Kidney stones for prospective kidney donor 5 minutes ago

I would greatly appreciate your opinion of my patient. A Caucasian male, 57-year-old, presented for altruistic kidney donation. He had a history o...

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RE: metabolic acidosis 4 hours ago

Urine pH is elevated at 7.5. Was this an early-morning urine sample? If the patient has a high intake of vegetables and fruits, resulting in increa...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 4 hours ago

The normal ESR and CRP make inflammatory bowel disease very unlikely. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 6 hours ago

Is this patient on any medication --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 ------------------------------...

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RE: can loop diuretics causes hyponatremia 8 hours ago

My guess would be that the cortical and juxtamedullary nephrons dilute the tubular fluid to a different degree and that the admixture of these woul...

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RE: can loop diuretics causes hyponatremia 8 hours ago

@John Mellas, during studying renal physiology in medical school we are told that tubular fluid osmolality that reaches the DCT is about 100 mOsmol...

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RE: metabolic acidosis 9 hours ago

Obtain a venous blood gas then make corrections for the pCO2 and HCO3 ------------------------------ John Mellas MD Nephrology and Hypertension S...

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RE: can loop diuretics causes hyponatremia 9 hours ago

In a simplified physiology (which I use) one needs to absorb Na, without water in the DCT to generate a dilute urine prior to passage into the CCD ...

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RE: metabolic acidosis 10 hours ago

Is the plasma lipemic? At this age a monoclonal gammopathy woukd be a very unusual cause of "metabolic acidosis " with an elevated AG. ----------...

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RE: can loop diuretics causes hyponatremia 12 hours ago

Dr. Mellas how do thiazides inhibit urine dilution? ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Phil...

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RE: metabolic acidosis 12 hours ago

Dr. Glassock So should i check the lipid profile only in that case? no Urinary Ammonium ? no work up for Sjoegren? she is young and had no signif...

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RE: metabolic acidosis 12 hours ago

I will try to do the gas and BMP at the same day, it is very hard to arrange this blood gas as an outpatient. Regular outpatient lab is not doing i...

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RE: metabolic acidosis 12 hours ago

not all BMPs have a gap and sometimes the bicarb is normal in the 22 range but she has this problem now since multiple years with bicarbs in the 15...

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RE: metabolic acidosis 12 hours ago

I did not check a lipid profile yet, will add it on ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philade...

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RE: metabolic acidosis 12 hours ago

no edema ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia PA ------------------------------

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RE: metabolic acidosis 12 hours ago

Pr/Cr ratio 292 mg/g no history of Sjoegren ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia ...

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RE: metabolic acidosis 13 hours ago

One needs to see a blood gas and chemistries drawn at the same time to define the disorder. ------------------------------ John Mellas MD Nephro...

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RE: metabolic acidosis 14 hours ago

Sorry- my stupid. The AG is 17. Obviously elevated. If confirmed on repeated measurement. The evaluation is for an AGMA not a NAGMA.. please disreg...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 14 hours ago

Agree pt needs a gastroenterologist and a rheumatologist to work together to figure this out. A 25 y/o with auto immune markers is suspect, maybe...

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RE: metabolic acidosis 14 hours ago

pseudohypobicarbonatemia - not common but not that rare, most commonly from hypertriglyceridemia and paraproteinemias, and always a good point when...

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RE: Solute clearance in fast transporters CAPD patients 14 hours ago

Rapid transporters means that the Dialysate to Plasma ratio of a given substance will approach 1 faster than a slower transporter. There is no back...

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RE: can loop diuretics causes hyponatremia 15 hours ago

Addendum Loop diuretics are used for treatment of 2 conditions (SIADH plus oral salt tablet for treatment of hyponatremia and CHF for treatment of ...

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RE: can loop diuretics causes hyponatremia 15 hours ago

From medicine textbook, we have learned that we should wait for RAASi prescription until correction of hypovolemia and hyponatremia so I think the ...

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RE: Sjogren nephritis 15 hours ago

Renal Involvement in Primary Sjögren's Syndrome: A Clinicopathologic Study. Saugar Maripuri, Joseph P Grande, Thomas G Osborn, et .PMCID: PMC273668...

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RE: can loop diuretics causes hyponatremia 16 hours ago

Dear Dr. Soleimani, thank-you for the info provided. Given the inverse relationship between SVR and CO in CHF, I find very useful to closely mo...

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Solute clearance in fast transporters CAPD patients 16 hours ago

Appreciate inputs for the following question and providing reference if available CAPD rapid transporter patients develops ultrafiltration failur...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 16 hours ago

I do not think her findings are related to SLE and certainly not AD alport. She needs evaluation by a gastroenterologist. Things like celiac and cr...

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RE: Sjogren nephritis 17 hours ago

Dear Dr. Venkat Thank you for your reply. During her second visit to my clinic two months ago, her PCR was 0.35 mg/mmol. Her C3 level was 0.7...

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RE: Sjogren nephritis 17 hours ago

Dear Dr. Anatole Besarab, Regarding persistent leucocyturia , she has no signs of urinary tract infection, and cultures came back negative many ti...

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RE: Sjogren nephritis 17 hours ago

Dear Dr. Jadav, Thank you for your reply. During her visit to my clinic two months ago, her urine PCR was 0.35 mg/mmol. Her C3 level was 0.7 g...

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RE: metabolic acidosis 1 day ago

Addendum- Is the serum lipemic? If so, and the calculated HCO3 level from arterial blood gas is normal , thus is ""Pseudo-hypobicarbonatemia ". D...

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RE: metabolic acidosis 1 day ago

What is the appearance of the urine sediment.? Is hypergammaglobulinemya present (if chronic respiratory alkalosis excluded ). Any SS-A .SS-B serol...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

A diagnostic conundrum. ANA and anti-dsDNA antibody negative. SLE is extraordinarily rare. A diagnosis of SLE cannot be made on true basis of the t...

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Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Lupus Enteritis? Alport-Associated Enteritis? 25-year-old female with known autosomal dominant Alport syndrome (COL4A3 mutation) Persistent mi...

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RE: metabolic acidosis 1 day ago

3+ LE, tubular proteinuria? Sjögren's Syndrome? ------------------------------ Sinasi Salman MD, FASN Owner Northlake Nephrology, PLLC Mooresvi...

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RE: metabolic acidosis 1 day ago

My suggestions, as well. If the patient is not on any bicarbonate-wasting medication, I would like to exclude respiratory alkalosis, as the major c...

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RE: can loop diuretics causes hyponatremia 1 day ago

Thank you, Dr. Campese, for your post and your question about my suggestion : " …… that ACEi through hemodynamic effects may alter the ability to e...

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RE: metabolic acidosis 1 day ago

Urinary Ammonium and an Arterial Blood gas. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------...

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metabolic acidosis 1 day ago

I am seeing in the clinic a 26-year-old lady who has chronically a metabolic acidosis Her most recent lab work: Urine analysis pH of 7.5 3+ leu...

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RE: can loop diuretics causes hyponatremia 1 day ago

Very nice paper. Hence, the use of furosemide to treat SIADH in the pre vaptan and oral urea era. Would like to see urine Na, K, osm on one of Dr...

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RE: Sjogren nephritis 1 day ago

Thank you FEIRON made no sense to me and I could not find it It is not easy growing old Tony Sent from Outlook

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RE: Sjogren nephritis 1 day ago

Tony, here is the link to the official Quantiferon site: https://quantiferon.com/jp/cd/patient-resources/quantiferon-tb-gold-2/ In the posted p...

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RE: Sjogren nephritis 1 day ago

Dr. Venkat Thank you , I tried to find the Acronym on the internet and I got zilch. Granted there are mant such acronyms which are new to me as the...

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RE: Sjogren nephritis 1 day ago

Dr. Besarab: I believe Quantiferon testing was done to look for tuberculosis as cause of sterile pyuria. Dr, Mohamed: Can you please provide tren...

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RE: can loop diuretics causes hyponatremia 1 day ago

I have attached a study by Dr. Schrier suggesting that the effect of furosemide on free water clearance may be independent of vasopressin. I find i...

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RE: Sjogren nephritis 1 day ago

What specifically does QuantiFERON measure? Persistent leukocyturia with neg urine cultures? ------------------------------ Anatole Besarab MD...

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RE: Sjogren nephritis 1 day ago

It appears that U/A has leukocytes but no hematuria or proteinuria. Do you have random urine pr/cr, albumin etc ? One of the earliest renal manifes...

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RE: can loop diuretics causes hyponatremia 1 day ago

it should be remembered that loop diuretics affect both concentration and dilution. The amount of tubular fluid leaving the ascending loop is incre...

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Sjogren nephritis 1 day ago

A 65-year-old female with a history of hypertension and Sjögren's disease is being monitored by nephrology for chronic interstitial nephritis. She ...

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RE: MMF-related Hair Loss and Edema in IgAN – Continue or Hold? 1 day ago

As far I know that DHP-CCBs are safe in HF, but NDHP-CCBs such as Verapamil and Diltiazem can aggravate HF by their negative chronotropic effects. ...

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