RE: hypophosphatemia suspocious for TIO 5 hours ago

FGF23 is not very high, but may be inappropriate. What was the serum phos when the urine was collected? Did you also get urine calcium and creatini...

View Discussion

RE: hypophosphatemia suspocious for TIO 6 hours ago

Does he take OTC antacids (calcium, aluminum or magnesium-containing) or Carafate (contains aluminum) intermittently? All these bind phosphate in t...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 8 hours ago

Our cardiology colleagues practice goal directed medical therapy i(GDMT) n regards to testament of HFrEF, CAD, etc. This is all based on excellent ...

View Discussion

RE: hypophosphatemia suspocious for TIO 8 hours ago

Patient denies any aspirin use at all, or any anxiety or dyspnea. His last hemoglobin was normal at 15.6 in December, 2022. His last blood pressure...

View Discussion

RE: hypophosphatemia suspocious for TIO 8 hours ago

Any signs or symptoms of an acute/chronic respiratory alkalosis or aspirin overdosing? ------------------------------ Richard Glassock MD, FASN L...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 9 hours ago

The following review mentions paracrine renal effects from SGLT2-I acting on perinephric fat - decreased production of leptin and other adipokines....

View Discussion

RE: hypophosphatemia suspocious for TIO 9 hours ago

Urine analysis in February, 2023 was completely normal, special gravity 1.020 and pH 7.5. Urinalysis has always been without any glucose since 2003...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 10 hours ago

APLS sent waiting for result This neck swelling is strange ! no mach cellulitis clinically or ludwig s angina ! Reactive lymphadenopathy is it par...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 10 hours ago

Study should start soon in incident HD (although just a pilot-trial-12 week exposure). I'd note that in EMPA-KIDNEY at least, SGLT2i were not stopp...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 10 hours ago

@David Charytan is going to study SGLT2i in dialysis patients and resolve this important question. ------------------------------ David S. Goldf...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 11 hours ago

"No hurry to biopsy" IMO it is now or never and now is too risky I think you have enough for empiric treatment Have you looked for Anti-phosp...

View Discussion

RE: hypophosphatemia suspocious for TIO 11 hours ago

FGF 218 is not impressive, although I believe there are some nuances to how FGF23 is run @Stuart Sprague FGF not very high but would you expe...

View Discussion

hypophosphatemia suspocious for TIO 12 hours ago

White gentleman age 61, started seeing nephrology for acute kidney injury when creatinine rose to 1.9 in June, 2022 after CT with IV contrast done ...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 12 hours ago

Hi all Unfortunately patient got neck swelling more on the left than right Soft tissue us showed sc odema,cellulitis?? Reactive lymphadenopathy Swe...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 14 hours ago

Hlad to know that PTX can replace quinine which is no longer available for cramps. Will pass this along to my graduates at the NKF --------------...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 15 hours ago

Has anyone worked out the mechanism for the ESa dose reduction. Do inflammatory markers change? Sent from Mail for Windows

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 15 hours ago

Many thanks. Has the RCT in Europe been published.?. I can't find it. I assume it was in DN, not FSGS ------------------------------ Richard Glas...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 15 hours ago

I, and my grauating trainees, use the drug in dialysis patient with the benefit of reducing cramps (work for good percentage). Also, PTX reduce ESA...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 15 hours ago

@Richard Glassock Yes, PTX efficacy has been shown in RCT in Europe. The VA embarked on repeating the study in the USA. They are using smaller dose...

View Discussion

RE: Hypercalcemia and Microscopic Polyangiitis 17 hours ago

Thanks for the follow-up. Unfortunately, in many posts in the Forum, final outcomes/diagnosis are not provided. Obviously, without such information...

View Discussion

RE: Guidance for acceptable KDPI in a younger patient 18 hours ago

Your patient being an unsensitized O getting an DD kidney offer after only 1 year is faster than expected depending on your geographical location. ...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 19 hours ago

As I had commented before. until there is a good RCT study, rationality obliges. to use the medication similar to lipid-lowering agents. If the pat...

View Discussion

RE: Hypercalcemia and Microscopic Polyangiitis 19 hours ago

Thanks for f/u Malignancy was my first impression --------------------------------- Bajinder Reen MD Brampton ON (905) 453-0821 ---------------...

View Discussion

RE: How to get re-credentialled in Nephrology 19 hours ago

Thanks everyone

View Discussion

RE: Hypercalcemia and Microscopic Polyangiitis 19 hours ago

Dr. Dinh- thanks for the follow-up. Sorry about the bad outcome. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 3...

View Discussion

RE: Hypercalcemia and Microscopic Polyangiitis 20 hours ago

Thank you Dr venkat I just wanted to give a followup and closure to this case. The urine microscopy showed tons of coarsely granular casts c/w ATN...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

this issue of urinary loss of Rituximab attenuating its effect is interesting but lets think about it, we use it a lot in patients with severe prot...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 1 day ago

Attached see a proposed study out of the VA system. published about 1.5 years ago I have used the drug t for PVD but not for proteinuria. The trial...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

meant to attach this ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center ...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

Is this really serum sickness, isnt that an antibody reaction to some antigen? That takes time, typically one to two weeks.. This appears to be i...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

Dr. Rubin. Good question . The passive serum sickness occurs in minutes as the endogenous kappa RF (anti-gamma globulin)binds with infused Rituxima...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 1 day ago

Interesting idea. Has the effects of Pentoxyphyline on DN ever been independently confirmed in a RCT. I doubt it. Also I know of no data supporting...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

Since proteinuria and hematuria have been present since May 2022 with increase in SCr from 120 to 525 micromols: 1. Do you have SCr levels over pas...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 1 day ago

Agree , Labs and Biopsy against primary FSGS and no indication for IS Maximamize supprotive and may add SGLT inhibitor -----------------------...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

I have a burning question Dr. Glassock. She has massive proteinuria. In this setting, reduced blood levels of Rituximab and more recently, eculizum...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 1 day ago

Another drug to add is pentoxifylline. It is very cheap and was shown in DN to reduce proteinuria and preserve renal function. Mechanism were never...

View Discussion

RE: Cryoglobulinemic MPGN 1 day ago

Very tough case with such recalcitrant non-compliance. I would treat emperically with RTX and low dose steroids and SMX/TMP for PJP prophylaxis . I...

View Discussion

Cryoglobulinemic MPGN 1 day ago

60 year old female S/P Post liver Tx 2010 / HBV with seroconversion, Treated HCV with sustained virological response On entecavir DM > 20 years - u...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

I agree with Dr. Klein about the role of ABIM certification in Re-credentialing. Since ABIM certification and recertification is a voluntary effort...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 1 day ago

Very interesting question. No good answer since there are no RCT of SGLT2i for CHF (HFrEF or HFpEF) in patients with ESKD on dialysis with no or ve...

View Discussion

RE: SGLT2Is in anuric patient on dialysis 1 day ago

I don't know what FEVI is but if this patient has heart failure I would continue it. the cardioprotective effects appear to be independent of the e...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

The reentry program at Cedars Sinai was run by Leo Gordon. It involved an oral exam by five nephrologists for about one hour. I don't know if we re...

View Discussion

SGLT2Is in anuric patient on dialysis 1 day ago

Hi! My name is Denisse, i'm nephrology fellow in Mexico, and recently i had a patient with 2 years in peritoneal dialysis without residual urine vo...

View Discussion

RE: Acute Antibody Rejection With Mild Biopsy Findings 1 day ago

I agree with Dr. Lerman that a rapid increase in SCr from 0.8 mg to 2.0 mg is unlikely to be the result of CNI-nephrotoxicity. However, a gradual c...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

The requirements to obtain privileges are defined by the hospital's bylaws. After a set period of time not practicing in your specialty you will be...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

The physician did not take a few years off from the practice of medicine. He practiced as a hospitalist where I am sure he dealt with nephrology pr...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

Satya: Good luck to you, as always. Dr Glassock has pointed out a viable option for re-certification which will help in re-credentialing. I don't k...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

As is usual Dr. Glassock gave you the answer to this conundrum in his last comment: restriction of your trade. The hospital & nephrology staff are ...

View Discussion

RE: Acute Antibody Rejection With Mild Biopsy Findings 1 day ago

I doubt a Tac level 8.5 is high enough to explain creatinine 0.8 -2 and response 2-1.4 with steroids suggests ACR even if biopsy is only borderline...

View Discussion

RE: How to get re-credentialled in Nephrology 1 day ago

This is physician reentry after prolonged absence not due to disciplinary action. It's governed by state laws and hospitals set up reentry programs...

View Discussion