RE: Collapsing FSGS post transplant 49 minutes ago

A 2.4 year gap between COVID and onset of Collapsing FSGS makes COVAN very unlikely, as well. Still a puzzle. ------------------------------ Rich...

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RE: Collapsing FSGS post transplant 1 hour ago

Collapsing lesions are quite common in viral and drug-induced FSGS, but seldom seen in maladaptive FSGS, I suppose that the long term consequence o...

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RE: Collapsing FSGS post transplant 2 hours ago

If SAlb is not very low and if FPE is not extensive, donor-recipient size-mismatch with chronic hyperfiltration causing secondary FSGS is a possibi...

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RE: Collapsing FSGS post transplant 5 hours ago

Thanks for the clarification. This is very late for recurrence of Primary FSGS, but I suppose it is possible. The normal Scr and lack of IFTA make ...

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RE: Collapsing FSGS post transplant 11 hours ago

This is unknown. ------------------------------ Pablo Garcia MD Albuquerque NM (732) 925-5825 ------------------------------

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RE: Collapsing FSGS post transplant 11 hours ago

Yes, that is what I meant. We did genetic testing on the patient and on the patient's kidney transplant. ------------------------------ Pablo...

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RE: Collapsing FSGS post transplant 11 hours ago

No vascular changes to go along with chronic CIN. Another piece of information, the creatinine is 0.95 mg/dl ------------------------------ Pabl...

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RE: Collapsing FSGS post transplant 11 hours ago

Was the Donor of West African ancestry? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------...

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RE: Collapsing FSGS post transplant 11 hours ago

You mean Kidney transplant tissue was sent for APOL1genetic analysis and was found to be G0/G0? ------------------------------ Richard Glassock M...

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RE: Collapsing FSGS post transplant 12 hours ago

Since no etiologic factors for de novo were uncovered & late for recurrent (not sure if NS vs NRP), were there any accompanying vascular changes to...

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RE: Collapsing FSGS post transplant 16 hours ago

Thank you. Donor tissue biopsy was analyzed with no APOL1 risk alleles. ------------------------------ Pablo Garcia MD Albuquerque NM (732) 925-...

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RE: Collapsing FSGS post transplant 16 hours ago

Do you know the APOL1 risk alleles of the Donor ? Would give consideration to high dose steroids first and then PLEX , probably with RTX as well, i...

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Collapsing FSGS post transplant 17 hours ago

36 year old Hispanic male with history of ESRD due to tip lesion variant FSGS (biopsy proven) around 20 years ago. Now s/p DDKT 2016 with no compli...

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Nephrology Quiz and Questionnaire 2023 18 hours ago

Calling all nephrology fellows and program directors-we need your help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nep...

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Nephrology Quiz and Questionnaire 2023 18 hours ago

Calling all nephrology fellows and program directors-we need your help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nep...

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RE: Non-resolution of proteinuria of native kidney origin during primary non-function of first kidney transplant and prompt resolution of native proteinuria with immediate graft function of second transplant 1 day ago

Dr. Brezin: Thanks for your comments. In our 2005 paper, we discussed whether acute CNI-nephrotoxicity selectively affecting the already chronicall...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 2 days ago

One (obvious) addendum to the above: As u osm reaches the low levels of beer potomania or "tea and toast" then the treatment surely is to provide o...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 2 days ago

That all makes great sense to me, and the only quibble I would add is that I try to avoid salt pills, they taste terrible and you need about six pi...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

I definitely teach the treatment of SIADH as a hierarchy. Obviously, step 1 is remove the inciting agent/pain/nausea is possible but it often isn't...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

Other psychiatric medications have been tried but we're not effective. She was previously taking 300 mg of trileptal twice dialy. We decreased it t...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

She seems like a challenging patient. I would offer the following observations: (1) Oxcarbazepine is the most likely culprit drug. Hyponatremia...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

Thanks. Where are Diet and CRRT in this algorithm.? It suggests that Tolvaptan, Urea and SGLT2 are equivalent in effucacy and safety. Has this been...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

The EFFUSE fluid trial failed to see benefit in fluid restriction + salt tablets + furosemide alone or in combination (although low dose furosemide...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

The hierarchical arrangement of diet, water restriction , oral urea, salt tablets/Furosemide , SGLT2i, Tolvaptan (generic or private label ), Hyper...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

I agree with a trial of SGLT2. I've used it in two patients with acceptable results. Re diet, here in West LA Bev Hills I rec treatment at a spec...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

Thanks for clarifying the exact findings of lower dose Tolvaptan in sIADH disorders.. Rulings by the FDA ate not the nd all of "truth". When in dou...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

I think a better comparison is a Big Mac (or equivalent) which has 25 gms protein and a gram of salt. That alone should prompt quite a bit of free ...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

Nice analysis -thanks. so 3 high-protein "bars" containing about 15 gms. Protein each would add about 250mOSM to the daily osmolal excretion and re...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication 3 days ago

nice discussion, lots here all good points the only solution I dont like is fluid restriction, urea works great. 'If the patient ha...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Sunday, September 24 @ 9:06 AM

Thank you all for your recommendations. I'll pursue the urea route, see how palatable it is and vaptan if all else fails (if insurance willing to p...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Sunday, September 24 @ 8:49 AM

This is a perfect case for UreaAide tablets. They are tasteless and currently 2.5 grams each . You could start her on 3 twice a day and that will p...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 8:59 PM

Yes, a glucose osmotic diuresis might improve hyponatremia in this case, but will it be any better than increase of protein (and salt) in the diet ...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 7:13 PM

If the patient had an extra 15 gram protein bar daily, what are the calculations regarding urea nitrogen generation and how much additional obligat...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 6:32 PM

It seems to me that it is chronic hyponatremia (medication induced SIAD). One approach tested both outpatient and inpatient is iSGLT2 inhibitors. ...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 4:47 PM

This chronic condition patient will continue his psychiatric medication for long time Because of potential hepatotoxicity, tolvaptan should not be...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:53 PM

Thank you Dr. Glassock! ------------------------------ Ralph Mohty MD, MPH Fellow Stanford Paradise Valley AZ (602) 509-4310 --------------------...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:49 PM

I have seen over correction with 7.5 in the hospital, (see attached link my fellow put this together a few years back) but I think we are really ta...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 2:07 PM

Dr Hirsch, I have seen rapid correction with 15 mg but so far not with 7.5. Unfortunately the other side of the coin is that anyone can prescribe a...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 12:50 PM

I concur with Hirsch and Kirsch (has a nice ring to it). She has isosthenuria and her U Na + K is < P Na, meaning she can excrete free water. T...

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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 12:27 PM

The first questions I have are: is the patient symptomatic; does he have orthostatic hypotension; does he have autonomic dysfunction? If the patien...

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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 11:36 AM

Another perspective on this very thought provoking question - progressive CKD and morality from CVD are "competing risks ". Patients with Non-dialy...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:54 AM

Thanks- interesting twist. No generics yet in the USA. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 --...

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RE: renal effects of Nivolumab Saturday, September 23 @ 10:51 AM

Dr. Rodby Agree with your assessment. Sometimes it is better care to step back and not push, particularly in the elderly. Id the Bicarb is under,...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:43 AM

Dr, Balan . Reading many of the discussions, it seems that in India, you have more generics and develop hem more quickly than we do here in the s...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 10:41 AM

Gosh I wish we could get talvaptan here in the US, esp for severe hyponatremia with high U osm/ADH levels. In this case, with the Na near 130 and...

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RE: Hypotension In CKD patients With HFrEF or HFpEF Saturday, September 23 @ 8:39 AM

I have found that the BP lowering of the renal and cardio protective agents you have listed to be variable and some better tolerated than others ...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 8:34 AM

Multiple generic brands of tolvaptan are available in our country at around 0.5$ for a tablet of 15 mg. We routinely prescribe this for chronic hyp...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 7:09 AM

Remember - the prescription should be for Samsca, not Jynarque. Same drug (Tolvaptan) but for different indications. ----------------------------...

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RE: C3 glomerulopathy ? Saturday, September 23 @ 5:29 AM

Definitely. Will post the biopsy results once I get them. ------------------------------ Adi Leiba MD Assuta Ashdod University Hospital Kiryat O...

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RE: Persistent hyponatremia in patient taking chronic psychiatric medication Saturday, September 23 @ 1:56 AM

Would you use the 1/2 FDA dose of 7.5 to start? or 15? ------------------------------ Ralph Mohty MD, MPH Fellow Stanford Paradise Valley AZ (602...

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