RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 16 minutes ago

Genetic testing done Obi given last night Eculizimab planned for tomorrow, Ravulizumab as an outpatient --------------------------------- Dr. Ho...

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RE: are foamy cells in kidney biopsy synonymous with fabry disease? 1 hour ago

I would do genetic studies for Alport and Fabry Disease on potential donor and intended recipient in this case. Interstitial foam cels are abnormal...

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Proteinuria 2 hours ago

I would like to ask my colleagues' opinion on this patient. 61 years old female with solitary kidney ( Donated her kidney 12 years ago), presen...

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RE: MCD-IgA nephropathy 2 hours ago

he does have microscopic hematuria, persistently 17-26 RBCs on UA. ------------------------------ Sarah Al Zoubi MD John Stroger Hospital of Cook...

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RE: MCD-IgA nephropathy 2 hours ago

He takes hydralazine, hydrochlorothiazide, bumex and metformin. I think it is more drug eruption from steroids. he was referred to dermatology fo...

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RE: Urine Sodium In Hyponatremia 3 hours ago

On 28th October his Pna was 118 . He was placed on 2% saline for 24 hours . His Una was 160 and Uosm was 550 while on 2% saline . On 29th October ...

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RE: Urine Sodium In Hyponatremia 3 hours ago

"His serum creatinine is 28 umol/l or 0.4 mg/dl, urea is 4 mmol/l ( 12 mg/dl) uric acid 72 umol/L" Dr. Dastoor: We're these the presenting values b...

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RE: are foamy cells in kidney biopsy synonymous with fabry disease? 4 hours ago

should i check for Fabry disease? ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

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are foamy cells in kidney biopsy synonymous with fabry disease? 4 hours ago

59 F coming foward to be considered as live donor for nephew PMH: 3 previous C sections - one under GA and 2 under spinal : Nil issues Frozen ...

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RE: Urine Sodium In Hyponatremia 5 hours ago

exactly why a measured urine sodium assuming no diuretics for several days would have been informative ------------------------------ [Mark] [Ler...

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RE: Urine Sodium In Hyponatremia 8 hours ago

I attached the aforementioned article about the value of the Una over the physical exam for euvolemia v hypovolemia in HypoNa. TO me this is a clas...

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RE: Urine Sodium In Hyponatremia 8 hours ago

Was urine sodium measured when pNA was 118? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Directo...

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RE: Urine Sodium In Hyponatremia 10 hours ago

Please see attachment . On 28th October :patient on 2% Ncal , which has 308 osmoles of Na - Uosm is 160 On 29th October : patient is 10 hours of...

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RE: Urine Sodium In Hyponatremia 11 hours ago

The calculation is made from the original patient's U Na of 160 and U osm of 585. Assuming the Na content of the excreted urine is unchanged a U ...

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

This is aggressive course of active lupus for sure based on clinical serollogical and histopathology but yes i would agree wigh dr dustoor to rule ...

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RE: Urine Sodium In Hyponatremia 12 hours ago

"if the U osm was 118 the U Na would be 32 mmol/L" -how was this calculated without measuring spot urine sodium? ------------------------------ [...

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RE: MCD-IgA nephropathy 12 hours ago

interesting-why with favorable response so far to steroids and no evidence at least posted of significant steroid toxicity-why switch to RTX which ...

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RE: Urine Sodium In Hyponatremia 15 hours ago

If the U osm was 118 the U Na would be 32 mmol/L. This suggests euvolemia but may overlap with modest hypovolemia. Under the influence of ADH the N...

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RE: Urine Sodium In Hyponatremia 15 hours ago

https://pmc.ncbi.nlm.nih.gov/articles/PMC12332142/ This addresses the question of the post, which I believe asks whether the kidney that perceive...

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RE: Urine Sodium In Hyponatremia 16 hours ago

Very interesting presentation. While several diseases can present with hyponatremia and salt wasting, the most important one is cerebral salt wasti...

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RE: Urine Sodium In Hyponatremia 16 hours ago

I find the above signs - turgor / sunken eyeballs not particularly reliable measures of volume status vs JVP and edema. Perhaps measuring fractiona...

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finerinoneh 17 hours ago

Good evening For patients with stable GFR around 20mls/min and K [More]

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RE: Urine Sodium In Hyponatremia 17 hours ago

Interesting case. It certainly sounds like the kidneys are not sensing a hypovolemic state or decreased effective circulating volume, even if he is...

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RE: Urine Sodium In Hyponatremia 17 hours ago

I think you have to trust the kidneys assessment of effective circulating volume. He may appear volume depleted (i prefer this terminology over deh...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 18 hours ago

I agree , but our rheumatologist is highly suspicious of antibody negative APLS and there are fibrin thrombi in the kidney biopsy which may be sugg...

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Urine Sodium In Hyponatremia 21 hours ago

Was reviewing a patient with hyponatremia and Pna 118 on admission . It was felt that he was dehydrated and was started on 2% Nacl , not 0.9% Nacl....

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RE: MCD-IgA nephropathy 1 day ago

To develop a new leucocytoclastic cutaneous Vasculitis due to IgAV ipwhile on high dose steroids - is highly improbable. ivwoukd continue with RTX ...

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RE: MCD-IgA nephropathy 1 day ago

does not look like typical rash from steroids? what other meds is patient taking? good response ( decrease proteinuria) so far FROM AI The typi...

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RE: Drug-induced lupus and ANCA GN 1 day ago

My answer to this question is NO! There are plenty of non-hydralazine agents that can be used for BP control. Why take the rusk? ----------------...

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

Why not the whole picture is just LN without systemic thromboembolic events as SLE can present with thrombosis events independent of APS. Agree fo...

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RE: Drug-induced lupus and ANCA GN 1 day ago

Is it safe to use hydralazine in patients with MPO MPA Anca vasculitis ? The reason I ask, is that we have a patient in the ICU, with severe MPO v...

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

Yes he was being PLexed with albumin. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh S...

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RE: MCD-IgA nephropathy 1 day ago

I saw the patient today, follow up labs with improving UPCR to 1.5 g/g, still on high dose steroids 60 mg daily, but he reported skin rash on his a...

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

‘ADAMTS13…no antibodies.’ ‘PLEX with FFP’. Had he been PLEXed leading up to recheck of ADAMTS13 activity & if so, was albumin being used then i...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

Dr. Dastoor. Many thanks for the clarification. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of M...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

Apologies, the lack of hematuria progress was in the IgA patient. The FSGS patient has no discernable hematuria ---------------------------------...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

I suppose that the lack of any beneficial effect of Atrasentan on hematuria in genetic FSGS should not be a surprise, since the glomerular lesion i...

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RE: unexplained renal failure 2 days ago

Thanks - of course and elevated ESR occurs in patients with active AS but the initial post " year old male patient who is a known case of ankylosin...

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RE: unexplained renal failure 2 days ago

Thank you Dr. Glassock! We will update our website to make this clearer. And yes, Wake Forest does testing for MUC1 unlike some of the other labs...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

this is the hematuria trendoverlast1year-essentiallyunchanged ------------------------------ Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Nephrogenic Diabetes Insipidus 2 days ago

Dr. Sands, there are new guidelines to diagnose NDI without Water Deprivation Testing by measuring unstimulated serum Copeptin levels. The Jo...

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RE: unexplained renal failure 2 days ago

To answer to one of the questions posed, the elevated sed rate in ankylosing spondylitis is quite classic, and hence he likely has active disease (...

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

We reviewed the case again today His renal function is improving with creatinine decreasing from peak of 400 umol/l to 250 umoll ( 3 mg/dl) the...

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RE: Nephrogenic Diabetes Insipidus 2 days ago

1) limit solute intake (low salt low protein diet may help) I think this is under appreciated 2) Thiazides... Slippery slope if on Li which is m...

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Are International Kidney Disease Guidelines Equally Applicable Across Different Healthcare Settings? 2 days ago

International guidelines provide an essential foundation for evidence-based nephrology. However, implementing their recommendations may be challeng...

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RE: Nephrogenic Diabetes Insipidus 2 days ago

Therapy of NDI, and its success, has not changed much in the last decade. Specifically - find and treat the cause (Lithium, hypercalcemia , etc) ; ...

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RE: Atrasentan in Genetic FSGS and IgA Nephropathy 2 days ago

I share the words of caution of Dr. Glassock regarding atresantan. This drug had no fortune in the management of hypertension because of significan...

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Nephrogenic Diabetes Insipidus 2 days ago

I am interested in the current treatment for nephrogenic diabetes insipidus (NDI). How are people currently treating NDI? How effective is this the...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 3 days ago

In my opinio this is not CAPS but rather macro-vascular thrombosis In patients with severe LN and hydralazine induced Anti-MPO due to non-criteria ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 3 days ago

My only suggestion is that this patient needs "triple immunosuppressive therapy " for aggressive Proliferative LN .pi woukd avoid any exposure to a...

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