RE: Acidosis vs proteinuria 4 hours ago

Gout Your experience is at variance with the published data on the effects of Bicarbonate therapy of CKD. See Hultin S et al KI Reports 2021 6: ...

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RE: high anti-GBM titers on dialysis 9 hours ago

Not all anti-GBM antibodies are capable of provoking lung hemorrhage. Thus as been explained on the basis of epitope specificity , not assessed wit...

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RE: Mpo Vasculitis Case 9 hours ago

Thanks for the Folllw-Up. The anti-MP0 antibody (by ELISA) was either a "false positive" or the kidney biopsy did not provide an adequate sample.. ...

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Acidosis vs proteinuria 14 hours ago

It is my experience that adding sodium bicarbonate to a CKD patient's regimen will often worsen proteinuria, as well as increasing BP and lowering ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 16 hours ago

I agree with Dr. Jorge Roman's post. I would perhaps add that if you do an averaged CCr + CUN with a 24 hour urine collection, you could perhaps b...

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RE: Mpo Vasculitis Case 16 hours ago

More info about biopsy Current conclusion is: Conclusion: Native renal biopsy: On light microscopy one glomerulus shows a focal abnormality r...

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high anti-GBM titers on dialysis 16 hours ago

92 year old, functional as baseline, baseline creatinine at 0.8-0.9 mg/dl from January 2025 w/ bland UA, non smoker. Came in for fall w/ decrease P...

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RE: Lab potassium normal range 20 hours ago

Ted: To this extremely interesting discussion, I hesitate to add, 2 slides I had come across sometime ago, more in keeping with the predicament tha...

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RE: Lab potassium normal range 23 hours ago

Eagerly awaiting the follow up data. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 --------...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 23 hours ago

Totally agree. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------------------

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

And here we are well over 1/2 a Century after chronic dialysis become common and we still check Urea and Creatinine, not able to define much less m...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

His calculated Nitrogen balance based on those values is = 19g negative nitrogen balance, in favor of significant catabolism. His illness but also ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

UNLIKE other capillaries elsewhere; Kidney capillaries FOLD twice: 1. GLOMERULAR folding 2. periTUBULAR folding = vasa recta Serum FILTRATEs tw...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

Interesting cases. Hard to evaluate the significance without knowing the denominator. Is thus 10% or some other number( larger or smaller) of the p...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

This conventional wisdom has been my understanding for years up until recently. I presently care for 2 females of African American ancestry with ES...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

I usually stop Hydroxychloroquine as well. As far as I know there is no evidence to support or deny that this decision is the "correct" one. Anothe...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

Unfortunately, the Tc99 DPTA nuclear scan (Gates method) is not very accurate and is not a replacement for a mGFR. see Xie, P, et al PLOS One, 20...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

In these kind of cases I use a Technetium nuclear study that provides a GFR independently of muscle mass and age. However, I rather use a "mosaic" ...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

Do you all stop the hydroxychloroquine or continue that in esrd patients? --------------------------------- Srilekha Sridhara MD Tucson AZ (314...

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RE: Lab potassium normal range 1 day ago

Dr. Filler, Thank you for that incredibly thorough and thoughtful response. You have touched upon every issue that we are dealing with in our ins...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Also, recurrence of lupus nephritis in the transplant kidney is quite uncommon, especially in patients transplanted after being on dialysis, even i...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Extra-renal manifestation of Lupus tends to decrease with increasing duration of HD or PD treatment for ESKD. Inly about 1 in 8-10 patients still h...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

This is a topic that has been of interest for years. I remember it as a controversy as an early attending in the 1990s. SLE is not limited to the k...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 days ago

What is the current absolute free light chains levels? Did the initial biopsy show light chains tubulopathy? ------------------------------ Ash...

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Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Good evening I want to ask about any evidence or statement that recommend immunosupressants withdrawl in SLE patients with ESRD who are on dialy...

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RE: Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 2 days ago

I take care of a patient with SAM. He is special as he also has hemophilia A. He presented years ago with right sided renal infarction (typical pai...

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RE: Lab potassium normal range 2 days ago

I agree with Dr. Hirsch. A causal direct association between a K level > 5.0mmmol/L in CKD and poorer outcomes remains unproven. It might represent...

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RE: Lab potassium normal range 2 days ago

"Persistent values >5.0 mmol/L-even if common in CKD-are associated with worse outcomes, suggesting that a lenient "CKD-normal" upper threshold may...

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RE: Lab potassium normal range 2 days ago

Thank you for the interesting discussion. I would like to offer a few thoughts. 1. Plasma vs. Serum Potassium Plasma potassium (P-K) and serum po...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 days ago

It depends. If you are asking about FDA approved indications, then no. FISH by itself does not have any bearing although hopefully soon, venetoclax...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

For sake of completeness check stool OB ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Center Beverly Hills CA (310) 657...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Dr. Cancarini. I Don' t disagree with your hypothesis that CCr + C urea /2 might be a more "accurate " estimate of GFR than creatinine or Cystatin ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

My guess GFR is much less than you think, closer to that suggested by hign BUN, like not enough. May be ask lab what of meds may be interfering wit...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

4 eGFR and urinary clearances and I still have no idea what this patients kidney function really is. Itvis time for a measured GFR. -------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 3 days ago

Did you ever perform a bone marrow FISH to examine clonality of PC in marrow and as a possible indication for Daratumumab? ---------------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 3 days ago

A year ago, the use of daratumumab for active relapse had been brought up by Drs. Glassock and Leung, thank you. Given the effectiveness of Darat...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Very true. Good idea. Thank you. _________________________________________ Ashraf El-Meanawy, MD, MS, PhD, FASN Professor of Medi...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Dr. El-Meanawy, Another study that looked at the role of urea in uremic syndrome by supplementing dialysate with urea: https://pubmed.ncbi.n...

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RE: Lab potassium normal range 3 days ago

Here is an interesting reference. Wang J et al Comp Struct Biotechnology J. 2024; 24: 1-11. ------------------------------ Richard Glassock MD, F...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

At GFR values ​​<20 ml/min, the urea clearance (which underestimates) and creatinine clearance (which overestimates) can be averaged and the result...

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RE: Lab potassium normal range 3 days ago

Very interesting discussion. The definition of a normal range for blood K concentration must clearly specify the serum or plasma source of the spec...

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RE: Lab potassium normal range Thursday, May 8 @ 7:29 AM

Thanks Kamyar. We are attempting to advocate for the same expansion (or retention) of P-K NR. But I would think that all clinical labs would be und...

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RE: Lab potassium normal range Thursday, May 8 @ 7:15 AM

Thanks. Would you be able to provide those references? ------------------------------ Theodore Saad MD, FASN [Christiana Care Health System] Newa...

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RE: Lab potassium normal range Thursday, May 8 @ 7:14 AM

Thanks. Yes, the root of our "problem" here is the difference between S-K and P-K. Our lab has reported ONLY P-K results for several years. When th...

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RE: PIGN with only proteinuria? Thursday, May 8 @ 6:10 AM

I woul agree that the clinical and pathological picture is most compatible with an Atypical non-hypocomolementemic " PIGN." Of unknown etiology. It...

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RE: Lab potassium normal range Thursday, May 8 @ 6:09 AM

At one of the major university centers, we successfully advocated for the pathology department to expand the normal serum potassium reference range...

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RE: PIGN with only proteinuria? Wednesday, May 7 @ 8:17 PM

To be more complete with the pathology findings, which will aid in the discussion. The pattern is Focal segmental endocapillary proliferative with ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Wednesday, May 7 @ 6:04 PM

'He has received total 40.8 g of protein in 24 hours the days of 24 hours urine collection' which is exactly what this gives us when I used 60 KG...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Wednesday, May 7 @ 6:03 PM

Dr Chander : Very weird results I think he is male ; do not have weight have assumed 110 lb = 50.2 Kg Creatinine excretion 7.8 dl at 365 mg/dl = 28...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Wednesday, May 7 @ 5:49 PM

Urine creatinine concentration very high and 24 hour excretion rate of creatinine greatly exceeds what would be expected in a malnourished ,sarcope...

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