RE: Opinion kidney biopsy 57 minutes ago

Dr Glassock and Dr Rodby any comments on the biopsy posted --------------------------------- Bajinder Reen MD Brampton ON (905) 453-0821 -------...

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RE: Crescentic IgAN 1 hour ago

Dr. Hirsch. - From the standpoint of the prognostic significance of crescentic lesions- the feature mist strongly associated with poor outcomes is ...

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RE: Opinion kidney biopsy 1 hour ago

Dear Dr vankat Thank you for your opinion and agree with youresponse That is why i posted --------------------------------- Bajinder Reen MD Bram...

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RE: Opinion kidney biopsy 2 hours ago

Serum kappa level is higher than lambda light chain level. Some of the elevation in kappa could be from renal dysfunction. However, biopsy report m...

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RE: Crescentic IgAN 2 hours ago

Would you R/o mmf in an Asian patient. I will consider --------------------------------- Bajinder Reen MD Brampton ON (905) 453-0821 ----------...

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RE: igg4 related disease-how to treat 2 hours ago

We have treated 2-3 patients with rituximab with good results. See the attached study. https://ard.bmj.com/content/74/6/1171 -------------------...

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Opinion RE: kidney biopsy 2 hours ago

Please see attached deidentified biopsy slides for history and pathology. This patient had a bone marrow biopsy which was normocellular and no cl...

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RE: Proteinuria in Kidney Transplant 3 hours ago

Hi BMI is ~30 and BP has been normal. I have cross posted this case in American Society of Transplantation as well, which helped me with receiving ...

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Elevated Renin with Normal aldosterone 4 hours ago

I am interested in suggestions on answering a physician's question about workup for high renin. A female patient, 40's, has hypertension treated wi...

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RE: A interesting hyponatremia case 4 hours ago

Dr.Huang, I might have missed, could you please list all her medication Home as well as in the hospital. Her lipid profile if any> Thx Dr.Ariv.Sw...

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RE: Crescentic IgAN 5 hours ago

With C1 lesions, nephrotic proteinuria and a normal serum creatinine, there is no doubt in my mind that these lesions and the proteinuria need immu...

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RE: A interesting hyponatremia case 5 hours ago

The high measured serum osmolality may be due to the fact she is so ill and leaking amino acids and other intracellualr osmotically active substanc...

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RE: A interesting hyponatremia case 6 hours ago

Thank you, all for your interesting in this case. Dr. Rodby: her Scr has always been normal since adm, in the range 0.33 to 0.74. The newer ones w...

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RE: A interesting hyponatremia case 6 hours ago

Looks like SIADH. The anasarca is likely related to significant IV Na infusions during a rocky and complicated hospital course. My guess is the osm...

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RE: Crescentic IgAN 7 hours ago

Roger: I'd do the same, with persistent nephrotic proteinuria and the diagnosis of "very awful looking lesions"! But I wonder this: Crescents are o...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 7 hours ago

Dr Glassock: do you use the PLA2R to predict the chances of a spontaneous remission and the decision to wait (vs treat immediately) and, if so, wha...

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RE: A interesting hyponatremia case 7 hours ago

Interesting problem indeed. One still has to explain the osmolar difference of 30mmol/L ! It remoinds of cases we see when urologists perfuse the b...

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RE: A interesting hyponatremia case 7 hours ago

Any liver issues ? as Dr Glassock suggested paraproteins ... Lipoprotein X is also linked to hyponatremia. Your assessment otherwise seems spot on....

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RE: A interesting hyponatremia case 7 hours ago

Interesting case. This appears to be a case of true hyponatremia (physiologically speaking) due to the presence of an osmotically active substance ...

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igg4 related disease-how to treat 8 hours ago

63-year-old female presented with a prodrome of 2-3 weeks of nightly chills and a headache and night sweats. No fevers. No previous history of an...

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RE: Crescentic IgAN 8 hours ago

ANCA negative Steroids was (and I HATE steroids) my thought too And I like the idea of maintenance with MMF afterward based on older and that new A...

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RE: A interesting hyponatremia case 8 hours ago

it acts like SIADH with the low serum Na/uric acid but Serum osm is normal. There must be some other circulating osmol. What was the Cl. The adrena...

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RE: A interesting hyponatremia case 8 hours ago

diagnosing inappropriate ADH in the setting of edema is tough, but I agree with your assessment. the declination with volume administration is clas...

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RE: Using icodextran for manual exchanges 8 hours ago

I assume the problem is with icodextrin, not icodextran because I am not aware of the availability of this solute that differs markly in its molecu...

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RE: Membranous with GFR 15 ml and bx not consistent with severity 10 hours ago

Dr. Tayeb: Has SCr continued to increase since 1/23/23? SAlb level? if renal function is worsening rapidly, there must be a component of AKI-on-CKD...

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RE: A interesting hyponatremia case 19 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 19 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 19 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 20 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 20 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 20 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 20 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 21 hours ago

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

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RE: Crescentic IgAN 23 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 23 hours ago

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

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Crescentic IgAN 1 day 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 1 day ago

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

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Using icodextran for manual exchanges 1 day 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? 1 day 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 2 days 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 2 days 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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