RE: sglt2 54 minutes ago

In the EMPA-Kidney trial there was no benefit on progression of CKD seen in non-albuminuric CKD,. Do we know what the UACR was before SGLT2 inhibit...

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RE: sglt2 1 hour ago

In my opinion- RASi, SGLT21 and GLP1RA are NOT universally indicated in CKD. They should be used selectively in patients likely to receive a benefi...

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RE: Treatment Of Sarcopenia In HD 2 hours ago

Thanks all for you comments. So the best strategy is a combination of nutrition and exercise plus increase frequency and time on dialysis and poss...

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RE: sglt2 3 hours ago

Agree with your assessment of EMPA KIDNEY as do the KDIGO guidelines which give the use of SGLT2i’s in individuals with an eGFR between 20-45 ml/mi...

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RE: GFR measurement in AKI with stable serum creatinine 9 hours ago

The supplement in the paper will explain the amount of creatinine excreted and retained at any time interval and when sampled gives the same result...

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RE: GFR measurement in AKI with stable serum creatinine 10 hours ago

Thanks- of course the law of mass conservation only applies to one unit of time (per minute, per hour , per day, etc. ) over extended periods of ti...

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RE: sglt2 10 hours ago

with virtually no albuminuria and 150 mg total proteins/g Cr. appears to have tubular proteinuria. Dr Glassock, could one get tubular casts with no...

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RE: GFR measurement in AKI with stable serum creatinine 11 hours ago

That is a rather tricky question. One does assume that creatinine production falls 2 to 3% per day in a hospital patient depending on their catabol...

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RE: sglt2 12 hours ago

"Cr 2.20-2.70 over last 6 months. eGFR 30-38 Off Lithium since 2023. UACR undetectable. UPCR 170mg/g On SGLT 2 since 3/2024 based on EMPA-KIDNEY ...

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RE: sglt2 12 hours ago

error

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RE: Treatment Of Sarcopenia In HD 13 hours ago

I would recommend adding more dialysis time, both by adding more hours and increased frequency of treatments. IDPN and slow incremental physical ac...

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RE: GFR measurement in AKI with stable serum creatinine 13 hours ago

Dr. Mellas- thanks for the paper. I should not be ignored. How do you interpret a "stable " serum creatinine concentration when endogenous producti...

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RE: GFR measurement in AKI with stable serum creatinine 13 hours ago

Dr Rodby is correct with all due respect to the other opinions. When ΔCr/ Δt = O, the creatinine production = excretion and the CrCl can be calcula...

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RE: GFR measurement in AKI with stable serum creatinine 18 hours ago

Agree. And sometimes onse sees where there is a very slow recovery after the initial phase so on cannot be sure that the function recovered is at i...

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RE: Refractory Vasculitis in a young woman 18 hours ago

I agree with Dr. Aledan- why not try OBI + DARA combination as a last resort before moving to CAR-T. The latter, if successful might contraindicate...

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RE: Refractory Vasculitis in a young woman 18 hours ago

Canot add more to discussion. Attached a abstract of a paper on dual vasculitis. Ubable to get full PFd Also a case on use of ANCa treated wit...

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RE: Natural History of treated IgAN 18 hours ago

Very well, thank you ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Associates In Kidney Care, PLC Des Moin...

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RE: sglt2 18 hours ago

"Proteinaceous casts are present in the tubules w/o cellular reaction. Protein reabsorption droplets are seen in the tubular epithelium. .............

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RE: Natural History of treated IgAN 18 hours ago

Both are possible in this case. The only way to distinguish the Alport + IgAN from the non-Alport TBMD + IgANis to do genetic testing. About 1/3 of...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 18 hours ago

The treating physician has written "I think the patient will do great on PD". (I can hear JoAnne Bargman nodding "absolutely") Why not do PD? The...

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RE: sglt2 18 hours ago

I agree with Dr Glassock Having a SGL2on board adds no real benefit unless the agent by inhibiting proximal tubular reabsorption of LI allows ma...

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RE: GFR measurement in AKI with stable serum creatinine 18 hours ago

Besides decreased muscle creatinine generation, increasing extrarenal (particularly intestinal) degradation of creatinine also contributes to stabi...

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RE: Refractory Vasculitis in a young woman 18 hours ago

Dear Dr. Glassock, I was answering Dr. Rodby suggestion of possible using Bortezomib “would you consider Bortezomib) so my suggestion is that Dara ...

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RE: Natural History of treated IgAN 19 hours ago

Dr Glassock: though I don't disagree with you at all conceptually, are you implying that here is a patient in whom IgAN & Alport's are co-existing,...

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RE: Refractory Vasculitis in a young woman 22 hours ago

ANCA-MPO titers only transiently normalized for a few months following plasma exchange but have remained persistently elevated since the last vascu...

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RE: Refractory Vasculitis in a young woman 1 day ago

She has already received 5 of 8planned doses of Daratumumab and remains with active, seropositive , symptomatic vasculitis and dialysis-dependent E...

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RE: Refractory Vasculitis in a young woman 1 day ago

Agree with the expert opinion and I agree for Dara and preferred over Bortezomib from recent data on desensitization of highly sensitized patients ...

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RE: Refractory Vasculitis in a young woman 1 day ago

Here is my take on this very unique (at least from my experience reference point) and very unfortunate patient. After nearly a year on dialysis the...

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RE: Natural History of treated IgAN 1 day ago

With borderline THin BM and unexplained persistent hematuria , I would recommend Genetic testing for Alport Spectrum disorder in this patient. Whil...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

I will take a somewhat different position compared to Dr. Rodby- defining a "steady state" by a stable plateau of Scr during recovery from AKI can ...

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RE: sglt2 1 day ago

We need to know the value of eGFR and UACR . What were the indications for a kidney biopsy? . Is the patient still receiving Lithium? . In the abse...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 1 day ago

This is a bit odd "fairly normal appearing kidneys, 30% fibrosis". Is he a liver patient? I would not do PD. Did he get PLEX? You can try Obi...

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sglt2 1 day ago

posting for colleague, 41y w htn, no dm, lithium for bipolar, bmi mid 30s Diagnosis: Focal and segmental glomerulosclerosis, perihilar varia...

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RE: GFR measurement in AKI with stable serum creatinine 1 day ago

If you are in steady state, creatinine stable, I dont think it matters if it is CKD or AKI , and a 24 hour urine should give you a reliable creatin...

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RE: Refractory Vasculitis in a young woman 1 day ago

unreal story. poor woman! Seems she has had CYC 3 times, a large cumulative CYC amount, but this is life threatening disease and I believe warra...

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Refractory Vasculitis in a young woman 1 day ago

I would really appreciate input for this tough case…. 21-year-old female under follow-up for ESRD on peritoneal dialysis, secondary to ANCA vasculi...

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GFR measurement in AKI with stable serum creatinine 1 day ago

Greetings to all community members If a patient developed AKI and serum creatinine stabilised at certain level for 3 days, is it valid to measure...

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RE: Natural History of treated IgAN 1 day ago

Here is the message I received from the nephropathologist: "I took 100 measurements of GBMs with a mean of 269 nm, range = 126-384 nm. This is ...

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RE: Treatment Of Sarcopenia In HD 1 day ago

Great question. As far as I know, nutritional supplementation and exercise ( *often intra-dialytic) are the main recommendations. Pharmacologic the...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

the ARR in the review paper cited by Dr. Balan to distinguish PA in pregnancy is a threshold 40 using picomoles per L for serum aldosterone and dir...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

Dear. Dr. Besarab, I have attached a good review article on the subject, I hope it helps ------------------------------ Vito M Campese Pro...

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RE: Another hypokalemia case 1 day ago

What is unique i this case is the very high Aldo level, high aldo/renin ratio, yet K+ almost overcorrected while 16 mEq/day taken 4h. So the dose i...

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RE: Natural History of treated IgAN 1 day ago

To my eye, some of the GBM appear "thin". I would request that pathology conduct a formal morphometric analysis of GBM thickness and if abnormally ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

Here is the article ------------------------------ Satish Balan MD DM DNB Senior Consultant Department of Nephrology Kerala Institute of ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

Dear Dr. Campese Could not find the refrence on he Journal website and PYb Med is down. Would you have a pdf of the article to share? ---------...

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RE: Natural History of treated IgAN 1 day ago

Here are the anonymized EM pictures ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Associates In Kidney Car...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

I think a final diagnosis at this stage is very difficult. The renin above 5, the low ARR ratio and the normal BP (although this could be explained...

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RE: Bartter's syndrome vs primary hyperaldosteronism 2 days ago

50 posts in the thread- second highest for 2025-so far.!! Great participation and a fantastic learning opportunity. Thanks to Dr. Jebur for startin...

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RE: Another hypokalemia case 2 days ago

Thank you both, that is the current plan. ------------------------------ Graham Rodwell MD Palo Alto Medical Foundation Palo Alto CA -----------...

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RE: Another hypokalemia case 2 days ago

I agree with Dr. Rodby. Stop the K supplemental Oral K and repeat the PRA and serum Aldosterone once the hypokalemia recurs, if it does at all.. ...

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