RE: SLE with proteinuria 47 minutes ago

Thanks for ur reply CMV Blood PCR was 33,400 IU/ml at the presentation, esophageal biopsy was suggestive of viral infection, showed squamous epithe...

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RE: SLE with proteinuria 4 hours ago

Hullo Re: CMV DId she have CMV in her blood - ? copy numbner What was shown on the GI biopsies Was there evidence of CMV on the biopsies - ...

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RE: Atypical ANCA vasculitis or immune complex GN with false ANCA? 5 hours ago

The disease appears to be immune complex driven . The antiproteinase levels are trending down but not seeing any improvement in renal functions. Re...

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RE: Another TMA...aHUS vs malignant HTN 5 hours ago

We need serial Hb, Plts, LDH, films, formal fundoscopy At a first presentation, the use of eculizumab (or FFP, or PEx) is almost aways empiric as ...

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RE: tolvaptan for ADPKD with imaging suggestive of early liver cirrhosis 6 hours ago

I think it will be worthwhile taking a GI opinion on this . ------------------------------ Rochak Varma MD Phoenix NY (917) 459-0750 -------------...

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RE: Oliguric AKI with tacrolimus 7 hours ago

Cyclosporine vs tacrolimus may not be different in nephrotoxicity. Cyclosporine is less diabetogenic and neurotoxic than tacrolimus. Cosmetic adver...

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RE: GN case 10 hours ago

This is great! Thank you for sharing ------------------------------ Mohammed Alshehri ------------------------------

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RE: GN case 10 hours ago

Thank you Dr.Glassock for your recommendation! I thought about this combination based on 2021 Kdigo GN guidelines but was hesitant due to the lac...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 11 hours ago

I thought hep c response was 12-24 months of treatment and the patient is going on hd now. would make sense to give as treatment of acute renal fai...

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RE: Another TMA...aHUS vs malignant HTN 11 hours ago

I am probably being redundant here, but there is an opinion that some of malignant HTN related TMA is actually aHUS/complement regulation deficienc...

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RE: GN case 11 hours ago

"Do you think treating this with ANCA regimen would be a reasonable approach? " totally see attached and figure below, Dr Glassock's suggestion...

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RE: GN case 11 hours ago

I agree with Dr. Rodby. Do you have RF level and cryoglobulins? . I probably would have used RTX + low dose CYC in this case. I doubt that PLEX wil...

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RE: Another TMA...aHUS vs malignant HTN 13 hours ago

Very interesting case, as well as comments, Is the patient still in renal replacement therapy? If kidney function has not recovered, and bloo...

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RE: GN case 13 hours ago

Thank you Dr.Rodby for your input! Do you think treating this with ANCA regimen would be a reasonable approach? ----------------------------...

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RE: Treatment with trimethoprim/sulfamethoxazole in ANCA-associated vasculitis 14 hours ago

It was effective at treating and prevention respiratory AAV. Our pulmonologists still use it for upper airway disease. It does not do much for rena...

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RE: Oliguric AKI with tacrolimus 14 hours ago

Was the patient also on an ACEI/ARB? Presume PLAR2 is negative? Repeat biopsy seems a good idea. Has renal vein thrombosis been excluded? Any polym...

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RE: GN case 14 hours ago

It is hard to put this together. the typical lesion of SS anemia is FSGS with large glomeruli , sometimes collapsing GN, MPGN was reported by Bakir...

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RE: GN case 14 hours ago

Thank you Dr.Venkat for the comment, we don't have a previous urine analysis to compare. Urine is dark but not bloody. Urine was examine manually:...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 14 hours ago

I also don't see the rational of waiting on the antiviral therapy. It is known that hep C replication will increase after RTX but unlikely Hep B, i...

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RE: GN case 15 hours ago

"Urine studies show active urine sediments and nephrotic range proteinuria." Was the urine grossly bloody (possible renal infarction in sickle cell...

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GN case 16 hours ago

A 38-year-old female with a history of transfusion dependent sickle cell anemia complicated with iron overload. She also has new diagnosis of Liver...

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RE: Hyponatremia in the ED 20 hours ago

Clearly this specific issue is causing problems and physician frustration If the number of cases could be reduced, then there would be less presen...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 20 hours ago

If there was 12 years between biopsies, then progression has been slow Where is she having the infusions ? if they were at home - then could be s...

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RE: tolvaptan for ADPKD with imaging suggestive of early liver cirrhosis 20 hours ago

I presume portal vein pressures normal ? ------------------------------ Shlomo Cohney FASN, PhD, FRACP, MRCP, MBBS Associate Professor University...

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SLE with proteinuria 23 hours ago

I have 23years old female patient known case of SLE, lupus nephritis, she was following in other hospital, kept on steroid, and cellcept. Presented...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 1 day ago

I support rtx Plasma exh then hep c txt Let us know how they did Thanks ------------------------------

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RE: Hyponatremia in the ED 1 day ago

Exactly the same with us. It helps to hear we are not alone! It is a LOT of hyponatremia! Same exact experience and concerns about burnout. You are...

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RE: Hyponatremia in the ED 1 day ago

YES. Exactly our experience. Thanks for the commiseration. ------------------------------ Meera Bajwa MD Marin Nephrology Greenbrae CA -----------...

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RE: Hyponatremia in the ED 1 day ago

This is what I am inclined to do....that being said if sodium is 123 and they're going to give a liter of saline and it will shut off ADH, do I nee...

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RE: Hyponatremia in the ED 1 day ago

I am inclined to agree with this point of view. No there is no thought to the hyponatremia in these patients, many of whom are old. This is what I ...

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RE: Hyponatremia in the ED 1 day ago

Yes--they are almost always administering NS to hyponatremic patients in the ED. That seems to be the real source of the problem and my question. T...

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RE: Hyponatremia in the ED 1 day ago

The esteemed and brilliant Dr. Phams were my teachers so I will definitely read it. Thanks! ------------------------------ Meera Bajwa MD Marin Ne...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Uploaded deidentified biopsy from 12 years prior - "moderate fibrosis". Has iron deficiency with a Hg range 10.5 to 12. Vit D deficiency, PTH/Phos ...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Thank you! ------------------------------ Nina Vasavada MD Louisville KY (502) 852-5757 ------------------------------

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Midodrine does seem like the next step and we will likely start this Perhaps I can cut back on salt tablets if her BP responds well - it is a relat...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Will post urine soon as obtained, thanks Here is most recent BMP: Na 131, K 1.4, Cl 89, CO2 30, BUN 43, Cr 2.07, Gluc 102, Ca 8.7. She likely lives...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

This is fascinating and I will look into. I think she would tolerate tacro well overall. ------------------------------ Nina Vasavada MD Louisvill...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Thank you! A lot to consider! ------------------------------ Nina Vasavada MD Louisville KY (502) 852-5757 ------------------------------

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RE: Hyponatremia in the ED 1 day ago

Hyponatremia is a major contributor to burnout. Most of our on call nights are sleepless, as we usually have 2-3 patients with low sodium levels an...

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RE: Hyponatremia in the ED 1 day ago

This problem is not limited to small practices or rural areas. I am one of 11 nephrologists in a practice 60 miles from NYC. Treatment of hyponatre...

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RE: Atypical ANCA vasculitis or immune complex GN with false ANCA? 1 day ago

In otherwise typical "pauci-immune" necrotizing and crescentic GN (ANCA +) the RF is not elevated. A + RF could be a sign of an Associated Cryoglob...

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RE: Atypical ANCA vasculitis or immune complex GN with false ANCA? 1 day ago

Question(s) The second biopsy is 6 weeks after the first which was described as having 100% crescents and yet the second biopsy reports only 10...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 1 day ago

Certainly outside of routine clinical practice. Firstly, can I ask how much fibrosis on the renal biopsy and how long ago was it ? Does she have o...

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RE: Another TMA...aHUS vs malignant HTN 1 day ago

Just for completeness I assume there were visible red cell fragments What was Hb ? What has happened to LDH - which can also reflect renal is...

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RE: Oliguric AKI with tacrolimus 1 day ago

In a small but well done study Weins and Ball (Front Pediatr, 2015). Found repeated bouts of AKI of varying severity in Children with SRNS in about...

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RE: Another TMA...aHUS vs malignant HTN 2 days ago

The absence of a history of HTN and no LVH on ECG make a Dx of malignant HT problematic. As an old school doc, I place emphasis on grade 3/4 fundus...

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RE: Hyponatremia in the ED 2 days ago

Phuong -Chi T. Pham FASN and Phuong-Tu T. Pham FASN Nephrology and Hypertension Board Review First addition This review suggests a very simple us...

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RE: tolvaptan for ADPKD with imaging suggestive of early liver cirrhosis 2 days ago

A curious mind would like to know - If he is consuming beer instead of water. : ) - How many tiny cysts the liver had in the left side of the live...

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RE: Oliguric AKI with tacrolimus 2 days ago

Serum albumin 1.7 Upr/cr 8.2 ------------------------------ Michael Allon MD University of Alabama at Birmingham Birmingham AL (205) 975-9676 ----...

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RE: Bartter Syndrome with worsening kidney function and recalcitrant hypokalemia 2 days ago

Have you considered that oral salt loading may be promoting the massive K loss? If so, eliminate NaCl and resume low dose indomethacin &/or an alph...

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