Senior nephrologist here: wonderful lecture, I used to teach residents exactly like this. Problem: glomerular hypertension and resultant proteinuria is a major theme here, yet even with ACEI or SGLT-2i, proteinuria is often ignored as a therapeutic target even in major studies. On the other hand, low eGFR with its major drawbacks and imprecision is substituted for all other clinical and individual markers of kidney disease as if CKD was nothing beyond "low eGFR disease". So instead of global individual assessment, we have partial statistical assessment on the population level. Do you see my frustration?
Thank you so much for posting this video, it was the perfect amount of detail for me. I am a pharmacist who graduated in 2017 and I really needed this refresher.
I have my semester exams in a few days and nephrology is one of the topics....and i have to agree that none of my professors have explained this topic so brilliantly. Keep up the good work Sir. ❤️👍
I think your explanation is the best I've seen on RUclips so far. It's concise, focused, and has very good notes. I think it's much better than my teacher's lectures. I'd like to ask when you could systematically explain antibiotics. This should be a very important topic, but it's also complex and confusing. Thank you.
Great explanation (even for a layperson audience). Excellent explanation of the maladaptive reaction to increased glucose & sodium in the filtrate (Similar concept to remodeling in HF).
Yeah, generally we stop metformin with eGFR drops below 30. And it doesn't have the renal protective effects that SGLT2 inhibitors have - but, that being said we do still consider it our first line medication for diabetes since it is so well tolerated with minimal side effects. So I don't think your doctor was wrong at all to have you on it! Generally we start with metformin -> add SGLT2 inhibitor or GLP-1 agonist as a second step!
After six month of 5 mg Dapagliflozin uses. My HB1C drops to 7.1 from 8. Egfr is 75 which was 90 before and creatinine is little bit increased but still in range. I was worried because of my egfr dropped down now after watching this video it gives me hope that its normal and will be helpful in the long run
Thanks for this video Conan, watched it as a refresher on how SGLT2is work- What are your thoughts on SGLT2i being constantly pushed to the limit in terms of renal function? Results of recent studies highlight its enduring efficacy despite declining renal function, and with future SGLT2i studies in dialysis patients, seems counterintuitive for a drug that needs to be filtered for it to work in the first place- seems like there might be more to SGLT2is than we originally thought!
You remind me of a resident that taught me many mechanisms during my internal rotations! I can imagine it being a blast to work with you. Do you plan on building your own clinic in the future?
Amazing video. Thanks for such detail lesson. Among the 2, Dapaglifazon and Empaglifazon, which one is better for initial stage renal patients with egfr around 40 and creatinine around 1.7, 1.2 being normal? Also, are SGLT2 Inhibitors better than Gliptins like Linagliptin among ckd patients?
Thank you for the Awesome video Dr Liu. Does the GFR reverse when they discontinue the SGLT2 inhibitors? What’s your suggestion for Type 1 diabetic patients?
Type 1 diabetics will typically need insulin! GFR probably will transiently improve after stopping SGLT2 inhibitors, but you will lose the renal protection aspect
Hmm I’m not sure how much I would have to add other than cystatin C is becoming more and more favored since it isn’t affected by muscle mass! It’s a great point you brought up. It’s also particularly helpful in elderly frail patients who have super low muscle mass too
Hi doc! Would you recommend forxiga 10 with trandolapril(ace inhibitors) for 24 year old male with proteinuria, isolated systolic hypertension and glomerular hyperfiltration, no diabetes, normal blood levels, >90 GFR. I have for the past 5 years been on a control of blood pressure and proteinuria , but my doctor says without kidney biopsy they cant know much , other than it is good to consume ace inhibitors and recently they added to it forxiga 10mg "for kidney protection". Thanks!
Hmm, I don't know if we have very strong recommendations/guidelines yet for this patient population. I'd probably have to defer to your nephrologist to see if it would be recommended. This video does hopefully provide a nice explanation for how it might be beneficial however
sir i want to ask, if there vasoconstrict in eferent, intraglomelural is increase/ high. egfr is increase. what the meaning of egfr increase? is it good or bad? creatinin is increase or not? egfr 90 is good, but egfr
Hello Dr. Liu, Could you please make a video on the step-by-step process of pre-charting on patient that was admitted overnight (or an unfamiliar patient being transferred to your care)? As a student, I find this to be the most time-consuming process and often get bogged down in the details. This is especially the case when the patient has been on the service for several days and has tons of progress notes, consults notes, and imaging to sift through. Also, more generally, how do you pre-chart efficiently in the AM? Do you recommend using a data tracker sheet like OME suggests? Thank you very much. Your videos have been very helpful!
Thank you so much for the thorough explanation, my question is does everyone have some decrease of eGFR when taking SGLT2 Because one of my friend his eGFR didn't affect while taking the medication, I heard even its drop for some people instance but later eGFR is back to normal is it true? my eGFR 72. I'm a little worried about taking the medication.
Is this video for medical professionals only? I want to hear from the actual patients that they actually cured. I’ve been taking farxiga for years without a decent result. Are there any patients that could give their testimonies?
The most stringent parameter in our body is osmolarity. Glucose is osmolaric effective which means that it's not that simple. Besides, bacteria love glucose. Again, it's not that simple. SGLT inhibitors may have its indication but it must be more closely defined. I had quite a few patients on my ward because of them.
Empagliflozin has been shown to continue to be beneficial in patients with GFR as low as 20. Below that and we usually don't prescribe it. CKD4 includes GFR ranging from 15-30 so a subset of patients would still qualify!
All this is nice...u have conveniently forgotten to mention what happens when all glucose enters the bladder...warm...moist... and nutrient medium for the bugs...u should have mentioned that...UTI...
Senior nephrologist here: wonderful lecture, I used to teach residents exactly like this. Problem: glomerular hypertension and resultant proteinuria is a major theme here, yet even with ACEI or SGLT-2i, proteinuria is often ignored as a therapeutic target even in major studies. On the other hand, low eGFR with its major drawbacks and imprecision is substituted for all other clinical and individual markers of kidney disease as if CKD was nothing beyond "low eGFR disease". So instead of global individual assessment, we have partial statistical assessment on the population level. Do you see my frustration?
Thank you so much for posting this video, it was the perfect amount of detail for me. I am a pharmacist who graduated in 2017 and I really needed this refresher.
I have my semester exams in a few days and nephrology is one of the topics....and i have to agree that none of my professors have explained this topic so brilliantly. Keep up the good work Sir. ❤️👍
Sir, thank you very much for this video. Much love people like you
Great job . Always very educational and helpful. Thank you ❤❤❤❤❤❤❤
I think your explanation is the best I've seen on RUclips so far. It's concise, focused, and has very good notes. I think it's much better than my teacher's lectures. I'd like to ask when you could systematically explain antibiotics. This should be a very important topic, but it's also complex and confusing. Thank you.
I’m a resident at Mayo! Super helpful. Keep it up!
thanks so much. this video was the one i needed.
Great explanation (even for a layperson audience). Excellent explanation of the maladaptive reaction to increased glucose & sodium in the filtrate (Similar concept to remodeling in HF).
Great talk and solid explanation.
Superb explanation. Are you able to do a video on how this same med helps with heart failure
This is really interesting. I've been taking Metformin for a few years and my egfr score has recently dropped to under
Yeah, generally we stop metformin with eGFR drops below 30. And it doesn't have the renal protective effects that SGLT2 inhibitors have - but, that being said we do still consider it our first line medication for diabetes since it is so well tolerated with minimal side effects. So I don't think your doctor was wrong at all to have you on it! Generally we start with metformin -> add SGLT2 inhibitor or GLP-1 agonist as a second step!
After six month of 5 mg Dapagliflozin uses. My HB1C drops to 7.1 from 8. Egfr is 75 which was 90 before and creatinine is little bit increased but still in range. I was worried because of my egfr dropped down now after watching this video it gives me hope that its normal and will be helpful in the long run
I am on Jardiance 10 mgs and in 8 weeks my HBa1c went from 7.4 to 6. perhaps you are not taking enough. my egfr is always the same for years now, 89
Thank you for simplifying the topic!
Explanation is good ❤, thank you sir🙏🙏
amazing explanation! it made things so clear,
Thanks for this video Conan, watched it as a refresher on how SGLT2is work- What are your thoughts on SGLT2i being constantly pushed to the limit in terms of renal function? Results of recent studies highlight its enduring efficacy despite declining renal function, and with future SGLT2i studies in dialysis patients, seems counterintuitive for a drug that needs to be filtered for it to work in the first place- seems like there might be more to SGLT2is than we originally thought!
You remind me of a resident that taught me many mechanisms during my internal rotations! I can imagine it being a blast to work with you. Do you plan on building your own clinic in the future?
Fabulous! Thank you so much...
Can you talk about the mechanism of euglycemic dka? It's one of the main issues we deal with in the ED regarding these meds
Excellent, thank you!
Amazing video. Thanks for such detail lesson. Among the 2, Dapaglifazon and Empaglifazon, which one is better for initial stage renal patients with egfr around 40 and creatinine around 1.7, 1.2 being normal? Also, are SGLT2 Inhibitors better than Gliptins like Linagliptin among ckd patients?
how protein being able to be filtered?
Thank you for the Awesome video Dr Liu.
Does the GFR reverse when they discontinue the SGLT2 inhibitors?
What’s your suggestion for Type 1 diabetic patients?
Type 1 diabetics will typically need insulin! GFR probably will transiently improve after stopping SGLT2 inhibitors, but you will lose the renal protection aspect
@@ConanLiuMD Thank you for getting back to me Dr. Liu. I use a combination of insulin a SGLT2 inhibitors for my Type 1
can you make a video on how SGLT2 inhibitors help in heart failure?
Can you make a video on how to accurately test the eGFR of a athlete/active person? Nobody seems to ever talk about a Cystatin-C test.
Hmm I’m not sure how much I would have to add other than cystatin C is becoming more and more favored since it isn’t affected by muscle mass! It’s a great point you brought up. It’s also particularly helpful in elderly frail patients who have super low muscle mass too
Hi doc! Would you recommend forxiga 10 with trandolapril(ace inhibitors) for 24 year old male with proteinuria, isolated systolic hypertension and glomerular hyperfiltration, no diabetes, normal blood levels, >90 GFR. I have for the past 5 years been on a control of blood pressure and proteinuria , but my doctor says without kidney biopsy they cant know much , other than it is good to consume ace inhibitors and recently they added to it forxiga 10mg "for kidney protection". Thanks!
Hmm, I don't know if we have very strong recommendations/guidelines yet for this patient population. I'd probably have to defer to your nephrologist to see if it would be recommended. This video does hopefully provide a nice explanation for how it might be beneficial however
Please do genetic testing, I am non diabetic, hypertension with proteinurea, later found out with genetic testing of Alport syndrome
sir i want to ask, if there vasoconstrict in eferent, intraglomelural is increase/ high. egfr is increase. what the meaning of egfr increase? is it good or bad? creatinin is increase or not? egfr 90 is good, but egfr
man, thank you soooo much
Hello. Is there a way i can get these slides of presentation?
Hello Dr. Liu,
Could you please make a video on the step-by-step process of pre-charting on patient that was admitted overnight (or an unfamiliar patient being transferred to your care)?
As a student, I find this to be the most time-consuming process and often get bogged down in the details. This is especially the case when the patient has been on the service for several days and has tons of progress notes, consults notes, and imaging to sift through.
Also, more generally, how do you pre-chart efficiently in the AM? Do you recommend using a data tracker sheet like OME suggests?
Thank you very much. Your videos have been very helpful!
Hi there. I have read this cant be given to patients having gfr below 45. In that case, doesn’t it contradicts its renal protective claim?
Thank you so much for the thorough explanation, my question is does everyone have some decrease of eGFR when taking SGLT2
Because one of my friend his eGFR didn't affect while taking the medication, I heard even its drop for some people instance
but later eGFR is back to normal is it true? my eGFR 72. I'm a little worried about taking the medication.
Yes you should expect some decrease in eGFR when starting an SGLT2 inhibitor, but the benefits for kidney protection outweigh that initial change!
Is there a preference for one SGLT-2 I over another for ...eg HF, CKD, comorbidity of all, some, disease state? and of course diabetes.)😊
Not too much, it kind of just depends on what the hospital or physician is used to! We use empagliflozin or Jardiance the most here
@@ConanLiuMD rhank you doe taking the time to reply. I am in Australia and also the same two, dapag for CHF
thank you very much, now we understand..
Is this video for medical professionals only? I want to hear from the actual patients that they actually cured. I’ve been taking farxiga for years without a decent result. Are there any patients that could give their testimonies?
The most stringent parameter in our body is osmolarity. Glucose is osmolaric effective which means that it's not that simple. Besides, bacteria love glucose. Again, it's not that simple. SGLT inhibitors may have its indication but it must be more closely defined. I had quite a few patients on my ward because of them.
Can I take SGLT 2 for my CKD 1 without diabetes?
I have not seen many providers treating CKD1 as we essentially consider this normal kidney function - but I would ask your own doctor.
No. Why? Because in hypoglycemia , the high insulin is inhibiting SGLT !
Well explained!
Outstanding 😊😊
Can a stage 4 cdk patients take this medicine
Empagliflozin has been shown to continue to be beneficial in patients with GFR as low as 20. Below that and we usually don't prescribe it. CKD4 includes GFR ranging from 15-30 so a subset of patients would still qualify!
Well explained thank you
All this is nice...u have conveniently forgotten to mention what happens when all glucose enters the bladder...warm...moist... and nutrient medium for the bugs...u should have mentioned that...UTI...