RE: Hypercalcemia case 3 minutes ago

Agree, I assume the PTS was meant to be PTH, thus this is most likley vit D overload, perhaps an occult source or someone needs to check all the me...

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RE: Hypercalcemia case 37 minutes ago

agree pure vitamin d intoxication should not cause high elevated 1,25 VIT d. would at least do a PTH scan and US to r/o obvious parathyroid mass. I...

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RE: The cause of cresentic GN 39 minutes ago

why should I consider vasculitis; however, the kidney Biopsy didn't show any picture suggestive of this? --------------------------------- Peter Yo...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 hour ago

Unmeasurable albumin in the UPEP could mean overflow proteinuria from FLCs in the urine.  This can cause progressive renal damage by multiple mecha...

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RE: Hypercalcemia case 1 hour ago

Seems like there might be two processes at play. Unless there is an error in measurement as mentioned above, with that level of 25 Vit D, she has t...

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RE: Hypertension and metabolic acidosis 2 hours ago

following on from Prof Soleimani's elegant explanation, the term "Aldosterone Paradox" was likely coined before the nature and role of Angiotensin ...

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RE: Renal sarcoidosis resistant to therapy? 2 hours ago

≡Thanks again for your valuable input ------------------------------ Ella Koifman-Zeltzer MD Tel-Aviv ------------------------------

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RE: Hypercalcemia case 2 hours ago

I recently had a similar case. Patient was told to supplement vitamin D.  He went online and purchased 50,000 Units/day.  Did not read the instruct...

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RE: Hypercalcemia case 2 hours ago

What method was used for the measurement of vitamin Ds?  There are different assays to measure vitamin Ds including the Abbott Architect i2000 au...

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RE: Renal sarcoidosis resistant to therapy? 3 hours ago

​I think it is definitely possible that the kidney pathology may be different.  The heart can still be sarcoid. I recently had a young woman with c...

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RE: Hypercalcemia case 3 hours ago

While I agree that excessive vitamin D intake is the most likely cause, I would suggest that the PTH level is not fully suppressed which could sugg...

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RE: Renal sarcoidosis resistant to therapy? 13 hours ago

Thank you, Dr Leung! Since chest CT LN and GIT clinical picture (abdominal pain& weight loss ) did respond to steroids& MMF, do you think he has ...

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RE: Hypercalcemia case 14 hours ago

“Pt does not take vit d supplements.” If this is actually true which’d be very hard to believe given her dementia & son’s poor history, does she dr...

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RE: Deciding biopsy for subnephrotic proteinuria at age 81 on apixaban and hypertensive 17 hours ago

Dr. Leung is spot on.  I second that it is still warranted to get PYP scan and tissue biopsy. At least salivary gland.  Is urine albumin actually m...

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RE: dialysis patient with osteoporosis 18 hours ago

This lady has progressive bone loss which is very significant – which surely needs to be slowed down. Three questions to answer before deciding o...

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RE: Hypercalcemia case 18 hours ago

By far the most common cause of this is increase in 25 is Vit D intake. Not sure what else fits --------------------------------- Roger Rodby MD, F...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 18 hours ago

Would anyone try an SGLT2i in this case? ------------------------------ Roderick Tan MD, PhD Assistant Professor University of Pittsburgh and UPMC ...

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Hypercalcemia case 19 hours ago

I need help with a tough case please. 86 yo female remote history breast ca s/p mastectomy, dementia, presented w weakness and increased confusion....

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 20 hours ago

Thank you all for the replies. I have emailed Dr Leung around the same time i had posted this case. Here is his very informative and valuable answe...

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RE: Renal sarcoidosis resistant to therapy? 23 hours ago

The granulomas in CLL are typical granulomas.  They are composed of both CD4+ and CD20+ cells.  The CLL cells are usually absent.  The granulomas r...

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RE: Deciding biopsy for subnephrotic proteinuria at age 81 on apixaban and hypertensive 23 hours ago

With negative monoclonal protein studies, the chance that his is AL amyloidosis is < 1%.  However, the patient still can have ATTR amyloidosis.  Th...

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RE: Deciding biopsy for subnephrotic proteinuria at age 81 on apixaban and hypertensive 1 day ago

The 24 hours UPEP on 2/16/21found no bence Jones proteins. Spot UPEP on 2/14/21 found no bence Jones proteins.  SPEP on 2/14/21 found only hypoalbu...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

In renal amyloidosis, kidney size is usually well preserved. Since SCr is higher now and UPr/Cr is lower, decreased proteinuria might be due to dec...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

That is an excellent breakdown of this diagnostic dilemma. I won't repeat it. But it I'm not convinced that a biopsy will discern what is old v new...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

Since WRF is accompanied by tubular proteinuria, a non-AL amyloidosis-related cause like AIN from PPI (I’d be skeptical that glomerular-predominant...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

I have seen him only once and he will be back in 3-4 weeks. I am repeating 24urine studies, renal panel and a renal us. Will add pla2r ab but pictu...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

Oh - I was anticipating that you would see both albuminuria and proteinuria since that would indicate glomerular disease, which it seems the patien...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

Thank you Dr Glassock and Dr Tan, - it is Autologous stem cell transplant - i do not have presently u ACR but i see a upep (urine spot) shows prote...

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RE: HCV-related recurrent or de novo renal disease in the kidney transplant? 1 day ago

Dr. Lerman: About 2 years ago (before transplant, when his SCr was 5.24 mg/dL), this patient had an elevated serum kappa light chain level of 173.8...

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RE: Hypertension and metabolic acidosis 1 day ago

Unless this is a small individual, those are small kidneys and suggest advanced CKD. As such, my previously-suggested kidney biopsy could be a risk...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 1 day ago

In the absence of RPGN, PPV of ANCA serologies drop sharply .   Hematuria and Pyruia in this case may be from chronic Cystitis/prostatitis.  I ...

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RE: Hypertension and metabolic acidosis 1 day ago

Thank you for your thoughts. I will send for 24 hour urine for electrolytes, serum and urine osmolality, although I started her on Candesartan 8 mg...

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RE: Hypertension and metabolic acidosis 2 days ago

The possibility of interstitial nephritis with non nephrotic range proteinuria was raised and tied to the impaired concentrating ability in this pa...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 2 days ago

Should we wait until he completes 15 days after the second shot of moderna COVID-19 vaccine that makes it 31st of March for the administration of r...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 2 days ago

Do you have a UACR or 24hour urinary albumin excretion? ------------------------------ Roderick Tan MD, PhD Assistant Professor University of Pitts...

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RE: HCV-related recurrent or de novo renal disease in the kidney transplant? 2 days ago

@K.K. Venkat so what have we learned from your patient? Biopsy post kidney transplant is unnecessary if proteinuria is predominantly non albumin an...

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RE: Hypertension and metabolic acidosis 2 days ago

Assuming the patient is indeed hypovolemic and we trust the urine studies provided (again, I'm not saying they're wrong; I would just feel more con...

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RE: Hypertension and metabolic acidosis 2 days ago

I would still suggest possible hypovolemia during the spot urine collection. Assuming a dilute urine of 100 mmol/L and a high urine output of 4 lit...

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RE: months of gross hematuria with IgA nephropathy? 2 days ago

Doppler YS and CT angiograms can be false-negative in post-biopsy AV fistula.  The definitive diagnosis requires selective renal angiography, in my...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 2 days ago

Very rarely Membranous Nephropathy may follow the use of autologous stem cell transplantation (SCT) for treatment of MM and I would  guess tgat the...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 2 days ago

Based on your description, I think a kidney biopsy is indicated, if there are no contraindications.I doubt that PPI is the culprit here. I assume t...

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RE: Hypertension and metabolic acidosis 2 days ago

If possible, I would pursue 24 hour urine studies.  Thanks.  ------------------------------ Stephen J. Knohl, MD Professor of Medicine/Division o...

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RE: Hypertension and metabolic acidosis 2 days ago

Thank you for all your replys, Actually, the patient is not apparently hypovolemic clinically, as she was referred as newly diagnosed hypertensive ...

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RE: Hypertension and metabolic acidosis 2 days ago

Thank you for your input , actually it was spot urine test --------------------------------- Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ----...

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RE: Hypertension and metabolic acidosis 2 days ago

Limitations of Aldosterone Paradox to this patient as well as to several other disease states: While AngII can enhance Na+ absorption in the DC...

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RE: Hypertension and metabolic acidosis 2 days ago

The aldosterone paradox is a very fascinating concept as it pertains to conditions where increased   AngII (consequent to increased renin) enhances...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 2 days ago

I dont know what the right answer is here, I really don't but I still think any decisions would be easier with a biopsy. If you cannot get a biopsy...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 2 days ago

But what should we do about this ANCA profile ? ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 -------------------------...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 2 days ago

As I had mentioned previously, the UAlb/Cr vs. UPr/Cr comparison (assuming that my interpretation of the values you had posted is correct) makes a ...

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Progressive CKD in patient with AL amyloidosis in hematologic remission 2 days ago

Dear all, I would like some guidance on a patient who is just establishing care in my office. he has a hx of AL amyloidosis in hematologic remissio...

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