RE: Persistent Hyperkalemia 27 minutes ago

First presentation with high K - (not sure if you were looking for a specific chemistry) - Thanks Na 137, K 9.3, Cl 110, HCO3 22, BUN 8, creat 0...

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RE: IgA Nephropathy 44 minutes ago

As always great questions Dr. Hirsch. Thanks. Unfortunately, the answers are speculative and not evidence based. Recent data (e.g. RADAR from UK) s...

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RE: Persistent Hyperkalemia 1 hour ago

Thank you. Any reason to suspect fluoride intoxication or trans-cellular K+ redistribution? Can you plz track down the very fist chem-10 panel for ...

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RE: Persistent Hyperkalemia 2 hours ago

Thanks-normocytic normochrimic anemia. Unexplained. Any splenomegaly.? Peripheral blood smear will be very helpful for RBC morphology . ---------...

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RE: Renal Cystic Kidney Disease 2 hours ago

Do you have a birth weight on this patient? Adaptive hyperfiltration injury seems to be a likely explanation for the proteinuria. ---------------...

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RE: Renal Cystic Kidney Disease 2 hours ago

Thank you @Fouad Chebib Patient has proteinuria since age of 16 years, almost 30 years. His albumin is normal and has no oedema, does have mild H...

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RE: Persistent Hyperkalemia 2 hours ago

Calcium 7.8 to 9.2 (bicarb and diuretics for treatment may have caused some fluctuation) - but not high. ------------------------------ Dilip Un...

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RE: Persistent Hyperkalemia 3 hours ago

Was your patient ever hypercalcemic?... ------------------------------ Prem Chandran MD Adj Clinical Professor, Univ of Iowa Associates In Kidney...

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RE: Spontaneously elevated Hb despite iron deficiency in a HD patient with heart disease 3 hours ago

Thanks for your prompt response. I am going to answer your questions: - The patient maintains Hb levels between 10 and 12 g/dL without requiring Ep...

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RE: Persistent Hyperkalemia 3 hours ago

This did cross my mind many times, although patient refused. Still, I am just surprised that if renal functions are normal someone can take enough ...

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RE: Persistent Hyperkalemia 3 hours ago

WBC 4.7 - Hb 10.4 - Hct 32.3 - MCV 93.6, MCH 30.1, RDW 13, Plts 227 (all within range except H/H) Retic count 1.9 (0-2.8%), LDH 245. I will ge...

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RE: Persistent Hyperkalemia 3 hours ago

No family history. Thanks. ------------------------------ Dilip Unnikrishnan MD Nephrology Associates LLC Newburgh IN (812) 479-3125 -----------...

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RE: Persistent Hyperkalemia 3 hours ago

Can you post the full hematological indices and a peripheral smear? Rarely spherocytosis can cause Pseudohyperkalemia (fragile erythrocytes) . - wi...

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RE: Persistent Hyperkalemia 4 hours ago

This is not Addison's disease. The Urine [K] is rather generous suggesting this is not related to decreased renal K excretion. Hemolysis has be...

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Apply today!! Travel Support Scholarship for Nephrology Fellows to attend Annual Dialysis Conference, Las Vegas 2025. 4 hours ago

Annual Dialysis Conference (ADC) is thrilled to announce its dedication to advancing Nephrology fellows' education through a comprehensive program,...

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Apply today!! Travel Support Scholarship for Nephrology Fellows to attend Annual Dialysis Conference, Las Vegas 2025. 5 hours ago

Annual Dialysis Conference (ADC) is thrilled to announce its dedication to advancing Nephrology fellows' education through a comprehensive program,...

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RE: IgA Nephropathy 5 hours ago

Dr Glassock and others: It was observed long ago that IgA patients with [More]

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RE: Persistent Hyperkalemia 5 hours ago

I suppose tgat surreptitious consumption of potassium salts also needs to be considered. If ------------------------------ Richard Glassock MD, F...

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RE: Duration of PKD treatment with tolvaptan 6 hours ago

There is currently no KFRE equivalent calculator to estimate natural history vs treatment effect for each patient. There is ongoing research in thi...

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RE: Duration of PKD treatment with tolvaptan 6 hours ago

The short answer is up to age 65 (see which subset /rationale below). Tolvaptan treatment in patients with ADPKD is indicated for those at risk o...

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RE: Duration of PKD treatment with tolvaptan 6 hours ago

Thank you Dr. Klein. The upcoming KDIGO guidelines will be helping to sort the nuances between the US and European practices. Stay tuned. Keep an e...

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RE: Renal Cystic Kidney Disease 6 hours ago

I agree with Dr. Glassock. Although blocking V2R could be a therapeutic strategy in ARPKD, the human data is lacking. I would not prescribe tolvap...

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RE: Persistent Hyperkalemia 6 hours ago

Although it is a long shot, i would do generic testing (SCN4A gene). The hypoglycemia and mild anemia ate puzzling . Low AM cortisol with normal AC...

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RE: Persistent Hyperkalemia 7 hours ago

Any family history of potassium problems? Sometimes with Anderson syndrome you can see fluctuating hypokalemia and hyperkalemia. ---------------...

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Persistent Hyperkalemia 8 hours ago

I have a 40 year old female patient who has hyperkalemia - requiring dialysis on three different admissions for potassium of 8.5 and over. (the thr...

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RE: SIADH in a patient with SAH 10 hours ago

Based on the records, he was. But, there is always the chance. I was wondering if others had noticed this as well. -----------------------------...

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RE: Recurrent convulsion in hemodialysis patient 13 hours ago

Thank you dr weal for sharing this case with a very fruitful discussion and learning points ------------------------------ Saja Mohammed MD, MB...

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RE: urine alkalinization in rhabdomyolysis 15 hours ago

Combined with inconclusive data on efficacy and the very real risk of doing harm, I agree with Dr. Rodby that the practice of routinely administeri...

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RE: SIADH in a patient with SAH 15 hours ago

Was he in the hospital, so that compliance with the fluid (water restriction) could be verified? Otherwise, excess water intake cannot be excluded....

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RE: SIADH in a patient with SAH 17 hours ago

Agree, he was on a fluid restriction plus he was dialyzing frequently . Redistribution of fluid to maintain isosmotic conditions was the considerat...

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RE: SIADH in a patient with SAH 17 hours ago

The commonest cause of recalcitrant hyponatremia in an anuric patient on hemodialysis is too much free water intake. I cannot understand how your p...

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RE: SIADH in a patient with SAH 18 hours ago

Thank you for the explanation, Dr. Glassock. i never recognized the relevance of potassium and phosphorus depletion until I had a patient recentl...

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RE: SIADH in a patient with SAH 18 hours ago

Low solute excretion (having nothing directly to to do with "intracellular solute depletion) is strongly associated with hyponatremia as it impairs...

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RE: SIADH in a patient with SAH 19 hours ago

Thank you for the insight, Dr. Glassock. I was referring to situations where post op patients are sometimes very malnourished due to poor intake /...

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RE: urine alkalinization in rhabdomyolysis 19 hours ago

alkalization for TLS and rhabdo has gone a bit out of favor (the former more than the later) , because if you have a lot of cellular breakdown, you...

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RE: Spontaneously elevated Hb despite iron deficiency in a HD patient with heart disease 20 hours ago

Assuming the rest of the CBC parameters are normal, nothing suggesting a myeloproliferative disease such as P vera, with 20 years of ESRD, I would ...

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RE: Spontaneously elevated Hb despite iron deficiency in a HD patient with heart disease 22 hours ago

What was the baseline hemoglobin level before it rose to 12 g/dL? Was he requiring ESA to maintain baseline hemoglobin levels (ESA must have been d...

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RE: interesting case 22 hours ago

I did qualify my suggestion regarding viral infection-associated FSGS with "If MN can be confidently excluded" I do agree that reexamination of t...

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RE: interesting case 1 day ago

Interesting, very Hickam's Dictum slanted, suggestion Dr. Venkat. In this instance I am in a Reverend Occam's camp. We need more information, but i...

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RE: SIADH in a patient with SAH 1 day ago

Could you specify what you mean by "intracellular solute depletion." The major intracellular solutes are magnesium, organic phosphorous , potassium...

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Spontaneously elevated Hb despite iron deficiency in a HD patient with heart disease 1 day ago

A 42-year-old patient with chronic kidney disease on hemodialysis for 20 years due to neurogenic bladder, presented an Hb level of 12 g/dL spontane...

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RE: SIADH in a patient with SAH 1 day ago

Great discussion! How was the nutritional status of the patient? Can Intracellular solute depletion prevent the correction of serum osmolality...

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RE: urine alkalinization in rhabdomyolysis 1 day ago

Very inconclusive data on efficacy of NaHC03 in preventing AKI from Rhabdomyolysis from a recent Systematic Review and Meta-analysis . Lots of vari...

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RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 1 day ago

Thanks for input Dr. Venkat You rightfully pointed out to cardiovascular benefit which my patient can get with RAAS inhibition although I will ha...

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urine alkalinization in rhabdomyolysis 1 day ago

Is there any bensefits of urine alkainazation or just theoretical one ?

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RE: Renal Cystic Kidney Disease 1 day ago

Sorry missed that 'homozygous pathogenic variant'. That seems rather conclusive. In that case one has to look for Carolis disease as already stated...

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RE: Renal Cystic Kidney Disease 1 day ago

The clinical presentation in this case is at variance with the genetic diagnosis. Was this mutation reported as pathogenic or likely pathogenic? An...

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RE: interesting case 1 day ago

If MN can be confidently excluded in the first transplant biopsy (which showed FSGS), one other possible explanation is a viral infection-related p...

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RE: interesting case 1 day ago

See attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL (7...

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RE: interesting case 1 day ago

I think it was meant to be Pronase digestion (otherwise known as Paraffin IF ). A technique to uncover masked (or concealed) deposition of an antig...

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