Dr.Tauqeer Nasir

Dr.Tauqeer Nasir MBBS (KMU)
Registered GP – SCFHS, KSA
MCPS Medicine(CPSP)
FCPS Nephrology (CPSP)

Consultant Nephrologist & Transplant Physician by profession .

12/10/2025

Awareness!

03/10/2025

🔹 HTN + Diabetes + Lipids in CKD – Quick Guide 🔹

✅ HTN

ACEI/ARB = kidney protection

CCBs safe all stages

Thiazides → only if eGFR ≥45

Loop diuretics → if eGFR

01/10/2025

𝐇𝐞𝐦𝐨𝐠𝐥𝐨𝐛𝐢𝐧 𝐓𝐚𝐫𝐠𝐞𝐭 𝐢𝐧 𝐂𝐊𝐃
𝐊𝐃𝐈𝐆𝐎 𝟐𝟎𝟐𝟓 𝐠𝐮𝐢𝐝𝐞𝐥𝐢𝐧𝐞𝐬:

Initiate treatment if Hb 100 ng/mL (non-dialysis CKD) or >200 ng/mL (dialysis).
Transferrin saturation (TSAT) >20%.

𝐂𝐊𝐃 𝐚𝐧𝐞𝐦𝐢𝐚 𝐦𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭:

Correct iron deficiency first.
Use ESAs if Hb

30/09/2025

𝐆𝐞𝐧𝐞𝐫𝐚𝐥 𝐏𝐫𝐢𝐧𝐜𝐢𝐩𝐥𝐞𝐬 𝐨𝐟 𝐂𝐊𝐃 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭

𝟏. 𝐈𝐝𝐞𝐧𝐭𝐢𝐟𝐲 𝐚𝐧𝐝 𝐓𝐫𝐞𝐚𝐭 𝐔𝐧𝐝𝐞𝐫𝐥𝐲𝐢𝐧𝐠 𝐂𝐚𝐮𝐬𝐞
𝟐. 𝐁𝐥𝐨𝐨𝐝 𝐏𝐫𝐞𝐬𝐬𝐮𝐫𝐞 𝐂𝐨𝐧𝐭𝐫𝐨𝐥
𝟑. 𝐆𝐥𝐲𝐜𝐞𝐦𝐢𝐜 𝐂𝐨𝐧𝐭𝐫𝐨𝐥 𝐢𝐧 𝐃𝐢𝐚𝐛𝐞𝐭𝐢𝐜 𝐂𝐊𝐃
𝟒. 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞 & 𝐃𝐢𝐞𝐭𝐚𝐫𝐲 𝐌𝐞𝐚𝐬𝐮𝐫𝐞𝐬
𝟓. 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 𝐨𝐟 𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬
𝟔. 𝐂𝐚𝐫𝐝𝐢𝐨𝐯𝐚𝐬𝐜𝐮𝐥𝐚𝐫 𝐏𝐫𝐨𝐭𝐞𝐜𝐭𝐢𝐨𝐧
𝟕. 𝐏𝐫𝐞𝐩𝐚𝐫𝐞 𝐟𝐨𝐫 𝐫𝐞𝐧𝐚𝐥 𝐫𝐞𝐩𝐥𝐚𝐜𝐞𝐦𝐞𝐧𝐭 𝐭𝐡𝐞𝐫𝐚𝐩𝐲:𝐀𝐝𝐯𝐚𝐧𝐜𝐞𝐝 𝐂𝐊𝐃 (𝐒𝐭𝐚𝐠𝐞 𝟒–𝟓)

𝟏. 𝐈𝐝𝐞𝐧𝐭𝐢𝐟𝐲 𝐚𝐧𝐝 𝐓𝐫𝐞𝐚𝐭 𝐔𝐧𝐝𝐞𝐫𝐥𝐲𝐢𝐧𝐠 𝐂𝐚𝐮𝐬𝐞
Diabetes Mellitus
Hypertension
Glomerulonephritis
Obstruction/structural cause

𝟐. 𝐁𝐥𝐨𝐨𝐝 𝐏𝐫𝐞𝐬𝐬𝐮𝐫𝐞 𝐂𝐨𝐧𝐭𝐫𝐨𝐥
( 30
SGLT2 inhibitors (empagliflozin, dapagliflozin): slow CKD progression & reduce CV risk.
𝐆𝐋𝐏-𝟏 𝐫𝐞𝐜𝐞𝐩𝐭𝐨𝐫 𝐚𝐠𝐨𝐧𝐢𝐬𝐭𝐬 𝐟𝐨𝐫 𝐚𝐝𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐂𝐕/𝐫𝐞𝐧𝐚𝐥 𝐩𝐫𝐨𝐭𝐞𝐜𝐭𝐢𝐨𝐧.

𝟒. 𝐋𝐢𝐟𝐞𝐬𝐭𝐲𝐥𝐞 & 𝐃𝐢𝐞𝐭𝐚𝐫𝐲 𝐌𝐞𝐚𝐬𝐮𝐫𝐞𝐬

Sodium restriction (

30/09/2025

𝐒𝐨𝐝𝐢𝐮𝐦 𝐁𝐢𝐜𝐚𝐫𝐛𝐨𝐧𝐚𝐭𝐞 (𝐍𝐚𝐇𝐂𝐎₃) 𝐓𝐡𝐞𝐫𝐚𝐩𝐲: 𝐈𝐧𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬, 𝐌𝐢𝐬𝐜𝐨𝐧𝐜𝐞𝐩𝐭𝐢𝐨𝐧𝐬, 𝐚𝐧𝐝 𝐂𝐨𝐧𝐭𝐫𝐚𝐢𝐧𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬

𝐊𝐞𝐲 𝐏𝐫𝐢𝐧𝐜𝐢𝐩𝐥𝐞

• Not every metabolic acidosis requires NaHCO₃.
• Unnecessary use may worsen intracellular acidosis, cause volume overload, or induce metabolic alkalosis.
• Always calculate the anion gap first:
• NAGMA (normal anion gap metabolic acidosis): NaHCO₃ often indicated.
• HAGMA (high anion gap): focus on treating the underlying cause; NaHCO₃ is rarely primary therapy.

𝐈𝐦𝐩𝐨𝐫𝐭𝐚𝐧𝐭 𝐂𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐈𝐧𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬

1. TCA toxicity → alkalinization of urine
2. Salicylate toxicity
3. NAGMA due to GI HCO₃ loss
4. Renal Tubular Acidosis (Type I & II)
5. Severe hyperkalemia
6. DKA → only if pH < 6.9

𝐎𝐮𝐭𝐝𝐚𝐭𝐞𝐝 / 𝐍𝐨𝐭 𝐄𝐯𝐢𝐝𝐞𝐧𝐜𝐞-𝐁𝐚𝐬𝐞𝐝

• Prevention of contrast-induced nephropathy (CIN)
• Rhabdomyolysis (alkalinization of urine)
• Empirical use in cardiac arrest

𝐃𝐨𝐬𝐢𝐧𝐠 (𝐊𝐞𝐲 𝐄𝐱𝐚𝐦𝐩𝐥𝐞𝐬)

• Urine alkalinization: 150 mEq NaHCO₃ in 1 L D5%, infuse 100–250 ml/h (keep urine pH > 7.5, not > 8
•Hyperkalemia (emergency): 50 mEq IV over 5 min
• DKA (if pH < 6.9): 50 mEq in 400 ml sterile water, infuse 200 ml/h, then reassess
• HCO₃ deficit calculation:Deficit = 0.3 × Body wt (kg) × Base Excess (BE)→ Give half immediately, reassess, then give the rest

𝐂𝐨𝐧𝐭𝐫𝐚𝐢𝐧𝐝𝐢𝐜𝐚𝐭𝐢𝐨𝐧𝐬

• Metabolic alkalosis
• Hypocalcemia
• Hypernatremia
• Hypersensitivity
• Volume overload

28/09/2025

Anti-Diabetic & Weight Effect !

💥Weight Gain = I Store Too Much
I = Insulin
S = Sulfonylureas
T = Thiazolidinediones (TZDs)
M = Meglitinides
💥Weight Loss = Get lean & Shed pounds
G = GLP-1 agonists
S =SGLT2 inhibitors
💥Weight Neutral = Metformin Doesn't Add
M = Metformin
D = DPP-4 Inhibitors
A = Alpha-Glucosidase Inhibitors

Commonly Asked Question in ExamTreatment of Hyperparathyroidism in CKDHyperparathyroidism in CKD is usually secondary hy...
19/09/2025

Commonly Asked Question in Exam

Treatment of Hyperparathyroidism in CKD

Hyperparathyroidism in CKD is usually secondary hyperparathyroidism (due to phosphate retention, low vitamin D activation, hypocalcemia). Treatment aims at correcting the underlying biochemical abnormalities and protecting bone/vascular health.

1. Correct Hyperphosphatemia
• Dietary phosphate restriction (limit dairy, nuts, cola, processed foods).
• Phosphate binders (taken with meals):
• Calcium-based: calcium carbonate, calcium acetate (avoid if hypercalcemia).
• Non-calcium: sevelamer, lanthanum carbonate (preferred if hypercalcemia or vascular calcification).

2. Vitamin D Supplementation
• Vitamin D analogues (active form) to suppress PTH and correct hypocalcemia:
• Calcitriol, alfacalcidol, paricalcitol.
• Must monitor calcium and phosphate to avoid hypercalcemia/hyperphosphatemia.

3. Calcimimetics
• Cinacalcet, etelcalcetide → increase parathyroid calcium-sensing receptor sensitivity, lowering PTH.
• Especially used in dialysis patients with refractory hyperparathyroidism.

4. Parathyroidectomy
• Considered if:
• Severe secondary/tertiary hyperparathyroidism,
• Persistent very high PTH despite medical therapy,
• Complications: bone pain, pruritus, calciphylaxis, or soft tissue calcification.

Treatment Approach by CKD Stage
• CKD G3–G5 (non-dialysis) → control phosphate, correct vitamin D deficiency, monitor PTH.
• Dialysis patients → phosphate binders + vitamin D analogues ± calcimimetics.
• Refractory cases → parathyroidectomy.

‏اگر یہ معاہدہ اسلام ، حرمین شریفین اور امت مسلمہ کے لیے ہے تو پاک فوج یہی والا فرض قبلہ اول بیت المقدس کے لیے کیوں پورا...
18/09/2025

‏اگر یہ معاہدہ اسلام ، حرمین شریفین اور امت مسلمہ کے لیے ہے تو پاک فوج یہی والا فرض قبلہ اول بیت المقدس کے لیے کیوں پورا نہیں کرتی؟

Crying alone... was the last thing she did 😥💔
12/09/2025

Crying alone... was the last thing she did 😥💔

04/09/2025

🩸 Erythropoietin Dosing – Anemia in CKD (Dialysis & Non-Dialysis)

✅ Starting Dose
IV or SC: 50–100 IU/kg, 3 times/week

🔄 Adjust Dose Based On Hemoglobin
📌 Check Hgb every 2–4 weeks
📈 If ↑ 1 g/dL in 2 weeks or Hgb >11 → Reduce dose by ≥25% or stop

🚫 Target Hgb: Stay ≤11 g/dL
Too high Hgb = ❗Risk of stroke, HTN, vascular events

01/09/2025

After completion of my MBBS from a recognised college I Got a decent job in CORPORATE hospital as a duty doctor

Under tremendous pressure from family to get married, I went to meet a girl under the arranged marriage system of India. After meeting girl rejected me upfront because she didn't liked my Job and of course I moved on and got married to another girl a year later.

After 5 years,
I saw the same beautiful lady at a traffic signal with her husband in a brand new Audi. And I was trying to kick start my hero Honda bike because the battery start was not working. She looked out of the car and briefly looked at me but without any hint of recognition due to helmet, she moves her eyes away!

At that moment, after riding a two wheeler for over 5 years, first time in my life I realized the value of a helmet
😂😂😂

So always wear a helmet in your own safety!

Issues in the public interest by an honest MBBS doctor

30/08/2025

🧪 Tumor Lysis Syndrome (TLS)

👨‍⚕️ Clinical Scenario:
A 48-year-old male was admitted to the ICU after receiving his first dose of chemotherapy for Burkitt lymphoma.
After 2 days, he developed:

Confusion

Oliguria (low urine output)

Tall T waves on ECG

Laboratory results:

Potassium: 6.8 mmol/L (⬆️)

Phosphate: high (⬆️)

Calcium: low (⬇️)

Uric acid: high (⬆️)

Creatinine: elevated (⬆️)

📌 Diagnosis: Tumor Lysis Syndrome (TLS)

---

📚 Definition

TLS is a life-threatening oncologic emergency caused by massive tumor cell lysis releasing intracellular ions and metabolites into the blood.

🧬 It commonly occurs after chemotherapy, especially in rapidly proliferating cancers like:

Burkitt lymphoma

Acute leukemias

---

🧠 Pathophysiology

Tumor cell lysis releases:

Potassium (K⁺) → Hyperkalemia → arrhythmia

Phosphate (PO₄³⁻) → binds calcium → Hypocalcemia

Nucleic acids → uric acid → Hyperuricemia → AKI

Creatinine rises due to kidney damage

---

🔍 Diagnosis – Cairo-Bishop Criteria

TLS = ≥ 2 lab abnormalities within 3 days before or 7 days after chemo:

Uric acid > 8 mg/dL

Potassium > 6 mmol/L

Phosphate > 1.45 mmol/L

Calcium < 1.75 mmol/L

Creatinine ↑ 1.5× baseline

OR: Arrhythmia or sudden death

---

🛡️ Risk Factors

High tumor burden

High proliferation (e.g., Burkitt, ALL)

High LDH

Pre-existing renal impairment

Chemo-sensitive tumors

---

🧰 Management

✅ Prevention (KEY)

💧 IV fluids (hydration)

🧂 Allopurinol (xanthine oxidase inhibitor)

💉 Rasburicase (high-risk or uric acid already high)

⚠️ If TLS develops:

1. 💧 Aggressive IV fluids: 2.5–3 L/m²/day

2. 💉 Rasburicase for uric acid control

3. 🧂 Hyperkalemia management:

Calcium gluconate (stabilizes myocardium)

Insulin + glucose (shifts K⁺ intracellular)

4. 💊 Phosphate binders

5. 🚫 Avoid calcium unless symptomatic hypocalcemia

6. 🏥 Dialysis if:

Refractory hyperkalemia/phosphatemia

Severe AKI

Volume overload

---

💡 Tips for Practice

Monitor K⁺, uric acid, phosphate, calcium daily after chemo in high-risk patients

Rasburicase works faster than allopurinol

Avoid NSAIDs, contrast — nephrotoxic

Early nephrology referral = better outcomes

---

✅ Key Takeaway:

Tumor lysis syndrome can be fatal if missed. Always think TLS in post-chemo patients with bulky tumors or lymphomas.

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