IgA nephropathy in the setting of psoriasis/psoriatic arthritis 9 hours ago

Dear all, can I please get your thoughts with my patient. 48-year-old male with psoriatic arthritis and hypertension presents with worsening kidn...

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RE: Anti-gap positive metabolic acidosis 10 hours ago

I agree venous pH is important just a little more difficult in a two year-old that I was consulted on the phone for a " curbside" consult .He was a...

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RE: Anti-gap positive metabolic acidosis 14 hours ago

I'm an adult nephrologist. Blood work is just harder to get on little kids but working on it. Sent from my iPhone On Sep 5, 2026, at 06:56, James H...

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RE: Anti-gap positive metabolic acidosis 15 hours ago

You're not critical, but there are some logistical issues. I was curbside consulted on the phone about this case. A pediatric nephrologist saw the ...

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RE: Anti-gap positive metabolic acidosis 15 hours ago

Yes I was thinking of hunting zebras. The child is nearly 3 and at the 50th percentile in both height and weight with normal intellectual function ...

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RE: Anti-gap positive metabolic acidosis 16 hours ago

Child voided in the laboratory and the mother reports the lab results were ready in less than an hour. Child hasnever received aspirin only acetami...

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RE: Hyponatremia 17 hours ago

Drs. Hirsch and Rodby - thank you. I think we largely agree clinically; my remaining points concern the limits of individual measurements. Dr. Hir...

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RE: Anti-gap positive metabolic acidosis 18 hours ago

Mother denies salicylate ingestion, and she is quite reliable person Sent from my iPhone

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RE: Anti-gap positive metabolic acidosis 18 hours ago

Please forgive me if I'm being critical, but Venus blood gases are so important in the initial evaluation of the serum electrolytes and anion gap. ...

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RE: Anti-gap positive metabolic acidosis 18 hours ago

Agree if previous recommended studied unraveling and VBG consistent with MA and osmolar gap are unrevealing Then plasma amino acids, acylcarniti...

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RE: Anti-gap positive metabolic acidosis 19 hours ago

The abdominal pain may be a non specific symptom of the acidosis. The elevated U Na suggests the unmeasured anion is being excreted in the urine. A...

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RE: Hyponatremia 19 hours ago

Thank you, Dr Liu, very nice. > However, in SIADH, the urine is concentrated (or at least not maximally dilute), so you will not have a vast u...

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RE: Latent TB and Membranous Nephropathy 22 hours ago

Be sure to screen for any HBV before giving RTX or OBI ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School ...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Also intense thirst and polyuria are often seen in the early phases of salicylate intoxication. The blood salicylate levels should prove to be inte...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Venus, blood gas is ordered, but not yet obtained. Ultrasound of abdomen is normal. Minimal to no abdominal tenderness.I forgot the blood sugar ear...

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RE: Anti-gap positive metabolic acidosis 1 day ago

The alkaline urine and HAGMA suggests salicylate intoxication. However, if the urine pH was not tested immediately after voiding , it could be a sp...

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RE: Anti-gap positive metabolic acidosis 1 day ago

venous BG? ketones? BG? acetylsalicylic acid level? B-hydroxybutyrate ?, BP? imaging for abdominal tenderness? assume no glucose or ketones in urin...

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RE: Latent TB and Membranous Nephropathy 1 day ago

With a Hemoglobin of 10.8 there is no rush to give EPO. The severe Hypoalbuminemia can be an indication for Warfarin prophylaxis of VTE but the GI ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

The therapy of polygenic LN is the same as with no famiky members involved. I do not know if Mendelian LN should be treat differently -too rare, no...

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RE: Latent TB and Membranous Nephropathy 1 day ago

Any one can help me with questions? Appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

If genetic lupus proven does that change management ? And if say children of patient were to have microscopic Haematuria and positive dna would w...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Thanks for case Agree with colleagues Is this not a NFH class V MLN with possibly class 2 Did the urine dip have red cell cast ? I would also us...

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

I agree with Dr. Venkat. ------------------------------ Song Liu MD Assistant professor New Mexico University Hospital Albuquerque NM (505) 456-7...

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

I agree with your plans to proceed with complement and genetic studies and deferring biopsy at present. Please do post follow-up information and ed...

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

Dear Professors Glassock and Liu, Thank you. I agree that biopsy and complement/genetic evaluation are complementary. However, since September 1,...

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Anti-gap positive metabolic acidosis 1 day ago

I was called to consult by phone on an interesting case. I am baffled and I'm hoping you'll be able to help me. 2 year 10 month old male with his...

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RE: Hyponatremia 1 day ago

Thank you, Dr. Hirsch - I agree that chronic SIADH generally reaches sodium balance and that superimposed gastrointestinal loss or post-diuretic vo...

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

I think the bottom line is if TMA is confirmed and TAC is reasonably implicated it should not be restarted. Belatacept would be indicated IMO rathe...

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

I agree- TAC induced TMA is an idiosyncratic reaction . Difficult or impossible to predict and not dose related, so it can occur or recurr even at ...

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

i don't disagree with restarting tac but FYI CNI associated TMA is not dose related. ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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

Thank you very much. The actual donor is a 23-year-old living-related female. Preoperative typing demonstrated limited HLA matching: 2/10 alleles (...

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

What about not restarting TAC and giving Belatacept instead? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen S...

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

Dr. Al-Saegh: Thanks for the update. Your patient is young. This increases risk of rejection if tacrolimus is withheld for too long. What was the ...

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RE: Hyponatremia 1 day ago

Agree with Dr's Neilson and Rodby. The standard teaching is that chronic SIADH is a state of Na balance: what goes in, goes out, U Na will reflect ...

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

Thank you. From POD2–POD7, urine output recovered after hemorrhagic shock and has remained satisfactory. Creatinine improved sequentially from 2.31...

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RE: Hyponatremia 1 day ago

In pure SIADH the urine sodium is a function of diet so it can be anything. I agree with Rodby that a low urine sodium is somewhat unusual. I don't...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

FYI-See Nipp R et al Case Rep Onc Med 2014: 27: 165670 for a very similar case, ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

Addendum - a meaningful but fairly small subset of Waldenstroms Macroglobulinemia patients display Rheumatoid factor (anti-IgG ) activity of the Ig...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

This new data clearly reclassifies the patients Disease from a MGRS to a neoplastic process demanding specific therapy for Waldenstroms Macroglibuk...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

Update to thread - new molecular result Thank you all for the discussion so far; your insights are most valuable. I suspect this to be clone resi...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

I agree with Dr. Aledan - the EM shoes typical findings of an early rather segmental form of MN, probably Class V LN or conceivably a NELL 1 MN sup...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

Thanks Dr. Mohammed- interesting information. I believe that Mendelian inheritance of SLE is very rare - about 1% and most often seen in young chil...

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RE: Hyponatremia 2 days ago

liver disease is a potent stimulus Na (renin) AND water (ADH) reabsorption, I agree I would have a hard time diagnosing SIADH in ANY liver patie...

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RE: Hyponatremia 2 days ago

Can a diagnosis of a "simple " case of SIADH be made with a urine Sodium of < 10mM/L in the presence of severe chronic liver disease ? In short, I ...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

Dr, Dastoor thanks for you kind remarks. Much appreciated. Here are my responses to your questions- 1) differentiation of monoclonal B cell ...

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RE: Hyponatremia 2 days ago

Agree. I have seen cases in which there is an obvious non-volume etiology of ADH release but the U Na is low. For example, with superimposed GI los...

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RE: Hyponatremia 2 days ago

I would like to add the caveat that the UNa as a surrogate for effective circulating volume is only valid if the urine is concentrated. The urine N...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

First , I want to applaud @Richard Glassock. He has this amazing talent , where he simplifies a tortous and complicated case , then interprets it's...

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RE: Hyponatremia 2 days ago

Yes, that illustrates the critical role of the U Na in hyponatremia.If it is high, then you can make the diagnosis of euvolemic ADH release and you...

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RE: Hyponatremia 2 days ago

"NS Saline is not the treatment of choice for SIADH. " Depending on the urine osmolality and unless true volume depleted isotonic saline (NS) may ...

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