RE: Hyponatremia 1 hour ago

I love the idea of giving this patient urea packets. Since we have gotten them on formulary at our hospitals I have been using much less salt table...

View Discussion

RE: young patient with agresive ANCA vasculits 3 hours ago

Thank you for sharing your case ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ------------------------------

View Discussion

RE: young patient with agresive ANCA vasculits 8 hours ago

I had the exact same case and was managed with 1. Pulse steroids 2. Plasmapheresis due to hypoxia with Diffuse alveolar hemmorage 3. Rituximab a...

View Discussion

RE: Hyponatremia 8 hours ago

I think this case highlights that the proper assessment and management of Hyponatremia should include 1. Clinical assessment of volume status 2. ...

View Discussion

RE: Management dilemma 15 hours ago

No benefits from Tolvaptan have been demonstrated in OFD1 related PKD. I would stop this therapy and focus on tight BP control . In the absence of ...

View Discussion

RE: young patient with agresive ANCA vasculits 15 hours ago

Dr. Reen has predicted my response to the PLEX question, if his kidney function improves sufficiently to avoid dialysis, I do not think that PLEX w...

View Discussion

RE: young patient with agresive ANCA vasculits 15 hours ago

I can get avacopan but not this weekend likely Monday i thought hitting the complement cascade with Eculizumab might help him over the weekend u...

View Discussion

RE: young patient with agresive ANCA vasculits 15 hours ago

He has been getting Plex from the start of treatment now on 4th session with no response. I am throwing the kitchen sink on this patient thanks ...

View Discussion

RE: young patient with agresive ANCA vasculits 15 hours ago

Sorry did not notice he is already on plex In Canada we are able to get Avacopan easily. May help in this case --------------------------------- B...

View Discussion

RE: young patient with agresive ANCA vasculits 16 hours ago

Thank you Dr Glasscok i will switch my approach and rituxvas protocol for induction i was planning to add 1 dose of ecu while awaiting to get A...

View Discussion

RE: young patient with agresive ANCA vasculits 16 hours ago

Although Dr Glassock may disagree with me, but I would consider Plex an addition to cyclophosphamide and retuximab as patient is young, has active ...

View Discussion

RE: young patient with agresive ANCA vasculits 16 hours ago

Just an opinion. I would add RTX and not change the CYC. Regimen ( For now). Avacopan would be nice, but I do not see the need for anti- C5 therapy...

View Discussion

young patient with agresive ANCA vasculits 17 hours ago

I would appreciate your input in this very ill 34 yo AA man with biopsy proven crecentic and necrotizing glomerular lesions 90% of the gloms , with...

View Discussion

RE: Hyponatremia 17 hours ago

Dr. Gunnell: If physical examination of your patient showed no signs of volume depletion + BUN of 10 mg/dL and SCr of 0.6 mg/dL indicate that your ...

View Discussion

Management dilemma 17 hours ago

41 years old Asian female who was diagnosed with spondyloarthropathy in 2014 was treated with sulfasalazine and Humira for short time and was disco...

View Discussion

RE: Hyponatremia 18 hours ago

Assuming 2 to 3 liters of urine, the totall N.A. excretion is 20 meq suggesting there is a salt depleted state. My guess is the urine volume is low...

View Discussion

RE: Hyponatremia 19 hours ago

Concomitant urine K concentration might give a clue, but 24 hour collections give the best information. Spot urines can be deceiving in the presenc...

View Discussion

RE: Hyponatremia 20 hours ago

For clarification the low Una. without knowing the urinary volume, how do you determine if this is low effective volume or dilution effect? ------...

View Discussion

RE: Hyponatremia 20 hours ago

His urine osm was rechecked and was 97. I think he is eating much less than he states with serum Cr .6 BUN 10 and is 90kg. I did the normal saline ...

View Discussion

RE: biopsy in patient BMI 14 thought? 20 hours ago

I suspect she has CKD from her eating disorder, see attached Normal electrolytes can be very deceiving in this disorder as patients are very good...

View Discussion

RE: To Biopsy Or Not 21 hours ago

I was unaware of HNF1B and reflux, I think of it with FH and limited renal cysts and hypoMg. Assuming no hematuria to speak of and limited prote...

View Discussion

RE: Hyponatremia 21 hours ago

He can dilute his urine just fine , and that is why his Una is low - not Na depletion. Anyone that drinks too much can be limited in the amount ...

View Discussion

RE: Hyponatremia 23 hours ago

mean "water restriction" not ingestion ------------------------------ Sheldon Hirsch MD Lakeside Nephrology Wilmette IL (312) 986-0110 ----------...

View Discussion

RE: Hyponatremia 1 day ago

Gatorade is a hypotonic solution (20mEq Na per liter ) and when ingested in large amounts in presence of pain can induce hyponatremia. It is not su...

View Discussion

RE: Hyponatremia 1 day ago

As I understand this, a U osm of 95 is a good bioassay that means ADH is appropriately suppressed and the hyponatremia is from an ADH-independent p...

View Discussion

RE: To Biopsy Or Not 1 day ago

Hi, interesting case. Have you sent DNA for genetic testing? VUR + gout suspicious for HNF1B or other (including ADTKD forms); any neurodevelopme...

View Discussion

RE: Hyponatremia 1 day ago

I suspect your diagnosis is correct. Gatorade is water with some electrolyte. the treatment is solute. This increase free water clearance by incr...

View Discussion

RE: To Biopsy Or Not 1 day ago

What does the ultrasound show. You have said left kidney scarring. Is the right also affected? Is there any pelvicalyceal dilatation? Has an MCU be...

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

Was eGFR stable at 60 mL till September 2025 and then suddenly drop to 37 mL/min or was it a slow progressive decline? Please post serial SCr/eGFR ...

View Discussion

RE: Friday : Unexplained metabolic acidosis 1 day ago

On presentation: How may we explain anion gap of 20 and serum bicarbonate of 20 with normal chloride and and Co2? why is the hypokalemia? -...

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

High PTH excludes Sarcoid. Provably primary hyperparathyroidism. Is she on Lithium.. I doubt hypokalemic or diuretic induced Nephropathy . Give us ...

View Discussion

RE: To Biopsy Or Not 1 day ago

I think I would do a DMSA scan of the kidneys to look for cortical scars. Examining urine fir erythrocyte dysmorphism would also be helpful, if the...

View Discussion

RE: To Biopsy Or Not 1 day ago

Urine albumin/creatinine and urine protein/creatinine ratios? You have stated in other posts that you do not spin urine and look at the sediment in...

View Discussion

RE: To Biopsy Or Not 1 day ago

Are cortical scars overlying pyramids present in left kidney? Is calyceal dilitation consistent with reflux present in Left kidney ?.. What is magn...

View Discussion

RE: aki caused by RAS? 1 day ago

"started hd via temporary vascath and might be recovering KF" Evidence supporting kidney function recovery? ------------------------------ K.K....

View Discussion

RE: To Biopsy Or Not 1 day ago

Also recent diagnosis of gout but been having pain last 10 Years and use of NSAID for 3 days every 6 month with episode of pain Is gout related t...

View Discussion

To Biopsy Or Not 1 day ago

30 year old man ( reflux Nephropathy as child ) Mum reports has uti and needed antibiotics at age 18 month to 24 month ( use of trimethoprim) Was t...

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

Is it hypokalamic Nephropathy? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

Is there a link with gout and Aki in this case ? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

Adjusted calcium highest 2.72(2.2-2.6) June 24 and been within normal I am thinking diuretic screen as well? Not sure if this high calcium sign...

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

Hi prof glassock Thanks You mean you don’t think kidney biopsy will change management ? Her na and k ok Ok sando k long time Hypokalaemic Neph...

View Discussion

RE: biopsy in patient BMI 14 thought? 1 day ago

I cant easily see how a kidney biopsy is going to halo management of this case.unless she has TIN due to Sarcoidosis. Better understanding if the m...

View Discussion

RE: aki caused by RAS? 1 day ago

thanks blood film no shistochytes now and ldh normal after bp well controlled with 4 agents started hd via temporary vascath and might be recover...

View Discussion

biopsy in patient BMI 14 thought? 1 day ago

43-year-old lady who has a BMI of 14. Her kidney function has been around eGFR 60 ml/min since 2018 but since September 2025 her eGFR has dropped t...

View Discussion

RE: Hyponatremia 1 day ago

Dr. Gunnell: Was patient euvolemic on physical exam? BUN, SCr and (if available) serum uric acid baseline and when SNa was 117 meq/L? Urine output ...

View Discussion

RE: Rituximab maintenance for lupus nephritis 1 day ago

Dr. Rodby- understood and your experience driven opinions are extremely valuable. What this pist is examining is whether RTX (or OBI or Voclosporin...

View Discussion

RE: Hyponatremia 1 day ago

I would repeat the urine osmolality and lytes again along with Urine Urea . The fact that his Uosm is less than Posm and also less than 100 , sug...

View Discussion

Hyponatremia 1 day ago

Curious how you would treat this patient. He is a 53yo with complex regional pain syndrome admitted with intractable pain. His sodium 138 on admitt...

View Discussion

RE: Rituximab maintenance for lupus nephritis 1 day ago

There are a lot of answered questions here 1) the role of rituximab for induction in SLE (v recently approved Obi) 2) The role of Ritux or obi ...

View Discussion

RE: Rituximab maintenance for lupus nephritis 1 day ago

Thanks Dr. Dastoor for your much appreciated comments . It is the totality of the Open Forum experience that makes it such a unique learning format...

View Discussion