RE: proteinuria in SLE - ? biopsy or not 10 minutes ago

With "only" 500mg of albumin/ D in urine, normal EGFR, and negative serology, what is the point of doing a kidney biopsy. Or, am I committing to "...

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RE: Hypokalemia in Sjogrens 39 minutes ago

" I was wondering if I should replace her K partly as the chloride salt and partly as citrate (as bicarbaturia would worsen kaliuresis)" I suspect...

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RE: proteinuria in SLE - ? biopsy or not 43 minutes ago

I probably would, bc history of lupus. this level of proteinuria and serum albumin I may not if not for the Lupus. A Cr of 0.7 may be high for a ...

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proteinuria in SLE - ? biopsy or not 1 hour ago

I have a 36 yo lady with PMH of SLE diagnosed in 1/2017 with positive ANA, fatigue, arthralgias and skin rashes, initially on plaquenil, h/o Transv...

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RE: PD in LVAD 1 hour ago

I believe we had and extensive Discussion on this topic several years ago on ASN Communities. I will try to find it. -----------------------------...

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PD in LVAD 2 hours ago

Hi everyone, i was listening to the podcast freely filtered and in the episode where they discuss ISPD guidelines, there was a mention of LVAD an...

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RE: Hypokalemia in Sjogrens 2 hours ago

Here is an anecdote- Schlicher G et al. Rheumatol. 2017;56:498-500. "Seek and ye shall find" ------------------------------ Richard Glassock MD, F...

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RE: Hypokalemia in Sjogrens 3 hours ago

Looking at it from a clinical viewpoint the main problem that the patient has is the hypokalemia and metabolic acidosis. This is usually unresponsi...

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RE: Hypokalemia in Sjogrens 4 hours ago

13 years is a long time, and the damage to H+ secreting cells may now be reversible, but at age 26 would RTX be worth a try? I do not know. If the ...

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RE: Hypokalemia in Sjogrens 4 hours ago

Thank you Drs. Hirsch, Venkat, Rodby and Balan, Glassock for your responses. I was thinking in the same lines as Dr. Glassock, if there is someth...

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RE: Hypokalemia in Sjogrens 5 hours ago

Since this is very likely a B-Cell mediated auto immune disease, is there any utility to considering therapy (rather prolonged) with RTX to attempt...

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RE: Hypokalemia in Sjogrens 6 hours ago

My experience in this condition is that immunosuppressive drugs rarely make a difference (my personal opinion is that they are diagnosed late becau...

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RE: SGLT2 and UTI 21 hours ago

Sounds like a very reasonable compromise. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----------------...

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RE: High Renin and Hypertension 21 hours ago

Thanks- if a Pheo workup is unrevealing, would you evaluate for a reninoma- the level of PRA just does not seem high enough to suspect a reninoma. ...

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RE: Hypokalemia in Sjogrens 22 hours ago

"(I was worried about exercise worsening her K level, not sure if this is a reasonable worry?)." Another consideration favoring physical activity r...

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RE: VEXUS In Renal Patients 22 hours ago

POCUS and VEXUS came into clinical practice after I retired from patient care. I cannot, therefore, comment on their utility from personal experien...

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RE: SGLT2 and UTI 22 hours ago

My practise is to use with caution and see what happens.

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RE: SGLT2 and UTI 23 hours ago

The level of urine glucose is not the determining factor in enhanced risk of UTI in DM, at least in experimental animals. See Murtha MJ, et al JCI,...

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RE: SGLT2 and UTI 23 hours ago

sort of contradicts the RCT publications. No increase risk of UTI among DM treated with SGLT2I. It seems to be the serum (or tissue ) glucose that ...

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RE: Hypokalemia in Sjogrens 1 day ago

This is certainly SS D-RTA I see no reason to biopsy in this case without AKI or significant pyuria From UpToDAte: Potassium wasting generated b...

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RE: High Renin and Hypertension 1 day ago

Agree that the HCTZ and ARB will raise PRA; The bystolic should lower it. Given that his initial BPs were so high I would continue to look for seco...

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RE: SGLT2 and UTI 1 day ago

I would not do screening urine culture unless a urinalysis (which should be available) suggests a UTI. Another curious twist. Here is the wording ...

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RE: Hypokalemia in Sjogrens 1 day ago

There are at least 3 reports in the literature (dating back to Eric Cohen in 1992) probing renal biopsies in patients with Sjogrens and clinical RT...

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Hypokalemia in Sjogrens 1 day ago

A 26 yr old female was referred to me for evaluation of severe hypokalemia. Since age 13, she has been having a dry sensation in her mouth and ey...

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RE: hyponatremia with normal serum osmolality 1 day ago

Agree ! This another example of why nephrology is such a great field and together we Will hopefully stave off the "blind application, of algorithms...

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RE: VEXUS In Renal Patients 1 day ago

Sorry, noticed some links were broken. Please find the attached articles referenced above. ------------------------------ Abhilash Koratala MD,...

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RE: SGLT2 and UTI 1 day ago

To take this interesting debate one step further, would you carry out a "routine" quantitative urine culture in an older asymptomatic from the urin...

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RE: VEXUS In Renal Patients 1 day ago

- It's a helpful bedside diagnostic aid in patients with fluid overload, both to establish venous congestion/congestive nephropathy as well as moni...

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RE: SGLT2 and UTI 1 day ago

I suppose that the arguments against using SGLT2i in patients deemed "at risk" for complications from a UTI have some intrinsic logic. However, thi...

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RE: hyponatremia with normal serum osmolality 1 day ago

So all issues of hyponatremia are resolved by algorthims. I guess not and this case seems to be a prime example. Hyponatremia and the euosmolal sta...

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RE: SGLT2 and UTI 1 day ago

As for myself I agree with the opinion of Dr Rudnick. I do not use SGLT2 inhibitor in patients with a history of recurrent UTI or a history of UTI ...

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RE: hyponatremia with normal serum osmolality 1 day ago

I hope that if I drank too much water my urine osmolarity would be closer to 50-100. But more often than not I find with water drinkers and tea and...

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RE: Isolated hyperchloremia 1 day ago

I think the most common cause of extreme pseudohyperchloremia in the USA is now salicylate poisoning, but this patient did not have salicylate in h...

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RE: hyponatremia with normal serum osmolality 1 day ago

An ancillary point: Many case reports of beer potomania (and probably tea and toast) describe urine osmolarities that are low but not maximally di...

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RE: Kidney biopsy In Pregnancy 1 day ago

I, too, am skeptical of biopsy now, in part because of the concern over complications during pregnancy (see Dr Venkat's note) and in part because t...

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RE: SGLT2 and UTI 1 day ago

Dr Glassock. I would define at risk as follows (1). Patients with active history of recurrent UTI per year (2) patients with history urosepsis comp...

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RE: polyuria and nephrotic syndrome- 30% Effacement of podocytes 1 day ago

This is most likely steroid responsive MCD. I am not too bothered by the FP effacement. He may have been entering a spontaneous remission at the ti...

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RE: VEXUS In Renal Patients 1 day ago

The arc of enthusiasm for a new procedure usually peaks just before the hard data on utility arrive. I remain a bit skeptical , but this test does ...

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RE: Kidney biopsy In Pregnancy 1 day ago

How will a "diagnosis " of the cause of CKD (which very likely antedated the pregnancy in this case) help in the management of this patient (ways t...

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RE: SGLT2 and UTI 1 day ago

How do you define an "at risk" patient, when no risk can be clearly identified in large RCT?To be avoid the use of SGLT2I based On the basis an eph...

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RE: SGLT2 and UTI 1 day ago

I'm not concerned for the average patient but this article does not mean there should not be a concern in every patient Although I suspect use in ...

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RE: Kidney biopsy In Pregnancy 1 day ago

Interesting discussion. I would also lean towards doing biopsy. While the options may be limited, diagnosis will help in determining treatment, as ...

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RE: VEXUS In Renal Patients 1 day ago

Dr Glassock is right of course but it would be challenging to do an RCT with such a heterogenous group of patients. I guess the paper on venous pre...

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RE: polyuria and nephrotic syndrome- 30% Effacement of podocytes 1 day ago

Follow up on the above case His repeated labs on Nov 27, 2022, after starting on prednisone 1 mg/kg (total 80 mg prednisone) on Nov 21, 2022 ...

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RE: VEXUS In Renal Patients 1 day ago

A lot of "testimonials". How good is the hard Data supporting a clinical utility for VEXUS.? Just curious.. ------------------------------ Richard...

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RE: VEXUS In Renal Patients 1 day ago

if you can get interlobular veins, I think that would tell you more about the intrarenal capsule pressure than any other more proximal IRV -------...

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RE: VEXUS In Renal Patients 1 day ago

Great topic for discussion. I have been trying VEXUS for my patients with AKI for some time. I have used an echo machine, a Sonosite and also a B...

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RE: Isolated hyperchloremia 1 day ago

To my recollection, the only time I have seen a negative anion gap of this magnitude, was a case of 'Bromo-Seltzer" abuse many many years ago. Fasc...

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RE: Isolated hyperchloremia 1 day ago

a negative anion gap of 55! This below is from a patient with Bromide toxicity this high I have to wonder about bromide, maybe iodide, I dou...

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RE: SGLT2 and UTI 2 days ago

No evidence for increased risk of UTI with use of SGLT2i, in well powered studies. This "risk", if it exists at all, should not be a barrier to SGL...

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