RE: Unclear cause of kidney function reduction in a single kidney 1 hour ago

My AI (Claude) gives a very equivocal answer to this Question. More data is needed. Very tricky issue because of acute effects of SGLT2i on GFR and...

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RE: Unclear cause of kidney function reduction in a single kidney 2 hours ago

Good question. I really do not know. uPEP might pick up urine LC missed by UPCR . ------------------------------ Richard Glassock MD, FASN Emerit...

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RE: Unclear cause of kidney function reduction in a single kidney 3 hours ago

With a normal UPCR, would a UPEP have the mcg-scale sensitivity needed to yield a reliable tubular pattern & the mathematical precision to separate...

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RE: Unclear cause of kidney function reduction in a single kidney 4 hours ago

Interesting and convincing argument. I wonder if a urinary electrophoresis would not give the same information concerning a light chain related tub...

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RE: Unclear cause of kidney function reduction in a single kidney 7 hours ago

Degradation in acidic urine is one of the reasons why I parenthesized β₂M. Without having to withdraw SGLT2i, I went back & forth with AI & ultim...

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RE: Unclear cause of kidney function reduction in a single kidney 13 hours ago

Since SGLT2 inhibitors tend to decrease proximal tubule reabsorption of filtered Beta 2 microglobulin, any increase is such excretion will be diffi...

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RE: Unclear cause of kidney function reduction in a single kidney 13 hours ago

Interesting suggestion. An increased urine B2 microglobulin excretion might be a biomarker of proximal tubule injury in this case. Be sure to alkal...

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RE: Unclear cause of kidney function reduction in a single kidney 15 hours ago

I will reach out to our laboratory personnel. May I know whether it adds clinical information in addition to serum beta-2 microglobulin? --------...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 15 hours ago

Can lab identify which of mixed enteric is urease +ve? If so, can you then try prolonged isolate-directed antibioRx? I’d restart NaHCO3, doubt it’d...

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RE: Unclear cause of kidney function reduction in a single kidney 15 hours ago

Can you check a urine α₁M/Cr (or urine β₂M)? --------------------------------- Oded Friedman ---------------------------------

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RE: is it primary hyperaldosteronism? 18 hours ago

I agree with Dr. Campese. Does this patient have any spontaneous hypokalemia or metabolic alkalosis.? ------------------------------ Richard Gla...

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RE: Unclear cause of kidney function reduction in a single kidney 19 hours ago

Thank you Dr Hirsch for the comments. I am implementing the approach you described. Thanks Dr Lerman. I have been in correspondence with the haem...

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RE: Unclear cause of kidney function reduction in a single kidney 19 hours ago

would consider switching off Pantoprazole as well as other suggestions. the Kappa/lambda ratio 7.75 is high for creat 190umol/l-given unexplained l...

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RE: is it primary hyperaldosteronism? 22 hours ago

Thank you. Confidentiality Notice: This electronic message, including any and all attachments hereto, is intended solely to be used by the individ...

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RE: is it primary hyperaldosteronism? 22 hours ago

I agree that there are compelling reasons to suspect primary Aldo in this patient. However, given the absence of critical information, such as seru...

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RE: is it primary hyperaldosteronism? 23 hours ago

Hi, Dr. Campese, Question about your advice not to start spironolactone. Are you concerned that it would spuriously elevated PRA? Dr. Jebur d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 23 hours ago

I see no issue with using citrate to treat the hypocitraturia and prevent oxalate stone . Have you considered using UROMUNE vaccine , to prevent r...

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RE: is it primary hyperaldosteronism? 23 hours ago

@Vito Campese the use of an ARB should have no effect on Aldosterone levels , as it is autonomous , but may increase Renin levels. I prefer not to...

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RE: is it primary hyperaldosteronism? 1 day ago

I would also discourage starting soironolactone: This would make the lab data uninterpretable. ------------------------------ Vito M Campese Pr...

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RE: is it primary hyperaldosteronism? 1 day ago

Dr. Glassock, as usual, You are raising a very relevant and intriguing point. Atenolol blocks β1-adrenergic stimulation of juxtaglomerular cells a...

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RE: is it primary hyperaldosteronism? 1 day ago

Dr. Campese. Will telmisartan increase PRA in the presence of Beta blocker therapy, as in this case.? ------------------------------ Richard Glas...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

Yes I agree that is quite possible because struvite stones are secondary to infection and the milieu of the renal calyces and pelvis. On thinking t...

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RE: is it primary hyperaldosteronism? 1 day ago

In interpreting PRA and Aldo levels in this patient one should not disregard that he is taking telmisartan; this should result in increased PRA lev...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

Struvite stones are generated mostly by the environment of the urinary tract , primarily ammonia production from urease secreting organisms, indepe...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

On a different note, how reliable are 24 hour urine values in a patient with Stage 4 CKD? Also I believe the stone forming risk decreased as renal ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

I meant the normal CFB , elevated C5b-9,low C3 and low C4 suggest activation of Classic pathway .. but am not sure I clearly understand why the AP5...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

Is this pattern, with normal CFB ,high C5b-9 and low C3/C4, exactly what you would expect in severe LN, without aHUS.? Just wondering. Does it indi...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 1 day ago

good morning/evening Just as a follow up. This gentleman is doing well , his renal function is improving on Obinutuzumab and MMF His initial d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

The cause of the NAGMA is likely the effect of bicarbonate secretion by the ileal pouch, not dRTA This is seen in an about 10-20% of patients with ...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

A urine pH that high is supraphysiologic. It's most likely from bacteriuria or from bacteria growing in the urine after it leaves the body (in the ...

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RE: is it primary hyperaldosteronism? 1 day ago

The obesity in this case represents a major confounding issue in interpretstion of the AAR. In some but not all cases of Obesity related hyperaldos...

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RE: Primary Aldosteronism on Medical Management 2 days ago

Many, myself included, are excited about the utility of ASI for primary aldosteronism but for now it's still exploratory and "off label" in the US....

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RE: is it primary hyperaldosteronism? 2 days ago

in the absence of spontaneous hypokalmia an aldo level > 30 , would be suggestive of Primary hyperaldo. in this case you may have to do confirmat...

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RE: is it primary hyperaldosteronism? 2 days ago

The aldo and PRA are markedly consistent with primary hyperaldo. What is her serum K? The urine K is surprisingly low but not something I'd typic...

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is it primary hyperaldosteronism? 2 days ago

Just wanted to share with the community the following details of a recently diagnosed hypertensive female patient of African origin with poorly con...

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RE: Primary Aldosteronism on Medical Management 2 days ago

It has been a really fruitful discussion. Currently if we decide to continue MRA, I should repeat renin levels and if that comes up, Aldactone is d...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

IMO, there are two almost competing aspects to this case. First, agree with all, we should be careful about giving medicines without clear cut in...

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RE: IgA nephropathy--repeat biopsy at this point? 2 days ago

Thank you so much Dr. Glassock--I appreciate your expertise. ------------------------------ Leah Metz MD Onalaska WI (608) 775-1673 ------------...

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RE: Primary Aldosteronism on Medical Management 2 days ago

"My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control." - v...

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RE: Primary Aldosteronism on Medical Management 2 days ago

Thank you for your answer, However, is it still indicated to change aldactone and finerenon with baxdrostat in those patients on the MRA?? giving...

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RE: Primary Aldosteronism on Medical Management 2 days ago

My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control. ---...

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RE: Proteinuria 2 days ago

This is a very challenging case. The clinical data provides a compelling story supporting Zoledronic acid nephrotoxicity provoking a partial podocy...

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RE: Primary Aldosteronism on Medical Management 2 days ago

Its really an interesting discussion. Thank you for bringing up the same . So in conclusion, we need to abandon aldactone and finerenon and replace...

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RE: Proteinuria 2 days ago

1g albumin per day is not small. I would biopsy if proteinuria persists without sign reduction after max ARB, SGLT2, and MRA (if BP tolerates it). ...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

We often encounter the scinario of unexplained renal function impairment in the context of using multiple synergistic medications , which all combi...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Interesting suggestion of "Ischemic Nephropathy due to RAS in a single kidney . The fact that the solitary kidney is almost 13cm. In length makes t...

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RE: Use rituximab or not 2 days ago

Noted and much appreciated. Will provide follow-up when available. ------------------------------ John Mellas MD Nephrology and Hypertension Spec...

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RE: IgA nephropathy--repeat biopsy at this point? 2 days ago

The original diagnosis likely should have been IgA Vasculitis not Primary IgA . Her long term course is entirely compatible with this diagnosis. Az...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Thank you, Dr Campese, Dr Rodby and Dr Venkat, I have confirmed with the radiologist who reported the MRI, and there was no evidence of renal arte...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

I totally agree with Dr. Rogby. Moreover, where is the scientific evidence that combination of all these drugs provides additive effects independen...

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