RE: hyponatremia with AKI, fluid question 10 minutes ago

Diffuse maculopapukar rash with AKI and mild  proteinuria (and hematuria) suggests  acute hypersensitivity interstitial Nephritis.  Needs a kidney ...

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RE: hyponatremia with AKI, fluid question 49 minutes ago

Yes I also thought of RAS but with long term albuminuria , won't it be too late for surgery to make any difference ? ------------------------------...

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RE: Treatment failure for Lupus Nephritis 5 hours ago

What is the ANCA serologies? If positive (coexistent LN with ANCA-GN), i would discontinue MMF and start either CYC or RTX. -----------------------...

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RE: Treatment failure for Lupus Nephritis 9 hours ago

I’d think your “easiest” options would be to 1. increase MMF to 3 g/d or 2. leave on MMF 2 g/d & add RTX 1 g x 2/2 wks or 3. switch MMF to Euro-Lup...

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RE: Treatment failure for Lupus Nephritis 10 hours ago

I think this patient would be a good candidate for Eculizumab  rescue therapy. ------------------------------ Richard Glassock MD, FASN Emeritus Pr...

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RE: Hypercalcemia and HTN 10 hours ago

It is important to recognize that about 10-15 % of patients with primary adenomatous hyperparathyroidism have low calcium excretion, but by definit...

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RE: Hemodialysis in chronic liver disease with SBP 10 hours ago

Agree that standard HD can be resumed if he is hemodynamically stable. I would assume the ascites is due to portal Htn with a low albumin.  My expe...

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RE: Hypercalcemia and HTN 10 hours ago

Sounds like primary hyperparathyroidism. My guess is the 24 hour urine will not help with the diagnosis. Let's wait and see. ----------------------...

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RE: MPGN-What next? 10 hours ago

Yes- this is the one. Sent from my iPad

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RE: Treatment failure for Lupus Nephritis 11 hours ago

Antiphhospholioid antibodies: Pending C3: 53, C4: 10 ( Oct, 2019) ADAMSTS 13: not done. Hematology does not think she has TTP/HUS. ----------------...

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RE: Treatment failure for Lupus Nephritis 11 hours ago

I suggest Rituximab and if there is picture of MAHA do plasmapheresis ------------------------------ Shafiq Alemad MD University of science and tec...

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RE: intracranial hemorrhage and CVVH 12 hours ago

There does not appear to be any significant change in ICP with or without CRRT.  Also, there are no hemodynamic changes either.  The mentation chan...

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RE: Treatment failure for Lupus Nephritis 13 hours ago

Antiphhospholioid antibodies? C3? Adamts13? I'd consider tpe and even Eculizumab if complement was part of her serologic and histologic picture. --...

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RE: intracranial hemorrhage and CVVH 13 hours ago

A mystery but one hour of cvvh isn't enough to do anything significant physiologically so I have to believe this cannot be related? Do you have int...

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Treatment failure for Lupus Nephritis 13 hours ago

We have a 44 Y.O. Asian female with lupus nephritis. Biopsy showed "diffuse proliferative focally crescentic lupus nephritis with moderate to sever...

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RE: hyponatremia with AKI, fluid question 13 hours ago

His Na is not the issue here. Give him iv fluid based on your volume assessment. If he drops you may need to start gentle RRT, he came in borderlin...

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RE: Mannitol & CRRT for elevated ICP 13 hours ago

When I last reviewed the literature, lowering of ICP by either hypertonic saline or mannitol was ineffective at improving survival compared to surg...

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hyponatremia with AKI, fluid question 14 hours ago

Gentleman white age 59, with known diabetes type 2 at least since 2007, untreated sleep apnea, and hypertension  for at least 15 years, past use of...

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intracranial hemorrhage and CVVH 14 hours ago

I need help on a patient with ICH who's mentation IMPROVES only on CVVH. 59yo F with ESRD who was admitted for ICH.  CT shows large intraventricula...

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RE: MPGN-What next? 14 hours ago

Thanks i will. ------------------------------ Mohamed Elrggal, MD Alexandria Egypt +20 1270004590 ------------------------------ ------------------...

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RE: MPGN-What next? 14 hours ago

It is a complex issue, not easily explained in a few words. Please read the excellent essay by Dr. Steven Kroft written in 2004. It is the best exp...

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RE: MPGN-What next? 15 hours ago

Can you explain the difference between monotypic and monoclonal Dr. Glassock? ------------------------------ Mohamed Elrggal, MD Alexandria Egypt +...

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RE: HTN/Proteinurea 17 hours ago

The EM finding of electron dense mesangial and sub-endothelial deposits and "negative" IF microscopy calls for studies of the paraffin embedded spe...

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RE: Hypercalcemia and HTN 18 hours ago

I agree this sounds like FHH. What is the phosphorus. You definitely need a 24 hr urine for calcium and creatinine. A spot is not sensitive enough....

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HTN/Proteinurea 19 hours ago

65 y/o AA female with HTN(not consistently controlled), IGT, obestiy(BMI 35), history of follicular thyroid cancer s/p thyroidectomy 2015(in remiss...

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RE: Hypercalcemia and HTN 19 hours ago

I agree that the very rare phenomenon of ectopic parathyroid adenomatous Disease might be considered, but FHH should probably be evaluated first, t...

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RE: Hypercalcemia and HTN 20 hours ago

I'm not sure about mediastinum. But I can ask tomorrow. ------------------------------ Elgun Haziyev MD, PhD Nephrology Fellow Bezmialem Vakif Univ...

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RE: Hypercalcemia and HTN 20 hours ago

there should be in some place some extra PTH producing cells. otherwise difficult to  explain a high PTH in a hypercalcemia setting  scintigraphy h...

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RE: Hypercalcemia and HTN 21 hours ago

Phosphate  level is normal. Tomorrow I'm going to tell you about everything in the 24-hour urine. The test results will be released tomorrow.  ​Tha...

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RE: Hypercalcemia and HTN 21 hours ago

What is the phosphate level? ------------------------------ Frans Zantvoort MD Bremen +494218398440 ------------------------------

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RE: Surgeon declines to place PD cath due to prolene mesh 23 hours ago

​I cannot remember how the catheter was placed, but will try look it up. ------------------------------ Raymond Krediet MD, PhD Academic Medical Ce...

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RE: Mannitol & CRRT for elevated ICP 23 hours ago

My query related to eliminating the need for repeated boluses or continuous infusion of hypertonic saline to MAINTAIN target Na in pt on CRRT. I wa...

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RE: Hypercalcemia and HTN 1 day ago

A 24hour urinary calcium would be the appropriate step as highlighted by Dr @Richard Glassock --------------------------------- Mohamed Elrggal, MD...

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RE: Hypercalcemia and HTN 1 day ago

The false negative Tate of Tc99 sestamibi tomography is about 5% in proven Primary adenomatous hyperparathyroidism. This test should be uniformly n...

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RE: Hypercalcemia and HTN 1 day ago

The major differential diagnosis in this patient is Primary adenomatous hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH). While n...

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RE: Membranous GN 1 day ago

​The MENTOR interpretation is indeed very interesting and helpful. I will certainly review the above mentioned results regarding Ab level in CNI tr...

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Hypercalcemia and HTN 1 day ago

I have a 36 y/o male with normal serum Cr. He has persistently elevated Ca of 10-11 with a high PTH 105, normal electrophoresis and Immunofixation,...

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RE: Mannitol & CRRT for elevated ICP 1 day ago

Agree. So I wonder if the delayed secretion of mannitol will increase the likelihood of a " reverse" osmotic effect, hence your suggestion to only ...

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RE: Mannitol & CRRT for elevated ICP 1 day ago

Thanks for the detailed review and references. The issue in this case was superimposed AKI which would limit the renal excretion of the infused Man...

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RE: Mannitol & CRRT for elevated ICP 1 day ago

From UpToDate . re mannitol "The effects are usually present within minutes, peak at approximately one hour, and last 4 to 24 hours [ 26,102 ]. Som...

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RE: Mannitol & CRRT for elevated ICP 1 day ago

Neurointesivists and neurosurgeons seem to use mannitol quite often, but the neurology literature does not support its use in intracerebral bleeds ...

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RE: Mannitol & CRRT for elevated ICP 1 day ago

This got in the wrong thread and I am copying into the proper thread: Dr Glassock asked: "Is it easier and more reliable to induce intentional hype...

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RE: MPGN-What next? 1 day ago

Dr Glassock thanks This was very helpful and clears lot of concepts --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc....

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RE: Hemodialysis in chronic liver disease with SBP 1 day ago

Sorry- these comments belong on a different thread concerning the use of CRRT and mannitol in management of increased intra-cranial pressure due to...

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RE: Hemodialysis in chronic liver disease with SBP 1 day ago

Oops, I'll put this into the proper thread. Using hypernatremic dialysate for HD would be difficult if even possible given conductivity limits of a...

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RE: Hemodialysis in chronic liver disease with SBP 1 day ago

Is it easier and more reliable to induce intentional hypernatremia (in AKI with Traumatic Brain Injury ) using CRRT or Conventional HD, or is there...

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RE: Minimal Change Diseae 1 day ago

Thanks- this explains the testing. I did not want participants to assume that protesting for CMV, EB and ZVZ antibody status is "routine " in pat...

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RE: MPGN-What next? 1 day ago

Monotypic but not Monoclonal. A subtle but important distinction. Sent from my iPad

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RE: Hemodialysis in chronic liver disease with SBP 1 day ago

If he is hemodynamically stable there is no reason to use crrt. --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush U...

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RE: Membranous GN 1 day ago

"A full bore relapse of NS with persistently negative anti-PLA2R antibody would give rise to Questions about the validity of the antibody assay mor...

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