RE: Primary Aldosteronism on Medical Management 2 hours ago

Thank you for your answer, However, is it still indicated to change aldactone and finerenon with baxdrostat in those patients on the MRA?? giving...

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RE: Primary Aldosteronism on Medical Management 3 hours ago

My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control. ---...

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RE: Proteinuria 4 hours ago

This is a very challenging case. The clinical data provides a compelling story supporting Zoledronic acid nephrotoxicity provoking a partial podocy...

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RE: Primary Aldosteronism on Medical Management 5 hours ago

Its really an interesting discussion. Thank you for bringing up the same . So in conclusion, we need to abandon aldactone and finerenon and replace...

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RE: Proteinuria 7 hours ago

1g albumin per day is not small. I would biopsy if proteinuria persists without sign reduction after max ARB, SGLT2, and MRA (if BP tolerates it). ...

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

We often encounter the scinario of unexplained renal function impairment in the context of using multiple synergistic medications , which all combi...

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

Interesting suggestion of "Ischemic Nephropathy due to RAS in a single kidney . The fact that the solitary kidney is almost 13cm. In length makes t...

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RE: Use rituximab or not 11 hours ago

Noted and much appreciated. Will provide follow-up when available. ------------------------------ John Mellas MD Nephrology and Hypertension Spec...

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RE: IgA nephropathy--repeat biopsy at this point? 12 hours ago

The original diagnosis likely should have been IgA Vasculitis not Primary IgA . Her long term course is entirely compatible with this diagnosis. Az...

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

Thank you, Dr Campese, Dr Rodby and Dr Venkat, I have confirmed with the radiologist who reported the MRI, and there was no evidence of renal arte...

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RE: Unclear cause of kidney function reduction in a single kidney 13 hours ago

I totally agree with Dr. Rogby. Moreover, where is the scientific evidence that combination of all these drugs provides additive effects independen...

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IgA nephropathy--repeat biopsy at this point? 13 hours ago

Hello, I have a 47 filipino nurse who follows with me for IgA nephropathy. Back in 1999, in the Philippines, she had acute glomerulonephritis. Th...

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RE: Use rituximab or not 14 hours ago

Low C3,, ANCA 1:160, Pr3 Ab, 56 (H), Bartonella henselae Ab 1:2560, Hi, patient owns 10 cats) This is classic Bartonella IRGN, the PR3 is classic...

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RE: Unclear cause of kidney function reduction in a single kidney 14 hours ago

I see this patient is on the 4 pillars of care, RAASI, SGLT2i , aldo antagonist and GLP1a. Im not sure she needs all four pillars. I have seen s...

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RE: Unclear cause of kidney function reduction in a single kidney 14 hours ago

As mentioned by Dr. Campese, possibility of renal artery stenosis (RAS) in a solitary functioning kidney needs to be considered in this older diabe...

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RE: finerinoneh 15 hours ago

Off label use of fineronone, can be used upto 40 mg per day --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head o...

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RE: Primary Aldosteronism on Medical Management 15 hours ago

I may have to go with Dr. Rodby in that it could be a dysregulated hyperaldosteronism state rather than true PHA caused by APA. In the latter cases...

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RE: Primary Aldosteronism on Medical Management 18 hours ago

Thanks for sharing this case. For the units, I believe 1 uIU/mL = 1 mU/L so we can use the bottom row from Endocrine Society guideline table 5: ...

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RE: Unclear cause of kidney function reduction in a single kidney 19 hours ago

With no protein in the urine and an inactive sediment, it is not likely this patient has a glomerular or tubulointerstitial disease. i am more in...

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RE: Primary Aldosteronism on Medical Management 20 hours ago

Please forgive the intrusion from a simple community nephrologist stepping into a discussion among such phenomenal experts; I am far from having th...

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RE: Use rituximab or not 21 hours ago

Further context; Surgery deferred as necessary but not emergent pending resolution of infection/vasculitis. On day 3; after neg blood cultures,...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 22 hours ago

I presume that the high urine pH is due to urea splitting organisms in the ileal conduit ( and local ammonia generation or due to Bicarbonate secre...

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RE: ?Mitochondrial disorder 23 hours 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...

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Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 23 hours ago

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

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RE: finerinoneh 23 hours 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...

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RE: Urine Sodium In Hyponatremia 1 day ago

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

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

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

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RE: Unclear cause of kidney function reduction in a single kidney 1 day 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...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

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

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

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

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RE: Dosing Of Rituximab In Pd Patient 1 day ago

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

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Unclear cause of kidney function reduction in a single kidney 1 day 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...

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RE: Dosing Of Rituximab In Pd Patient 1 day ago

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

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RE: Primary Aldosteronism on Medical Management 1 day ago

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

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

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RE: Dosing Of Rituximab In Pd Patient 1 day 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...

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RE: Use rituximab or not 1 day 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 ...

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RE: Use rituximab or not 1 day ago

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

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Use rituximab or not 1 day 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...

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Dosing Of Rituximab In Pd Patient 1 day 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?...

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RE: Primary Aldosteronism on Medical Management 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 days 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 2 days 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 2 days 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 2 days 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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