RE: ANCA Neg NCGN with Membranous- treatment advice 2 hours ago

In 2017 and International Consensus Group recommend abandoning IIF-based screening tests for ANCA ( due to high variability of results and lack of ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 3 hours ago

This makes 3+ of us emphasizing the importance of time on many cases in reaching a diagnosis. Ass i wrote in this bog, I could not get a definitive...

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RE: Natural History of treated IgAN 5 hours ago

from what I understood the question that you (your patient) is trying to pose is even if proteinuria improves with current management and reaches t...

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RE: Bartter's syndrome vs primary hyperaldosteronism 6 hours ago

"As King Solomon might have said, sometimes the true diagnosis is revealed not by the test result, but by time." "I teach this to trainees all th...

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RE: Bartter's syndrome vs primary hyperaldosteronism 6 hours ago

Dr.Filler had an excellent point here with diagnostic humility. It was very interesting discussion , I definitely learned alot. in pregnancy it ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 6 hours ago

"As King Solomon might have said, sometimes the true diagnosis is revealed not by the test result, but by time." I teach this to trainees all the...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 7 hours ago

What was the initial biopsy like in regards to chronicity and activity? the assumption here is rituximab might not be giving the adequate respon...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 7 hours ago

Measurement of renal length by ultrasound is not always accurate. Do the kidneys also show increased echogenicity and is the renal cortex thinned? ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 8 hours ago

Thank you for your astute recommendations. Adrenalectomy would be my last resort. Agree with rest. Give a little tincture of time and very close fo...

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RE: Hyperkalemia Post Kidney Transplant 8 hours ago

for years would have said no danger from hyperkalemia without ecg changes - peaked T waves , functional rhythm , etc.- but in some patients sensiti...

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RE: Bartter's syndrome vs primary hyperaldosteronism 9 hours ago

Dear colleagues, This has been a truly rich and thought-provoking discussion. I'd like to offer a reconciliatory perspective that draws from the i...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 9 hours ago

If the hematuria is not due to ongoing glomerular inflammation, does hematuria is common in progressed CKD and what are the possible mechanisms? ...

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RE: Hyperkalemia Post Kidney Transplant 18 hours ago

Yes, ECG done. and was normal ------------------------------ Ahmed Emara MD, FASN Ain shams university, cairo Cairo ------------------------------

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RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago

YES i FAVOR COHN'SSYNDROME BUT I ACCEPT THAT I COULD BE WRONG. MELBY'S PROCEDURE NOT POSSIBLE AT HER STAGE OF PREGNANCY. SELECTIVE CATHERIZATION OF...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

At this body height , 7-8 cm kidney are definitely "atrophic" and a normal CRP would be very unusual in active ANCA Vasculitis. You may be right th...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

C3 and C4 are both normal. Endocarditis has been ruled out — no clinical signs, negative blood cultures, and echo was unremarkable. We haven’t for...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

What c3Nd c4 level Has endocarditis been r/o What is frailty score If frail would not treat --------------------------------- Bajinder Reen MD Et...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

• ANCA (ELISA) has consistently been negative throughout the course. • The patient is 175 cm tall and weighs 74 kg. • The episode of herpes zoster ...

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

Thanks Dr Glassock and Dr Besarab for being kind. Seems like you are both CONN-fident Hope we get follow-up on this. -------------------...

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

Complex case Bartter It is very unlikely; renin should be much higher and serum chloride much lower Probably pregnancy is afecting renin activi...

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

A PRA greater than 5 is not depressed considering the patient has a urine Na excretion greater than 100 mol/day. I would consider this 3-4 times gr...

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

No gumption for Gitelman, lots of confidence for Conn!! Hosanna! ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) ...

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

HURRAH ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------------------

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

What happened to ANCA serology (by ELISA)? What is the patients height? Has the H. Zoster fully healed.? Have you restarted RTX + Avacopan-why not?...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

interesting, I have seen a lot of false positive ANCA (titer positive but Elisa negative) but not vice versa. ------------------------------ Rog...

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RE: Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

This is a TOUGH one. Approaching ESRD by creatinine and kidney size. Avacopan is an add-on drug, not studied by itself as far as I know , reall...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

The IF ANCA screen may have been a False Negative. I would wait until the results of ELISA are available before declaring that this is "ANCA negati...

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

I can be so lazy reading these long histories. The devil is in the ... I did not see that, and it is hard to ignore even though incidentalomas...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

Cresentic GN is associated with MGN PLA2r is not common in these but patients often have ANCA or anti-GBM I think logically this ca...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

Thank you. Indeed, NCGN = Necrotizing Crescentic GN To answer your clarifying questions no linear IF pattern, IF only peripheral gran...

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

There has been many interesting suggestions for this lady's condition. But coming late to this and reading the original case presentation I notice ...

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RE: Management Of bleeding From Exit Site 1 day ago

Thanks so much very helpful . Do you see increased rate of line infection compared to unit who do not purse string suture Best wishes ----------...

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RE: Management Of bleeding From Exit Site 1 day ago

The exit bleeding issue can be frustrating. We do all of our own permcatheters and temp catheters under Ultrasound guidance for the past 13 years. ...

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Management Of bleeding From Exit Site 1 day ago

Dear team , I was wondering if people have any strategy to manage bleeding exit site tunnelled Line. Do we do pursed string suture for every tunne...

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Renal-Limited Vasculitis (ANCA-Negative) in Elderly Patient 1 day ago

• 73-year-old male with renal-limited necrotizing glomerulonephritis, ANCA-negative • Received induction therapy with IV cyclophosphamide (6 doses,...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

Excellent comments Dr. Glassock, so the best approach is precision medicine and pathway targeted therapy using the biomarkers related to the underl...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

I agree with Dr. Venkat. The information requested us crucial to determine the best approach to therapy. ------------------------------ Richard G...

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RE: ANCA Neg NCGN with Membranous- treatment advice 1 day ago

I assume NCGN is necrotizing, crescentic GN. Was serum anti-GBM antibody also negative? Was there linear immunofluorescence pattern (if discernible...

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RE: Natural History of treated IgAN 1 day ago

Based on the biopsy findings I would very slowly taper the NEFECON and continue the MMF with low doses of oral systemic steroids, once the NEFECON ...

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RE: Natural History of treated IgAN 1 day ago

Folks: I am giving F/up on this case of a physician with Bx proven IgAN. Based on the recommendations I received, he was re-biopsied: IgAN again, O...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 2 days ago

This very interesting and highly clinically relevant thread stimulated further per reading. Of course, the landmark ACCOMPLISH trial (orchestrated ...

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

PRA seems to be getting traction Based on lowish renin, high aldo this is a very valid point And Bp should be low in pregnancy and 110/70 may ...

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RE: ANCA Neg NCGN with Membranous- treatment advice 2 days ago

Sorry I am afraid this will be a duh, but what is NCGN? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Universit...

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ANCA Neg NCGN with Membranous- treatment advice 2 days ago

Good morning I am seeking input re: next treatment options for my 76 year-old patient with longstanding (>12 years) PLA2R neg membranous previ...

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

And she needs superior obstetrical care for her and the fetus for another 20 weeks or more. Her progressive resp alk will only get worse as her ute...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 2 days ago

SGLT2i are increasingly used in many circumstances. Part of the difficulties of being semi-retires sa the lack of knowing the cost of a particular ...

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

Let's not forget this patient is pregnant and has a superimposed respiratory alkalosis resulting in diminished proximal HCO3 absorption and an alka...

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

Gitelman or Conn. It all hinges on what the normal PRA should be in the 11th week of pregnancy. I still favor Conn. -----------------------------...

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

Presumably yes, but other opinions are welcome ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---------...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 2 days ago

I suppose you are presuming 100% compliance with the prescribed dosing of NMF . Thus can only be assured by pill counts and/or MPA blood levels. ...

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