RE: A interesting hyponatremia case 3 hours ago

Wondering if this is “sick cell syndrome” --------------------------------- Edgard Wehbe MD, FASN Wichita Nephrology Group Wichita KS (316) 99...

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RE: A interesting hyponatremia case 4 hours ago

Thank you, Dr. Glassock. No, I did not check paraprotein. Just added light chain ratio to tomorrow's lab. Thought about hyperproteinemia as the und...

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RE: A interesting hyponatremia case 4 hours ago

Just curious. Did you look for circulating monoclonal paraprotein?. There are some features suggestive of Clarkson syndrome of enhanced vascular pe...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 4 hours ago

True. Thank you for your response Dr Glassock ------------------------------ Biresh Kumar MD Temple TX (269) 598-9324 ------------------------------

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RE: Membranous with GFR 15 ml and bx not consistent with severity 4 hours ago

It would depend on serum albumin and the extent of symptoms related to Nephrotic Syndrome. RASi has a relatively small effect on spontaneous remiss...

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A interesting hyponatremia case 5 hours ago

I would like to share an interesting hyponatremia case. I apologize in advance for the lengthy presentation. A 67 year-old female had anterior lum...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 5 hours ago

Dr Glassock, if the renal function was normal in this patient would you still you RTX as first line or give try with ACEi/ ARB first for 3-6 months...

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RE: Crescentic IgAN 6 hours ago

Asian patient May consider mycophenolate (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800997). ------------------------------ K....

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RE: Crescentic IgAN 7 hours ago

What is the ANCA ? I would likely treat with oral steroids (Moderate dose TESTING regimen) despite the normal Scr. I know this goes against KDIGO r...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 8 hours ago

your responses are greatly appreciated ------------------------------ Jukaku Tayeb MD St. Clair Nephrology Detroit MI (313) 886-8787 -------------...

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Crescentic IgAN 9 hours ago

42 y/o Asian female, found to have proteinuria in insurance physical 7/22. Creatinine 0.5, PCRatio at that time, 2.3 g/g, we started losartan 6 mo...

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Calculation of creatinine clearance 11 hours ago

------------------------------ Ahmed Akl MD, MBChB, PhD, FASN MISHRIFAH DIST. ------------------------------

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Using icodextran for manual exchanges 13 hours ago

Icodextran is typically used for the last fill/long dwell for patients on CCPD. I have a patient who does CAPD 5 x 3 L with inadequate UF and very ...

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RE: MMF Monotherapy In IgA Nephropathy? 15 hours ago

IgA nephropathy is thought to be more prevalent in Oriental ethnic populations, at least that is what I have been told. Could there be an ethnic di...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

This reply is wonderful just to read Prof Glassock now include SGLT2i aka flozins as part of standard of care in IgA nephropathy! (Arguably this tr...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

This is a very unusual and unfortunate case. I do think a biopsy to determine if this is ca oxalate as opposed to ca phosphate would be key in this...

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

I am not sure if its over-collection, but his spot UCr correlated with his 24 hour UCreatinine. PD training w/ a 500 cc Starbucks... -------------...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Issues- 1) single center 2) open label 3) all Chinese 4) no SGLT2 inhibitors 5) no stratification for Oxford-MEST will similar results be found i...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Mmf has some beneficial effects in Chinese population. This study is also from China Need data for other countries ------------------------------...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

I have read that calcium phosphate can be identified by the von Kossa stain as silver-containing black deposits. Calcium oxalate shows birefringenc...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

I can predict the response, and it is hard to criticize (even though I have used MMF in some cases of IgAN in the past especially if there were pro...

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RE: Use of both ACE inhibitors and ARBS in comination 1 day ago

Having any medication available is sometimes not an option in underdeveloped countries; taking into account the adverse effects (hyperkalemia) that...

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MMF Monotherapy In IgA Nephropathy? 1 day ago

The MAIN trial has been just published. Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800997 (And attached). KDIGO guideli...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

Calcium oxalate tissue deposition can be distinguished from calcium phosphate deposion by staining with Alizirin Red at two different pH (4.2 and 7...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

you say Ca Phosphate calcification, is this biopsy proven? this degree of calcification is unusual no matter what the Po4 and Ca Are? Any possibili...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

Problem solved. Thanks Dr. Venkat. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

This is certainly SIADH. It may be a consequence of the (hormone inactive) adenoma and there is no way to predict the response with resection. In t...

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RE: ESRD incidence 1 day ago

I estimated a while back (and this is probably somewhere in an ASN online in 2019), that flozins will likely clamp the ESRD incidence to 2016-2017 ...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

I would be fearful about using kayexalate with the history of ischemic colitis, and bowel resections ------------------------------ Lawrence Klein...

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RE: severe hyperphosphatemia and calcinosis in a dialysis patient 1 day ago

He has a short bowel syndrome. Is he scrumptiously taking large doses of Vitamin C that is being converted to oxalate? Being on dialysis , one woul...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

Please see following reference. There are several other similar case reports in PubMed. Nothing is new under the sun! https://pubmed.ncbi.nlm.nih.g...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

Has a hypothalamic tumor secreting ADH ever been described? I can't find any reports of this paraneoplastic event causing SIADH. But I suppose that...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

Am cortisol 18 Thanks for all the references --------------------------------- Brendan] [Mielke] [MD] [Kootenai Clinic] [Coeur d Alene] [ID] [2...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 1 day ago

Renal dysfunction is likely multifactorial including cardiac element, ? ATN, ? renal edema. As mentioned by others, cancer screening is needed wi...

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

Wow! why is he polyuric? 5 L? ------------------------------ Anatole Besarab MD ABesarab Consulting Bend OR (734) 417-4793 -----------------------...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 1 day ago

Is the BUN:SCr ratio disproportionately high suggesting pre-renal azotemia? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -...

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

Yes, urine output 5L ------------------------------ Sarah Aloudat ------------------------------

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

All great questions! - Indeed, I was really not sure how to interpret his Aldo and renin, My usual cases are clear cut straightforward, I never h...

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

I agree with Dr. Rodby. SIADH is very rarely reported in pituitary adenine's and all of the cases seen had some manifestation of a hypopituitary st...

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

Can you please explain the first column? ------------------------------ Sarah Aloudat ------------------------------

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RE: How to diagnose hyperaldo. in ESRD? 1 day ago

Yes, Indeed, my calculation was wrong, the units are different To use ARR, first Renin - should be [More]

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RE: Unusual case of apparent SIADH with suprasellar mass 1 day ago

That cortisol level may not be normal, the easiest explanation is he is hypo cortisol from a prolactinoma. https://www.ncbi.nlm.nih.gov/pmc/artic...

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Unusual case of apparent SIADH with suprasellar mass 2 days ago

Was hoping to get some help understanding the physiology of an unusual SIADH in a 45 yo man with no medical hx and no meds but occasional marijuana...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 2 days ago

The renal failure portends a bad prognosis, I suspect there is some ATN. Did you look for RV thrombosis, and PE? Pt needs good cancer workup And I...

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RE: ESRD incidence 2 days ago

Indeed dialysis has improved a lot since I was a fellow with Al toxicity, acetate dialysate, fluid removal dependent on UF coefficient and TMP, but...

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RE: ESRD incidence 2 days ago

Dr. Sekhon- Thanks for your post. I can resonate with your wishes about diet and exercise forestalling progressive CKD . It is just so disappointi...

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RE: ESRD incidence 2 days ago

Yes lot of excitement in nephrology with newer home dialysis machines in the horizon which are easy to carry and manage. I think we really need t...

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RE: ESRD incidence 2 days ago

Roger: The implantable kidney is one thing on the horizon. Maybe xenografting; both might be game changers. Probably other things we might not even...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 2 days ago

What is the patients serum albumin level. Prohykzctic anti-coagulation my be required if S alb [More]

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RE: Membranous with GFR 15 ml and bx not consistent with severity 2 days ago

"Presents with SOB and Creatinine 2.7 11/22, new Atrial Fib." With this presentation, either inadequately treated CHF or over-diuresis with pre-ren...

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