RE: ?Mitochondrial disorder 27 minutes ago

Yes we can test I did not consider MELAS but she had no other features to support the condition. She has been referred for genetic testing so ho...

View Discussion

Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 32 minutes ago

Good evening, I would be grateful for any suggestions/thoughts? 64 yo female previous staghorn struvite calculi - PCNL and complete clear...

View Discussion

RE: finerinoneh 52 minutes ago

Thank you. I agree likely low risk and potasium can be managed with binders if needed, I wasnt sure how much greater reduction in proteinuria likle...

View Discussion

RE: Urine Sodium In Hyponatremia 1 hour ago

I think these parameters are consistant with salt losing nephropathy!!, any radiology reports? --------------------------------- Wael Jebur MD, F...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 8 hours ago

Thank you. I will bring this up on the next clinic. ------------------------------ Daniel Christiadi Canberra Hospital Canberra ACT -------------...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 9 hours ago

Thanks-I agree that a normal UPCR makes LCCN unlikely and thecserum electrolyte pattern is not suggestive of Tenofovir toxicity. Can you obtain gen...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 10 hours ago

Thank you Dr Glassock, His protein/creatinine ratio and albumin/creatinine ratio were normal. I have not done the urine electrophoresis. His elec...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 11 hours ago

What is his UPCR and urine electrophoreses. This might be light chain cast Nephropathy . What are the serum electrolytes considering a possible dia...

View Discussion

RE: Dosing Of Rituximab In Pd Patient 11 hours ago

I am very confused here. Dialysis dependent kidney failure presumably due to ANCA+ Vasculitis with elevated serum IgG4- was the ANCA Vasculitis bio...

View Discussion

Unclear cause of kidney function reduction in a single kidney 12 hours ago

Dear all, I am seeking wisdom from the crowd of experts. 72-year-old gentleman from Tanzania was referred for reduced kidney function. Backg...

View Discussion

RE: Dosing Of Rituximab In Pd Patient 13 hours ago

DIAGNOSES: CKD stage 4/5 with proteinuria following ANCA associated vasculitis. Initial immunosuppression with Cyclophosphamide and Prednisone ...

View Discussion

RE: Primary Aldosteronism on Medical Management 13 hours ago

Here is the deidentified renin aldo report. ------------------------------ Hassan Abdullah MBBS Resident Nephrology Shaikh Zayed Hospital Lahore...

View Discussion

RE: Primary Aldosteronism on Medical Management 13 hours ago

We were expecting HCO3 to be lower than 22 in RTA with the degree of hypokalemia. UOG was close to 100 or so. The blood pressure on one clini...

View Discussion

RE: Dosing Of Rituximab In Pd Patient 14 hours ago

Hiw long has thepatient been on PD. What was the serology of the ANCA Vasculitis?. What are the manifestations of the "flare". When was the last do...

View Discussion

RE: Use rituximab or not 14 hours ago

If the 9x4 mm vegetation is very mobile or shows any extension into a paravalvulsr abscess , then surgery needs to be reconsidered. A short course ...

View Discussion

RE: Use rituximab or not 15 hours ago

Based on a very strong suspicion of bicuspid aortic valve Bartonella endocarditis and GN, I would treat with appropriate antibiotics and observe. W...

View Discussion

Use rituximab or not 15 hours ago

21 yo male sent to ED by primary MD with new finding of SCr 5 mg/dl associated with blood tinged urine for several days. Patient in good health exc...

View Discussion

Dosing Of Rituximab In Pd Patient 16 hours ago

Patient is on PD and having flare of Vasculitis Having maintenance dose after induction Regime APD Is there a need to alter 2x1 g or do the same?...

View Discussion

RE: Primary Aldosteronism on Medical Management 18 hours 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 19 hours ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 21 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 21 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 22 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 23 hours ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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. ---...

View Discussion

RE: IgA nephropthy 1 day ago

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

View Discussion

RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day 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...

View Discussion

RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day 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...

View Discussion

RE: IgA nephropthy 1 day 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...

View Discussion

RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

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

View Discussion

RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

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

View Discussion

RE: IgA nephropthy 1 day ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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.? ---------...

View Discussion

RE: IgA nephropthy 1 day 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 ...

View Discussion

RE: IgA nephropthy 1 day 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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...

View Discussion

RE: Urine Sodium In Hyponatremia 1 day 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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 ...

View Discussion

RE: IgA nephropthy 1 day 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...

View Discussion

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...

View Discussion

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...

View Discussion

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...

View Discussion

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...

View Discussion

RE: IgA nephropthy 2 days 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...

View Discussion

RE: IgA nephropthy 2 days 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 ...

View Discussion

RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

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

View Discussion

RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

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

View Discussion

IgA nephropthy 2 days 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...

View Discussion

RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days 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...

View Discussion