RE: neuropsychiatric Management 5 hours ago

Only on month with poor compliance Her creat is normal not rising Albumine/ratio 600 Serology done once at diagnosis Not repeated I have concep...

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RE: neuropsychiatric Management 5 hours ago

How long was she on mycophenolate sodium + prednisone (appears to be less than 1 month) before she developed seizures? Compliance with medications?...

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RE: Would you rebiopsy? Is this C3GN? 5 hours ago

Recent UPr/Cr and UAlb/Cr values are confounded by dialysis-requiring AKI. Both AKI and intermittent dialysis cause rapid changes in the denominato...

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RE: Would you rebiopsy? Is this C3GN? 5 hours ago

AKI especially "ATN" can produce significant proteinuria. If he is at the stage of requiring dialysis, there has been insufficient time to resolve ...

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Pla2r positive MN 9 hours ago

A 80 year old man with "acute on chronic cognitive decline" and nephrotic syndrome. Reasonable GFR. Classical pla2r IgG4 on biopsy. Pla2r titer ...

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neuropsychiatric Management 9 hours ago

I have patient 21 yrs female recently diagnosed SLE. Lupus nephritis class III. 11/24 Normal Renal profile, she was on myfortec 720 bid and steroid...

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RE: Low Potassium 9 hours ago

As Dr Rodby mentioned hypokalemic hypertension with high aldosterone and typically very low renin with urinary K loss. The DD is 1ry hyperaldostero...

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RE: Would you rebiopsy? Is this C3GN? 10 hours ago

Dr. Glassock I edited the post to add those values in there :) Dr. Venkat Here is a table of the UPC/ UMicroalbumin/Creat that I could find in t...

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RE: Low Potassium 11 hours ago

Agree with Drs. Rodby and Mellas. A MRA should be better treatment than Nifedipine and oral K for her presumed Primary Aldosteronism. -----------...

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RE: Low Potassium 12 hours ago

Clinicians who saw her --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Low Potassium 12 hours ago

Many thanks prof rodby I am not at Hospital till next Thursday . Will do when I am back . Patient told me she had this blood pressure for ages not...

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RE: Low Potassium 13 hours ago

Agree with Dr Rodby on all comments. When I see patients like this, with the elevated aldo/renin ratio and no cofounding elements such as meds I pr...

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RE: Would you rebiopsy? Is this C3GN? 13 hours ago

Sorry, I missed the normal C3/C4 levels. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----------------...

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RE: Would you rebiopsy? Is this C3GN? 13 hours ago

Sorry! Complement levels ok on initial workup in April. I'll work on getting the biopsy with imaging tomorrow ------------------------------ Nimr...

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RE: Would you rebiopsy? Is this C3GN? 14 hours ago

"(UM/Creat 1649 12.16), 24 hour protein 5.8 g 12.23." I assume UM/Creat means urine microalbumin/creatinine or UAlb/Cr. I note that UM/Creat and ...

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RE: Cause of Disproportionally High Urea 14 hours ago

Dr Friedman you are right, while calculating 24 Hr clearance I put the values as 282 and 0.85 per Litre instead of per day and indeed the clearance...

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RE: Cause of Disproportionally High Urea 15 hours ago

Then why our values disagree to a minor degree is because I also added non-urea N and to a major degree because I assumed 282 mmol/L rather than 28...

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RE: Would you rebiopsy? Is this C3GN? 20 hours ago

What is meant by "low grade" subepithelial deposits of C3? What did the EM show?. What were the C3/ C4 levels? So far, the description of the kidne...

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RE: Cause of Disproportionally High Urea 21 hours ago

I just back calculated from a Urea of 282 to Nitrogen and Protein. 282 mmol of urea = 0.282 mols or urea, each mole of urea has 28 Gram Nitrogen...

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Would you rebiopsy? Is this C3GN? 1 day ago

Hi! I'm taking care of a 67M that got biopsied for nephrotic syndrome in 4.4.2024. PMHx: DM, autoimmune hepatitis, HTN, CHF EF 45, AFib on apixaban...

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RE: Measurement of Electrolytes 1 day ago

Thanks for the detailed explanation. ------------------------------ Brian Cronin MD, FASN Hypertension Nephrology Associates, P.C. Huntingdon Val...

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RE: Cause of Disproportionally High Urea 1 day ago

Agree with Dr Rodby that unit conversion requires work. From the values presented and 1; assuming the patient is in a steady state and 2; convert...

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RE: Cause of Disproportionally High Urea 1 day ago

these units drive me batty but I think a blood "urea of 33 mmol/l" is the same as a blood urea of 198 mg/dl or a BUN of 92 mg/dl. BUN 92 mg/dl,...

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RE: Low Potassium 1 day ago

According to your values, the patient is making more than 3 liters of urine a day (may have a concentration defect brought on by hypoK) , unless th...

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RE: Cause of Disproportionally High Urea 1 day ago

I just used the values you provided of UUN 282 mmol/L, 24-hr UV 1.822 L & wt 70 kg to plug into Maroni equation after I adjusted it for SI units. W...

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RE: Low Potassium 1 day ago

Thanks prof glassock and prof Rodby Blood pressure chronically high in clinic was 170/79 mm Hg. Medication - nifedipine 30mg mr and ran out of Sa...

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RE: Measurement of Electrolytes 1 day ago

Just to get back to first principles on how these techniques work. Ion selective electrodes (ISE) measure a voltage across an ion selective membran...

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RE: Low Potassium 1 day ago

Assuming she has HTN, this is Primary hyperaldo which is either adenoma, bilateral hyperplasia, or Glucocorticoid suppressible hyperaldo. I canno...

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RE: Low Potassium 1 day ago

Yes this is renal K loss. What is the patients Blood Pressure, current medications and other serum electrolytes( sodium, Chloride and Bicarbonate) ...

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Low Potassium 1 day ago

74 female referred to general nephrology clinic for chronic hypokalaemia. She has very high aldosterone/pra ratio.been referred to endocrine for co...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

Nephrotic range y (but no data on serum albumin) at initial presentation . The kidney biopsy was delayed for 3 months after introducing Intensive t...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

I share Dr Abdalla assumption about Podocytopathy as both Nephrotic Syndrome is uncommon in Class II LN and Class switch from III/IV/V to Class II ...

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RE: Cause of Disproportionally High Urea 1 day ago

Thanks Dr Friedman I agree with high FeUrea. But how did your calculation come out for protein out of 103, as when I calculated it comes at 47 In...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

The patient presented with nephrotic proteinuria and achieved complete remission in a short time on steroids and MMF. Kidney biopsy showed Class II...

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RE: Cause of Disproportionally High Urea 1 day ago

Here are a couple of articles looking at creatinine (1945) and cystatin-C (2021) in neuromuscular disease. Creatinine is a poor maker of eGFR, but ...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

I would just give acyclovir in full dose for 2 weeks while monitoring renal function and ensuring adequate fluid intake. I see no reason to stop im...

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RE: Cause of Disproportionally High Urea 1 day ago

The low creat may be the dominant driver of the high BUN/creat but there is a contribution from high urea generation as evident from the high FEure...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

The biopsy was done 3 months after therapy initiated . How can you make a diagnosis of "lupus podocytopathy" under these circumstances?. Why stop B...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 day ago

In my opinion, the patient was likely suffering from lupus podocytopathy due to the presence of nephrotic syndrome, which resolved with the use of ...

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RE: Cause of Disproportionally High Urea 1 day ago

I can't see any rationale for reducing protein intake below 0.8gms/kg/d, but I might favor plant over meat or dairy protein. Just an opinion. --...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 2 days ago

Interesting suggestion. I have no personal experience with Leflunomide in LN. Would it be as effective as MMF in preventing a relapse of LN and wou...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 2 days ago

Dr Glassock What do you think about using leflunomide instead of MMF for a short period? With steroid And hold benlysta @Richard Glassock -----...

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RE: Cause of Disproportionally High Urea 2 days ago

I had a similar case. I agree with all above expert explanations. I need help/explanation with use of STATINS in muscular dystrophy cases. Ca...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 2 days ago

Thanks- He likely has very active immunological disease so discontinuing IS at this point virtually guarantees a clinical relapse . Any opinion on ...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 2 days ago

Most recent dsDNA Ab was on 11/26. It was >300. Yes, he is on acyclovir.

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RE: ATI, Anuria post kidney transplant 2 days ago

Remind me if you gave a dose of retuximab and your previous post said you stopped plasma exchange after six doses if that's not correct how many to...

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RE: Measurement of Electrolytes 2 days ago

Hct is not a measured value in most labs, rather a calculated value, hence not as accurate as the Hgb, which is measured ------------------------...

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RE: Measurement of Electrolytes 2 days ago

Most laboratories measure total CO2 concentration as part of the standard electrolyte profile. It is technically difficult to measure bicarbonate i...

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RE: Anca vasculitis relapse without circulating antibodies 2 days ago

Maybe this has been severe crescentic IgA N (or IgAV) all along (with a FP C-ANCA) . Do you have EM on the original Biopsy. Can you post a de-ident...

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RE: Cause of Disproportionally High Urea 2 days ago

I think that Dr. Rodby''s analysis is "spot on ". The problem is not a "too high" serum urea - it is a "too low" serum creatinine, undoubtedly trac...

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