RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 4 hours ago

Dr. Lerman, in his case, the Na corrected gradually-123 this past Friday, 127 on Sat, 131 Sunday and 135 yesterday and today and he was discharged ...

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RE: Obstructing Urinary Stone 5 hours ago

Thanks- the obstructing stone was uneventfully removed via ureteroscopy last week . The patient is now home without any symptoms , I am awaiting ne...

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RE: Obstructing Urinary Stone 6 hours ago

So sorry; I know no one may be interested in this thread anymore; but I did talk to a few of our endourologists about this. In my experience, the...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 7 hours ago

Thanks , have attached the final report from Thailand for review. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisio...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 7 hours ago

I agree with Dr. Rodby. This is not Class I LN . The subepithelial depidits inducted an early Class V +II lesion. I would treat with MMF + low dose...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 9 hours ago

subepithelial and mesangial deposits on EM I suspect this is an early lupus membranous (V) responsible for the proteinuria, at 1 gram, I thin...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 10 hours ago

If the transplant biopsy reveals TMA, I would definitely evaluate complement activity and perform genetic analyses. -----------------------------...

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RE: Sarcoidosis? 12 hours ago

I do not but I think anything approaching 2 I think I would avoid. Epocrates says CrCl (eGFR) 10-50 usual dose by 50%, [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 12 hours ago

Re tolvaptan: Dr Hirsch: "Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, ju...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 12 hours ago

Thanks for the follow-up! You should report this. Case reports are case reports but when you have a case like this, it feels like a seminal event. ...

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RE: 28 year old patient with severe myasthenia/myopathy whose strength significantly improves after dialysis. 12 hours ago

Dear Colleagues: Thank you all for your great responses, and i will let you know what happened. To recap, the patietn developed kidney failure of u...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 12 hours ago

Dr. Anand-how quickly did serum sodium rise in relation to iv Bumex , have you repeated urine sodium. I want to discuss the risk if any regarding C...

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RE: AKI & Immune complex GN 14 hours ago

Her serologies including lupus, and compliments were normal at the beginning of the workup, and were not repeated. She's coming back next week. I ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 14 hours ago

Thank you, Drs. Lerman and Venkat. I am glad the Page-kidney report was helpful. Professor Glassock, I agree that an allograft biopsy, once the pl...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 16 hours ago

Ok, the test done in Thailand shows 2.9 grams of proteinuria . Am questioning the reliability of the test Examined her and she has no edema She ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 18 hours ago

Interesting case. About 60% of SLE is due to hereditable polygenic factors including genetic variation of HLA, Complement (C2 and C4), Fc gamma rec...

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Class 1 Lupus With Nephrotic Range Proteinuria 22 hours ago

19 year old female seen with rheumatology. She had 1.5 grams proteinuria and no hematuria in June 2026 Ana 1: 640 , ds DNa titer 60 sm RNP positiv...

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RE: AKI & Immune complex GN 23 hours ago

Any follow up on thus , especially SLE serology and current status would be much appreciated.. ------------------------------ Richard Glassock M...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 23 hours ago

Dr. Al-Saegh- Do you plan to perform a transplant kidney biopsy when the platelet count exceeds 50K? . The very slow return of kidney function, t...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Dr. Lerman -I agree that Hepatic Vein Doppler US can give important clues to the presence of Portal Hypertension in Chronic Liver Disease but the "...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Thank you all for your responses, I learnt so many things from this post. My patient's Na finally budged-135 this morning. His BP is stable in t...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

@Edwin Anand-just FYI-Hepatic vein doppler might help to distinguish etiology of low EABV( HYPONATREMIA) in this case from significant TR ----...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

thanks Dr. Liu for the article which drives home all the important points -increased RI, reversal in diastolic flow, perinephric usually sub capsul...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Thank you very much, Professor Lerman. Her younger brother developed ESKD at nearly the same age and underwent a successful kidney transplant seven...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Dr. Lerman: I can recall 2 cases of Page Kidney following kidney transplantation, in the setting of implantation biopsy + early post-transplant sta...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Thank you very much, Professor Glassock. We agree that ATG-associated thrombocytopenia/hemolysis is currently the leading explanation; ATG was stop...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Here is one article for Page kidney after kidney transplant. ------------------------------ Song Liu MD Assistant professor New Mexico University...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Post transplant "Page Kidney" excellent point but never seen it happen in my Transplant Nephrology career . Per literature presents with sudden dec...

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RE: Sarcoidosis? 1 day ago

Dr. Rodby- do you have a threshold of Scr in Sarcoidosis above which you do not use MTX for therapy. Just curious!! ----------------------------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

I have customarily avoided Tolvaptan in patients hospitalized with hyponatremia due to chronic liver , especially if the latter is clinically worse...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

I like the simplicity and the prudent use of laboratory testing!!! Thanks ------------------------------ Richard Glassock MD, FASN Emeritus Prof...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, just redose 7.5 QAM until the ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Looks like ATG induced thrombopenia and hemolysis. Should improve gradually. What is happening to the peri-graft hematoma? Watch out for a "Page Ki...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

@Sheldon Hirsch how do you monitor response to Tolvaptan ?? 1. Decrease in Uosm 2. Increase in urine volume 3. Rise in Pna 4. All of the above ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

I use talvaptan only in-hospital, not chronically (for hyponatremia), and only (usually just several days) until the Na increases (then stop, to pr...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

the potential danger in option 2. is relative overcorrection(I continue to assume asymptomatic hyponatremia?) if necessary due to symptoms or ref...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

thank you for additional details so recipients younger brother had ESRD and successful transplant 7 yrs ago-was brother's donor living vs deceased?...

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RE: AKI & Immune complex GN 1 day ago

I always thought that the absence of a "full house pattern" means no lupus, but seems Pathology believe in the existence of serology negative, inco...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

There are only two options 1.give normal saline or 2.diuretic/aquaretic. You tried option 1 and it didn't work, time to try option 2 -----------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Fist something does add up in the urine osms calculation! what was the urine urea? Is he on SGLT2i with severe glucosuria? GI sodium wasting coul...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Thank you, Professor Venkat. She had significant residual urine output before transplantation: a documented 24-hour urine volume of 1.21 L with cre...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Thank you, Professor Lerman. I share your concern that graft recovery is slower than expected following living-donor transplantation. Her documen...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

I share Dr. Lerman's concern regarding slow decline of serum creatinine and modest urine output following a living donor transplant. I asked about ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Even though urine osm > 500 can predict Free water restriction failure per Dr. Hirsch , if patient is asymptomatic can still observe and escalate i...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Concerned creatinine is falling so skowly usually normal after a few days with living donor. Urine output 1.5 l /day seems low -what was pretranspl...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Did she make urine before transplant? Total WBC and absolute neutrophil and absolute lymphocyte count trends? If these are falling in addition to h...

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Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 1 day ago

Dear colleagues, I seek your opinion regarding a 33-year-old, 55-kg woman following living-donor kidney transplantation. DSA and final T/B-cell cro...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

I agree that liver/heart disease/decreased effective arterial volume is the likely etiology, after the failure to respond to 3L saline. I doubt wat...

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RE: Sarcoidosis? 2 days ago

Be very careful with MTX if thexpatient has a reduced eGFR (adjusted for age) . ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

Dr. Anand - I believe that your assumption that portal hypertension is required for dilitation of splanchnic vessels (and reduced effective arteria...

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