RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 9 minutes ago

Dr. Anand: You had mentioned that the initially low BP improved after IV normal saline and permitted the use of diltiazem and beta-blockers. What...

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RE: Sarcoidosis? 2 hours ago

Thank you all for your input. since this seems to be uncharted territory. I will try the methotrexate. --------------------------------- J Gunnell...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 hours ago

Drs. Boobes and Lerman, the 3L of IV fluid that he received on D1/2 was Normal Saline. Unfortunately his urine output was not monitored. His oral f...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 3 hours ago

We have new tools available such as Bioimpedence cardiography and Spectroscopy, which are bedside tools to estimate Cardiac output , cardiac index ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 4 hours ago

we need to know what type iv fluids were given ( NS? RINGERS? COLLOID ?) hard to believe urine sodium [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 6 hours ago

Thank you all for this fascinating discussion. Before invoking a rare hepatic or tubular mechanism, I wonder whether the simplest explanation-very ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 7 hours ago

Thanks Dr. Mellas for raising the "effective arterial volume " deficit as an explanation for renal sodium aviditiy and water retention in this case...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 7 hours ago

The history and the following features: · Hypotonic hyponatremia: serum Osm 269 · Strong AVP effect: urine Osm 584 · Strong RAAS stimulation: ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 8 hours ago

Both cholestatic CLD (in absence of cirrhosis) & TR could lead to Na (+ H2O) avid state (with persistent, now hypervolemic, hypoNa) by aldo-dep & a...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 8 hours ago

Based on this very thorough description one must speculate a decrease in effective arterial volume/perfusion as opposed to hypovolemia per se, sinc...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 18 hours ago

Just speculating, but could this be "vanishing bile duct syndrome ," and severe enough chronic liver disease to provoke the hyponatremia and low ur...

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Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 19 hours ago

An 83 yr old male with Afib on apixaban, cholestatic hepatitis of unclear etiology (MRI of liver normal, no ductal dilation, bili around 4, AST and...

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RE: FeNa 21 hours ago

Thank you for your response, Melanie. If it is still on the Steps, we must talk about it! ------------------------------ Anna Vinnikova, MD Assoc...

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RE: Refractory membranous Nephropathy 1 day ago

Dr. Dastoor - From the descriptions you have provided, I would conclude that this is not immunologically refractory PLA2R mediated MN. Rather the...

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RE: Refractory membranous Nephropathy 1 day ago

Thank you for the new information. So it looks like it is still a case of PLA2R1-MN, where anti-PLA2R1 antibodies may be the culprit of this pathog...

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RE: Refractory membranous Nephropathy 1 day ago

My pathologist just called me , and he just had a conversation with @Samih Nasr at Mayo. It is an IgG4 and anti pla2r on biopsy is positive- done ...

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RE: Refractory membranous Nephropathy 1 day ago

I just read all the above comments on an interesting and very unusual case of MN, which is at least initially PLA2R1-associated MN. I think that th...

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RE: AKI & Immune complex GN 1 day ago

She was not on any meds. that's what I thought, no full house no lupus. What is it though!? ------------------------------ M. Samih, MD, FAC...

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RE: AKI & Immune complex GN 1 day ago

Does the absence of full house ( ie IgM and IgA ) and seronegativitiy rule out Lupus ??? was the patient on any medications ?? ----------...

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RE: Refractory membranous Nephropathy 1 day ago

We are sending this biopsy slides to the Mayo clinic for further investigations ..currently she is on max anti proteinuric therapy with ARB, SGLT2i...

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RE: AKI & Immune complex GN 1 day ago

She's on Bactrim. ------------------------------ M. Samih, MD, FACP, FASN, FASDIN Cayuga Medical Center Ithaca, NY, 14850 -----------------------...

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RE: Refractory membranous Nephropathy 1 day ago

Thank you , Dr Glassock . ------------------------------ Rochak Varma MD Oro Valley AZ (917) 459-0750 ------------------------------

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RE: AKI & Immune complex GN 1 day ago

What is the differential? c1q Nephropathy? IC GN 2/2 IE? IC GN 2/2 Serology negative Lupus? sounds good to me. Treat like Lupus Nephritis? Yes I ...

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RE: AKI & Immune complex GN 1 day ago

So yes UACR dropped but not sure how accurate was the 1100 mg/d nevertheless this happened over 1 week and after starting the combo prednisone and ...

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RE: Refractory membranous Nephropathy 2 days ago

See Giri, Glassock and Fervenza. KI Reports 2026; 11: 106416 for a discussion of defining refractory (resistant) MN. ----------------------------...

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RE: AKI & Immune complex GN 2 days ago

"UACR dropped 1,100--->60mg/d" Was this after starting prednisone + mycophenolate? Has SCr improved from peak of 2.4 mg over the last 10 days sin...

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RE: Refractory membranous Nephropathy 2 days ago

Great question. I wish I had a good answer. Electron lucent deposits are presumed to be a sign of inactive disease . Whether electron dense fresh d...

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RE: Refractory membranous Nephropathy 2 days ago

Dr Glassock , Does presence of deposits on EM indicate active disease ? Are there any Electron microscopy features which suggest active disease ...

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RE: C3G Or FSGS 2 days ago

Since genetic testing is not indicated in steroid-sensitive MCD, I would (probably) ignore these findings, unless there is a family history of CKD....

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RE: AKI & Immune complex GN 2 days ago

Yes Doc. RF was negative. C3, and IgG equal IgG (3+) C1q (3+) C3 (3+) Kappa (3+) Lambda (3+). No significant staining for IgA, IgM and fibri...

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RE: AKI & Immune complex GN 2 days ago

If a Rheumatoid Factor is normal I think you can stop the evaluation for Endocarditis. I might look for a viral lobby- Parvovirus or EBV.. how inte...

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RE: SGLT2 inhibitors in MCD 2 days ago

Probably yes, but long term FU data are largely lacking. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Schoo...

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AKI & Immune complex GN 2 days ago

Hi all, sorry for the long post. Need your help --------------------------------------------- 38 YO WF Presentation: Gross hematuria (later Mi...

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RE: C3G Or FSGS 2 days ago

Just wanted to give an update and get some thoughts on the genetic profile of this patient . He responded well to steroids with complete resoluti...

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RE: SGLT2 inhibitors in MCD 2 days ago

can we say the same about statins, as some of this patients severe dyslipidemia is reversible once the immunologic process is reverse ----------...

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RE: Sarcoidosis? 2 days ago

Finding papers on GN in sarcoid was not hard. Finding papers on crescentic GN in sarcoid was harder. Finding papers on ANCA GN in sarcoid was much ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Since "interferon storm" has been implicated in causing podocyte injury in the setting of viral infections, use of interferon in this patient might...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 2 days ago

Hi everyone, It has been a while since I posted this thread. It turns out that she has chronic parvovirus viremia with a relatively low titer (14...

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RE: FeNa 2 days ago

Hi Anna, yes, we are still teaching FENa to pre-clerkship students. Although FENa is flawed, it is helpful conceptually to teach about how fantasti...

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RE: cause of AKI 2 days ago

Did you stop the Ashgawanda as well? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCL...

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RE: cause of AKI 2 days ago

agree with avoiding infliximab but given persistent intense TIN with lymphocytes and apparent lack of IFTA-MMF seems worth a try unless leukopenia ...

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RE: cause of AKI 2 days ago

Personally, I would avoid Infliximab in this case due its propensity to induce vasculitis. ------------------------------ Richard Glassock MD, ...

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RE: Sarcoidosis? 2 days ago

Thanks prof rodby Sorry pred 60mg first and wean and then add mmf and continue for 12 month with low dose steroid and mmf rheumatologist prefer met...

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RE: cause of AKI 2 days ago

Thanks prof rodby worth exploring Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Sarcoidosis? 2 days ago

I would use moderate dose prednisone starting 60 and taper as response, I think that will give you the fastest response. then for maintenance I ...

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RE: cause of AKI 2 days ago

steroids didn't work and yet the kidney is not "dead" as i wold have predicted if on hd this long nd no recovery. Im not excited about MMF what...

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RE: cause of AKI 3 days ago

I have no opinions on this very difficult questions, Simply no data upon which to base an opinion. ------------------------------ Richard Glassoc...

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RE: Sarcoidosis? 3 days ago

Thanks prof glassock . I would do mmf and small dose pred Mmf 500 mg bd and pred 5 mg od for 12 month and review (opinion not ebm) Repeat biopsy ...

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RE: cause of AKI 3 days ago

@ prof glassock would you consider mmf as second line and if so at what dose and at what point ( how long would you call futility? --------------...

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RE: cause of AKI 3 days ago

I do not know of any comparative data concerning the risk of severe TIN is Ashgawanda vs PPI.this risk of developing AIN with PPI is estimated to b...

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