RE: Unexplained Renal Failure or Not 29 minutes ago

What is the 24 hour creatinine excretion compared to estimates based on Age, sex, weight, height?. Ethnicity. I would do a measured GFR. I have lil...

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RE: Unexplained Renal Failure or Not 1 hour ago

Peak SCr levels during 2 episodes of rhabdomyolysis? May consider an accurate 24hr urine collection for measured creatinine clearance or radioisoto...

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RE: salt losing nephropathy 1 hour ago

In a steady state with euvolemia and negligible insensible losses of Na and H2O; 2000 ml .45% NS = 154 meq Na in, 1000 ml H2O in, 154 meq Na out, 1...

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RE: salt losing nephropathy 2 hours ago

In a situation of euvolemia and a steady state with negligible insensible losses of Na and H20. 2000 ml .45% NS = 154 meq Na in, 1000 ml free wat...

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RE: salt losing nephropathy 2 hours ago

@John Mellas i didn't understand point number 2. Is it possible you could elaborate with some numbers ...thank you ------------------------------...

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RE: salt losing nephropathy 3 hours ago

2 points; 1 If the kidney function is improving a salt wasting state is not likely and reflects infused and retained solute. 2 The urine Na exc...

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Unexplained Renal Failure or Not 3 hours ago

This is a case of a 42 year old male , who is the legal counsel of our hospital. He comes from London , but is of mixed Afro Caribean origin from...

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RE: Denovo Idiopathic MPGN of Renal Allograft 4 hours ago

Dr. Sarwat- thanks for posting the native and allograft biopsy reports. As I was concerned given using Tac monotherapy alone- particularly in a pat...

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RE: salt losing nephropathy 7 hours ago

Your patient is experiencing polyuria from an osmotic diuresis (NaCl induced). I suspect that thus is more related to the infusion therapy than to ...

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RE: salt losing nephropathy 7 hours ago

In a normal subject infusion of 0.45% Saline would be expected to induced a water diuresis (suppress ADH) so urine sodium concentration would decli...

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RE: salt losing nephropathy 7 hours ago

The specimen is not native renal urine; it has transited an intestinal reservoir,, which actively reabsorbs and secretes electrolytes and water. Bo...

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RE: salt losing nephropathy 9 hours ago

In steady state, urinary sodium reflects intake. Normal saline has double sodium content and urinary sodium expected to be higher ---------------...

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RE: salt losing nephropathy 12 hours ago

Out of curiosity , a question for anyone What would you expect urine Na to show if u infuse a patient 0.45% Nacl vs 0.9% Nacl. Will it be around ...

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RE: salt losing nephropathy 13 hours ago

He was resuscitated with NS initially then shifted to RL --------------------------------- Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ----...

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RE: salt losing nephropathy 15 hours ago

(He is anuric for few hours) , can we consider him truley anuric? Did you repeat renal US and the hydro resolved. What is the type of fluids an...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 16 hours ago

I wondered, he is minimally proteinuric , which apparently denotes lack of active disease in the presence of advanced renal failure!!, what s the r...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 16 hours ago

Whats kidney size by US study? Girst biopsy was on 2017. I feel repeat kidney biopsy is imperative for further planning of the management. If, IFTA...

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RE: salt losing nephropathy 1 day ago

Sorry, misread the Urine k of 7 mmol/l as serum K ... Apologies --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional He...

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RE: salt losing nephropathy 1 day ago

Thank you for your replys. The patient is hypokalemic and hypernatremic with diuresis and natriuresia. His creatinine amounts to 3.2 mg/dl and ure...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

Patient initially Received LKDT from her sister that lasted 2 years but failed due to CNI toxicity . she is now s/p DDKT since 2016 , Creat continu...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

2004 Native Biopsy The tissue examined at the ultrastructural level includes one (1) glomerulus. The capillaries appear largely obsolescent, wit...

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RE: salt losing nephropathy 1 day ago

Looks like post obstructive diuresis . How high was the urea or BUN levels . Any clue why despite the diuresis the K is high??? Is it due to obst...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

thanks. Will talk to pathologist. Jingjing ------------------------------ JingJing Zhang MD, PhD [Associate professor of Medicine] Sidney Kimme...

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RE: salt losing nephropathy 1 day ago

Most likely postobstructive diuresis , urine studies c/w osmolar diuresis . Slowly reduce fluid replacement and correct hypernatremia with hypotoni...

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salt losing nephropathy 1 day ago

45 year old patient with a history of total cystectomy due to ca. bladder with creation of surgical pouch as an artificial kidney from bowel loop, ...

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RE: GLP -1 RA question 1 day ago

I agree- the problem is not the GLP1RA per se but the rapidity of HBA1c fall that us the hazard for worsening pre-existing Diabetic Retinopathy. ...

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RE: GLP -1 RA question 1 day ago

"can we start GLP1-RA in view of treated diabetic retinopathy? Yes what if diabetic retinopathy was not yet treated would colleagues start GLP-1 ...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

I have encountered quite a few cases of "C3G" diagnosed by very good renal pathologists that turned out to be PGNMID with masked monoclonal deposit...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Hi, Dr. El-Meanawy, thanks for another thought. The previous pathologist retired, I will discuss with current pathologist to see if he can hel...

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RE: GLP -1 RA question 1 day ago

8-9 % ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transplant Medical...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Thank you so much for sharing the experience. I feel more confident now about using these agents if needed. best, jingjing ----------------...

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RE: GLP -1 RA question 1 day ago

The risk of worsening retinopathy is not related to GLP-1 -, It's the rapidity of the correction of the hemoglobin A1c which is usually temporary ....

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RE: GLP -1 RA question 1 day ago

Hb1ac 80-90 --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: GLP -1 RA question 1 day ago

How high is Hgl A1c levels? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancrea...

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GLP -1 RA question 1 day ago

1- patient has Type 2 diabetes and treated diabetic retinopathy and CKD 4 with increased BMI and HB1AC not in range can we start GLP1-RA in view ...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Dr. Schwartz- thanks for the PDF's of the citations,. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School o...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Here are the 2024 ASN Presentation and the 2025 NEJM Publication of Valiant trial. ------------------------------ John Schwartz MD Dallas Ne...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Dr. El-Meanawy raises an interesting point that requires additional consideration, I think. Although tge clinical and pathological features of tgis...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

The stability of creatinine through the years is interesting. I have seen IgG related GN / MN with hidden epitopes mascaraed as C3. The problem...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

The Sobi ERA 2026 release looks like the right lead — let me pull the full poster list. I think the poster you mean is first-authored by **Dean Wa...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

In terms of infections , I have used Pegcetacoplan in around 10 cases with C3G and Iptacopan for 8 patients with IgA Nephroapthy. All patients wer...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Hi, Dr. Dastoor, thanks for your suggestions and reference. I am wondering if the increase of proteinuria is due to worsening kidney function s...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Hi, Dr. Lerman, thank you so much for your suggestions. I will relay your opinion to our transplant team. Jingjing ------------------...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Hi, Dr. Glassock, thank you so much for the reply. I am actually not sure between these two. Our pathologist reported C3GN. I did not see lipod...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

What type of donor LKD vs DD ? Tac monotherapy is unusual unless HLA identical LKD which is still uncommon not to use antimetabolites +/- low dose ...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

It depends on whether the C3 IF was interpreted from an advanced sclerotic glomeruli or not. We need to see the full (deidentified ) full biopsy re...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

Wouldn’t ‘trace’ C3, despite low serum C3, weigh heavily against both (masked) PGNMID & IRGN? C3 staining is nearly universal in PGNMID & C3 domina...

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RE: A case of a young man with a biopsy showing full house pattern on IF, with negative Lupus serology and positive MPO Antibody 3 days ago

He has not taken Hydralazine ------------------------------ Katafan Achkar MD, FASN Houston Methodist Hospital and CLS Health Webster TX (832) 46...

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RE: Denovo Idiopathic MPGN of Renal Allograft 3 days ago

What was the evidence that the disease of the native kidney was IgAN? I agree with Dr. Rodby that excluding an infection or PGNMID is very importan...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 3 days ago

Thanks Dr. Lerman Very helpful advice. I also agree with the suggestions of Dr. Dastoor, but I am not optimistic about favorable response to Pegcet...

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