RE: Primary Aldosteronism on Medical Management 2 minutes ago

Dr Hassan; is HCO3 22 or 32 mmol/L? Can you post deidentified results report for renin and aldosterone as many units are used in measurements which...

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RE: Primary Aldosteronism on Medical Management 32 minutes ago

I suppose the lower serum aldosterone could have been due to the concomitant Hypokalemia. I am reasonably confident of the diagnosis Primary Hypera...

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RE: Primary Aldosteronism on Medical Management 2 hours ago

The aldo renin ratio is driven by the aldo AND the low renin and I am 10% reluctant to just accept the diagnosis of PHA. I thought aldo should be...

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RE: Primary Aldosteronism on Medical Management 3 hours ago

Dr. Glassock thanks Of course in order to undergo AVS the patient should be a good candidate for surgery and have a desire to go to surgery as a...

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RE: Primary Aldosteronism on Medical Management 3 hours ago

Dr, Venturelli- Your advice is greatly appreciated but with a highly satisfactory response to oral MRA and with bilateral adrenal adenine's b...

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RE: Primary Aldosteronism on Medical Management 5 hours ago

Dr. Abdullah, bilateral disease on imaging doesn't necessarily equals bilateral aldosterone producing adenoma. In my opinion this patient should...

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RE: Primary Aldosteronism on Medical Management 6 hours ago

Should have mentioned the units, my apologies. Renin was measured as plasma direct renin and was <0.5 uIU/ml, and Aldosterone was 10.5 ng/dL. ---...

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RE: IgA nephropthy 7 hours ago

Sorry I meant .. I agree with u and wouldn't recommend either...came out wrong, should stop messing on the go. --------------------------------- ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 9 hours ago

I contacted the Mayo clinic and genetic testing , and fluid phase complement profile is pending . I am not sure if it will add much to the diagnosi...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 11 hours ago

Presume you are talking about renal limited TMA secondary to severe LN (a fairly common condition).. No RCT of terminal C pathway inhibition availa...

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RE: IgA nephropthy 11 hours ago

Interesting, I experience no such pressures in the USA. The use of such agents for such a patient would be borderline off label in the USA- but tha...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 12 hours ago

Evidence & Clinical Positioning in Lupus-TMA Clinical Scenario Role of C5 Inhibition (Ravulizumab / Eculizumab) Evidence & Practice Guideline...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 13 hours ago

GM Any updates about the genetic testing and the clinical course of this challenging case with the complicated hematoma, especially considering the...

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RE: IgA nephropthy 14 hours ago

I would recommend either ... I do feel there is some pressure on my nephrologists to consider using it , and justifiably insurance companies pushin...

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RE: Primary Aldosteronism on Medical Management 19 hours ago

Dr. Dastoor. My apologies - after reading the recent seminal paper by Fioretti F et al ( JACC; 2025; 86:354-375 )concerning the risks of MRA therap...

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RE: Primary Aldosteronism on Medical Management 20 hours ago

I thought that MRA use reduced risk of AA Fib, LVH,CVD events and CKD progression. Where is the evidence that MRA use is so hazardous.? ---------...

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RE: IgA nephropthy 20 hours ago

C3d and C3g are inactive degredation products of C3b metabolism. Their presence in scars do not indicate a pathogenic role , in my opinion. Just a ...

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RE: IgA nephropthy 20 hours ago

thank u and i concur with you on all 3 points . Just wanted to highlight that in the Cara paper , which was also presented by Dr. Sethi in KW , C3a...

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RE: Primary Aldosteronism on Medical Management 22 hours ago

Not an expert in Renin aldosterone issues , but i feel that whenever presenting such levels and ratios , its always important to get a context of t...

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RE: Urine Sodium In Hyponatremia 23 hours ago

thanks , i read the CSWSIADH article , seems its a matter of semantics , as volume status without CVP measurements , is difficult to discern . In e...

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RE: Primary Aldosteronism on Medical Management 23 hours ago

With a good BP response and resolution of hypokalemia with Aldactone, I see no good reason to do any further , assuming that the Aldactobe is well ...

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RE: IgA nephropthy 23 hours ago

Dr. Dastoor- Thanks for your post - it raises a number of important but unresolved issues 1) your patient would not have qualified for entry in...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Hi, Dr. Glassock, thank you so much for the quick direction. Will talk to oncologist and prepare vaccine first, then hopefully, can start treat...

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Primary Aldosteronism on Medical Management 1 day ago

Wanted to discuss the case of a 51 yr old female, previous history of Hypertension for 5 years on Amlodipine with average pressures around 140 syst...

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RE: Urine Sodium In Hyponatremia 1 day ago

Diagnostic rules for hypotonic conditions really only apply in steady state--this requires some clinical judgement. This person is not dehydrated b...

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RE: IgA nephropthy 1 day ago

@Richard Glassock thanks for your responses . His BP is very well controlled . His office BP is 125/80 this morning He is not obese , and curr...

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RE: IgA nephropthy 1 day ago

I wonder if measurement of serum gdIgA1 (by lectin not KM55 method) would have any value for therapy decision making in patients like this. No defi...

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RE: IgA nephropthy 1 day ago

Tough case (as usual for IgAN) - the findings you describe suggest a chronic scar rather than active disease so I would use supportive therapy. Is ...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Great question. Not an evidence based suggestion. Just an opinion. I have more experience with Iptacopan - easier to administer. Some concerns abou...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

@Richard GlassockI noticed u pointedly mentioned Factor B inhibitor and excluded C3 blockers . Is that personal experience or some reservations . ...

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IgA nephropthy 1 day ago

40 year old male from Bangladesh , diagnosed with IgA nephroapthy with M1 E1 S1 lesions Was treated with TESTING course of steroids His eGFR w...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Thanks. This excludes a PGNMID. He has C3 GN with slow but steady loss of nephrons - for me this is active disease. I would treat with Iptacopan in...

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RE: Urine Sodium In Hyponatremia 1 day ago

The Fe uric acid was 18% --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh Shakhbout Medic...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Hi, Dr. El-Meanawy, I just wanted to update the paraffin IF result. Per clinician request, paraffin immunofluorescence (PIF) was performed at x...

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RE: Proteinuria 1 day ago

Thanks for your reply. She is short and her kidney size was similar at the donation time. She didn't have any proteiuria or haematuria prior to thi...

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RE: A difficult case of IgAN 1 day ago

It would be a lot cheaper and convenient to carry out a Pronase digestion of paraffin embedded material with staining for LC and Ig locally The add...

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RE: Urine Sodium In Hyponatremia 1 day ago

Also- If the ithe tube feedings contained protein, the additional urea load might have contributed to improvement of the hyponatremia of SIADH by...

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RE: Urine Sodium In Hyponatremia 1 day ago

Dr. Dastoor: What was the FEuric? I still find it difficult to reconcile the low BUN/SCr/serum uric acid values with a volume depleted state. ---...

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RE: A difficult case of IgAN 1 day ago

Also out of curiosity would Dr. Sethi agree to perform MS/LD if requested and is there a charge associated with this testing . Any idea on the esti...

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RE: Urine Sodium In Hyponatremia 1 day ago

It is a interesting concept but one that I find somewhat confusing. HTS and HTS with free water deliver an identical amount of Na. In the latter ...

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RE: finerinoneh 1 day ago

You would probably get more proteinuira reduction with dose increase , at the expense of higher risk of Hyperkalemia. Worth a try as long as you ca...

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RE: A difficult case of IgAN 1 day ago

Not without a confirmatory Pronase digestion, just an opinion, ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffe...

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RE: A difficult case of IgAN 1 day ago

@Richard Glassockthere is an MPGN pattern of injury on LM and IF shows Kappa restriction. Wouldn't that be enough to consider a diagnosis of PGNMID...

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RE: Urine Sodium In Hyponatremia 1 day ago

I agree , the drop in Na with normal saline is typical of SIADH, since Uosm is typically greater than the osmolality of the infused fluid , free wa...

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RE: Urine Sodium In Hyponatremia 1 day ago

A few comments; I concur with Dr Fenves that dehydration is not the appropriate term in this case since this implies a lack of free water. This w...

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RE: Urine Sodium In Hyponatremia 1 day ago

Thanks Dr. Dastoor. The evidence for volume depletion and inappropriate renal salt wasting was weak and the solutions you administered were are ver...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

Just a follow up on this case over the last 96 hours Patient given Obinutuzumab last thursday and planned for second dose after 2 weeks Last w...

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RE: Urine Sodium In Hyponatremia 2 days ago

Just to give you a synopsis of the case as we treated him over the last 72 hours This patient was clinically dehydrated , Hyponatermic , and ext...

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RE: A difficult case of IgAN 2 days ago

Thanks for all your suggestions, Dr Glassock. Will try to organise whatever we can get done! ------------------------------ Tanuj Lamech Clinical...

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RE: finerinoneh 2 days ago

In a diabetic with SBP of 120 mmHg in the sitting position I would check BP during orthostasis. Orthostatic hypotension in these patients could gen...

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