ASN - Kidney Week, 1 Question to Physicians

Summary

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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

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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.

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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)

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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)

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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.

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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.

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Transcript

[Podcast Host]

Hello and welcome to Blood, Sweat and.

[Podcast Producer]

Smears, a podcast produced by Macheon Diagnostics.

[Podcast Host]

In this podcast series, we will be discussing thrombosis and hemostasis from the perspective of our host benign hematologist and medical director of Macheon Diagnostics, Dr. Brad Lewis. Please remember to subscribe and leave a review with that. I'll turn it over to Dr. Lewis. Brad, take it away.

[Bjorn (Guest Host)]

Hi, this is Bjorn sitting in for Dr. Brad Lewis. Mecheon Diagnostics recently exhibited at Kidney Week Again this year we've been exhibiting at Kidney Week, the American Society of Nephrology's annual meeting for the last decade. Maybe 11 years, save for the COVID years of course. We're generally there to talk to physicians about our genetic testing for atypical HUS or 24 hour turnaround times for Adamts 13 and solid label C5B9 and our anti CFH testing. You know, the testing that's most interesting to nephrologists. Although we've been there also to talk to pharmaceutical companies about testing within clinical trials, including for Alport Syndrome, PKD and complement related diseases. It's often a place where we reconnect with physicians who use our testing and value our fast turnaround times, people who we've helped make speedy diagnoses or decide on a course of treatment. Honestly, we love having those conversations and it's one of the reasons we love this meeting. This year we decided to ask a question of nephrologists visiting our booth. We asked, what is the most critical test you order for your patients, and we let the physicians define exactly what that meant. What follows are those responses. Thanks to all who visited our booth. We hope to see you again next year.

[Nourasa Shoubaki]

My name is Nourasa Shoubaki. I'm one of the attending nephrologists at Midwest Nephrology based in Milwaukee, Wisconsin. The most critical lab I order that gets me excited is potassium.

[Podcast Host]

Kalyani Chandra, Kaiser Permanente Creatinine with gfr.

[Multiple Pediatric Nephrologists (Ikuyo Yamaguchi, Anna, Aya Elmagrabi)]

This is Ikuyo Yamaguchi, Pediatric Nephrology at Glaucoma Children's Hospital. I think the most critical genetic testing for pediatric nephrology is atypical HUS genetic testing.

[Song Lu / Leon Rovner]

Song Lu Mexico University Hospital the potassium is sometimes critical. Leon Rovner, nephrologist in Los Angeles Downtown Very anxious about making the right diagnosis when there is TMA and the first and critical test to start with, it's Adams 13.

[Robert Gillespie / Aldo Torres]

I'm Robert Gillespie with Cook Children's Medical center and the most critical test I order is Urinalysis.

[Brian Wong]

Brian Wong is brain nephrology. The Adams 13 activity and inhibitor is a test I often want to know the quickest and most reliable way.

[Multiple Pediatric Nephrologists (Ikuyo Yamaguchi, Anna, Aya Elmagrabi)]

My name's Anna. I'm from Yale. The most protocol test that we need to order is a Chem7 for most patients.

[Robert Gillespie / Aldo Torres]

Hey, this is Aldo Torres. I'm from Tulane University. I work mostly at University Medical center in New Orleans. And the most important test, I would say it's a bmp. And 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, meet a patient to the hospital, you know, if they have hyperkalemia or hyponatremia, anything that is critical that would warrant emergent treatment for that patient. So.

[Multiple Pediatric Nephrologists (Ikuyo Yamaguchi, Anna, Aya Elmagrabi)]

My name is Aya Elmagrabi and a pediatric nephrologist work at UVA in Charlottesville, Virginia. And the most important test for us will be atypical HUS panel.

[Irfan Moinuddin]

Hi, this is Irfan Moinuddin from Virginia Commonwealth University in Richmond, Virginia. And I think the most critical test that we order for our patients, mostly in the inpatient setting, is the atypical HUS genetic testing panel, based on what we see multiple times on the inpatient setting when the patient starts hemolyzing.

[Bjorn (Guest Host)]

And there you go. Thank you to all the physicians who agreed to participate. Who knows what we'll ask next year in Houston. We hope to see you there.

[Podcast Producer]

That's it for us here at Blood, Sweat and Smears, a podcast produced by Macheon Diagnostics, your reference lab and CRO, specializing in thrombosis, hemostasis and rare disease. Thank you for listening. And if you have a question or comment or there's a topic you'd like Dr. Lewis to speak to, please send us an email to blood sweatandsmeersachiondiagnostics.com that's M A C H A O-N diagnostics.com you can follow Matrian at Twitter ationdx. Be sure to subscribe to stay in the know. Share this podcast with clinicians you think might appreciate it, and we hope you'll join us next time here at Blood, Sweat and Smears.