electrolytes, and it tells me if I need to act emergently...if they have hyperkalemia or hyponatremia, anything that is critical that would warrant emergent treatment for that patient.” (03:20)
    • Quote (Anna): “The most protocol test that we need to order is a Chem7 for most patients.” (03:10)

2. Specialized and Rapid Diagnostics in Thrombotic Microangiopathy (TMA)

• ADAMTS13 Testing:
  • Leon Rovner and Brian Wong stress the urgency and importance of ADAMTS13 testing when TMA (such as TTP) is suspected, for guiding therapy and management.
    • Quote (Leon Rovner): “Very anxious about making the right diagnosis when there is TMA and the first and critical test to start with, it's Adams 13.” (02:22)
    • Quote (Brian Wong): “The Adams 13 activity and inhibitor is a test I often want to know the quickest and most reliable way.” (02:57)

3. Genetic Testing for Complement-Related Diseases

• Atypical HUS (aHUS) Genetic Testing:
  • Ikuyo Yamaguchi, Aya Elmagrabi, and Irfan Moinuddin (pediatric nephrologists and adult specialists alike) repeatedly identify genetic analyses for aHUS as vital, reflecting the increased role of personalized and precision medicine.
    • Quote (Ikuyo Yamaguchi): “I think the most critical genetic testing for pediatric nephrology is atypical HUS genetic testing.” (02:08)
    • Quote (Aya Elmagrabi): “The most important test for us will be atypical HUS panel.” (03:50)
    • Quote (Irfan Moinuddin): “The most critical test that we order...is the atypical HUS genetic testing panel, based on what we see multiple times on the inpatient setting when the patient starts hemolyzing.” (04:04)

4. Urinalysis: The Classic Bedrock

• Robert Gillespie:
  • Asserts the enduring value of urinalysis, reinforcing that traditional, inexpensive tests remain foundational.
    • Quote: “The most critical test I order is urinalysis.” (02:50)

Notable Quotes & Memorable Moments

• “The most critical lab I order that gets me excited is potassium.”
  — Nourasa Shoubaki (01:50)

• “Very anxious about making the right diagnosis when there is TMA and the first and critical test to start with, it's Adams 13.”
  — Leon Rovner (02:22)

• “It tells us very important initial information such as the kidney function, electrolytes, and it tells me if I need to act emergently...”
  — Aldo Torres (03:20)

• “I think the most critical genetic testing for pediatric nephrology is atypical HUS genetic testing.”
  — Ikuyo Yamaguchi (02:08)

• “The most protocol test that we need to order is a Chem7 for most patients.”
  — Anna (Yale) (03:10)

Timestamps for Key Segments

• 00:31–01:50:
  Introduction by Bjorn; overview of Machaon Diagnostics’ participation at ASN Kidney Week and explanation of the question posed.

• 01:50–04:04:
  Rapid responses from nephrologists on their most critical tests (individual timestamps provided above).

• 04:23–04:34:
  Closing remarks and reflections from Bjorn.

Episode Takeaways

The episode provides a concise yet vivid snapshot of clinical priorities among nephrologists, balancing frontline electrolyte and kidney function assessment with the increasing necessity of rapid and reliable molecular diagnostics, particularly for thrombotic and complement-mediated diseases.

Whether it’s potassium, creatinine, ADAMTS13, urinalysis, or aHUS genetic panels, the essential nature of informed, fast, and strategic testing stands out as the backbone of nephrology practice—offering lessons both for clinicians and laboratory professionals alike.