RE: Primary Vs Tertiary Hyperparathyroidism 3 hours ago

I would not leap to the conclusion that this is Primary HPTH.  The PTH is very high and the initial serum ionized Ca was on the lowish side. The ur...

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RE: membranous nephropathy 3 hours ago

Thank you Dr Glassock. Will ask Weill Presbyterian to re look at biopsy. If not rituximab how would you treat. Also ? Duration of treatment and wou...

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RE: Primary Vs Tertiary Hyperparathyroidism 8 hours ago

Would love to see de identified neck US report --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical D...

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RE: Primary Vs Tertiary Hyperparathyroidism 9 hours ago

A false positive US fir a parathyroid adenoma is uncommon, but would you confirm the US findings with a Sestamibi scan before having a surgical par...

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RE: Hypokalemia and Hypocalcemia 9 hours ago

What is the UACR to UPCR ratio.  If it is > 50 % a concomitant glomerular disease (? MN) is likely . ------------------------------ Richard Glasso...

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RE: membranous nephropathy 9 hours ago

Two comments- 1) how certain are you that "transverse myelitis" is the correct diagnosis.  Could this be inflammatory demyelinating polyneuropathy...

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RE: Hypokalemia and Hypocalcemia 10 hours ago

The proteinuria is basically Albuminuria as Albumin/creatinin is high --------------------------------- Wael Jebur MD, FASN drwaellatif@hotmail.c...

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RE: Primary Vs Tertiary Hyperparathyroidism 11 hours ago

Dr. Jebur - even though your patient likely has asymptomatic PHPTH, I would still advocate for PTX due to the presence of CKD. Primary HPTH can hav...

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RE: GERIATRICIAN ANA NEPHROLOGIST...WHO TAKES OVER? 11 hours ago

I would like to offer you a nephrology – business solution. Every consultant needs to learn the preferences of the physicians that refer to him or...

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RE: PLA2R 11 hours ago

I think that 1-3 represent very reasonable clinical decisions.  I would watch the serum albumin as well. ------------------------------ Richard Gl...

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RE: Primary Vs Tertiary Hyperparathyroidism 11 hours ago

Would think tertiary HPTH would be very unusual in non dialysis dependent CKD and involves all parathyroid glands. -------------------------------...

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RE: Hypokalemia and Hypocalcemia 11 hours ago

Good question.  In Dent Disease (a classic genetic tubulopathy) 46% of patients presented with Nephrotic range proteinuria but normal serum albumin...

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RE: Hypokalemia and Hypocalcemia 11 hours ago

Regarding 3 g proteinuria in this patient: we need UAlb/Cr vs UPr/Cr on same sample of urine or urine protein electrophoresis to better understand ...

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membranous nephropathy 11 hours ago

72 yo Asian very frail male with cad, hpt, prostate ca, transverse myelitis ?from flu vaccine, presented with edema 8/2020.  Nephrotic proteinuria ...

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RE: PLA2R 11 hours ago

Thank you, very helpful The other details of the case are: mid-aged male, 5 grams proteinuria, asymptomatic (picked up on routine exam, patient did...

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RE: Primary Vs Tertiary Hyperparathyroidism 12 hours ago

Agree with primary and I would switch to cinacalcet while awaiting para thyroidectomy. ------------------------------ Brian Michel MD Haddon Renal...

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RE: Creatinine clearance estimation in AKI 12 hours ago

Right on the mark. What is the precision of the parameters?  We have almost too many eGFR estimating equations and in China and in some other ethn...

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RE: Hypokalemia and Hypocalcemia 12 hours ago

Dr Glassock.  Can you get 3 gm of proteinuria per day which is tubular from a chronic tubule interstitial nephritis ? I was always taught tubular p...

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RE: Creatinine clearance estimation in AKI 12 hours ago

Will answer Dr Glassock's questions in subsequent posts. Day-2 The problem with serum creatinine (C) when measuring creatinine clearance (K) in AK...

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RE: Primary Vs Tertiary Hyperparathyroidism 13 hours ago

Despite the CKD and one Alpha this sounds like primary hyperparathyroidism. Suggest parathyroidectomy of the parathyroid adenoma -----------------...

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RE: interstitial scarring with foci of intraluminal neutrophils 14 hours ago

Dr Ramanarayan, any family history of CKD? Previous Cr readings? Looks like fairly chronic KD similar to what’s seen in ADTKD. From description I d...

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RE: interstitial scarring with foci of intraluminal neutrophils 16 hours ago

Interstitial inflammation with luminal neutrophil accumulation  is fairly well described in ANCA + Vasculitis. This seems  to be due to formation o...

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RE: interstitial scarring with foci of intraluminal neutrophils 17 hours ago

Dear Dr Glassock Many thanks for your valuable opinion. We did tell him the potential levamisole contamination and advised him to be abstinent. Is ...

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RE: interstitial scarring with foci of intraluminal neutrophils 17 hours ago

This case may fall within the spectrum of levamisole contaminated cocaine abuse.  The typical necrotic skin lesions are lacking but the kidney  pat...

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RE: Creatinine clearance estimation in AKI 17 hours ago

Dr. Mellas.  You have written about the mathematical derivation of formulas designed to approximate GFR in non-steady state situations like AKI. do...

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interstitial scarring with foci of intraluminal neutrophils 17 hours ago

Dear colleagues Man in his forties with significant history of smoking and intermittent cocaine intake (says once every two weeks - sniffs them) pr...

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RE: Hypokalemia and Hypocalcemia 18 hours ago

In light of the physical signs of volume depletion a trial of increased NaCl intake might be appropriate.  I do no5 know of the addition of NSAID w...

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Primary Vs Tertiary Hyperparathyroidism 20 hours ago

A young lady doctor who is having strong family history of chronic kidney disease, presented for check up. She is hypertensive on medications, inve...

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RE: Hypokalemia and Hypocalcemia 20 hours ago

Thank you for your reply, he is posted for a biopsy, and will update u. Any suggestion for the management as he is only on on K replacement. ----...

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RE: Hypokalemia and Hypocalcemia 22 hours ago

Thanks for the FU.This finding, in conjunction with the high urinary NaCL excretion, provides strong support for  an acquired "tubulopathy" (Pseudo...

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RE: Hypokalemia and Hypocalcemia 23 hours ago

Just wanted to update you about this patient, as we were planning to admit him for saline infusion and repeat of. Renin and Aldosteron, I checked m...

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RE: Creatinine clearance estimation in AKI 23 hours ago

Be sure that you examine bias, precision and accuracy.  No one parameter is sufficient..  an unbiased but imprecise metric is practically useless a...

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RE: Crescentic IgA - Thoughts and advice 1 day ago

Thank you as well Dr. Glasscock for your reply.  The patient apparently did not do well with the low(er) doses of steroids given for his ILD and ha...

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RE: 26 yo with IgAN since 2016 on CsA. sCr 2.2. 1 day ago

I would stop the CsA. There is no good evidence that it benefits Primary IgA N and it commonly causes nephrotoxicity. RTX AND MMF are likewise of n...

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RE: Crescentic IgA - Thoughts and advice 1 day ago

I agree with Dr. Rodby. This is advanced C2 IgAN. Treatment with steroids and CYC could be tried but I am not very optimistic about potential rever...

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RE: PLA2R 1 day ago

Using the ELISA anti-PLA2R results as the reference “gold-standard is a mistake— the IFA anti-PLA2R is the Reference Standard as it is the most sen...

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RE: PLA2R 1 day ago

Roger: Good point about the ANCA testing, thanks But...if I read the Mayo data right, and there's no other contrary data out there, seems like the ...

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RE: PLA2R 1 day ago

Thanks, Dr Friedman, the Bobart/Mayo paper seems right on point, relating IF and ELISA to biopsy results (Note they use 2, not 14 as lower limit of...

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RE: Crescentic IgA - Thoughts and advice 1 day ago

Thank you very much for your answer, Dr. Rodby. ------------------------------ Stanley Sicher MD Parkview Medical Center Pueblo CO (719) 561-5264 ...

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RE: PLA2R 1 day ago

To clarify, I think the initial screen is positive (Im not sure what this test really is) but the actual PLA2R antibody by ELISA is normal.  Akin...

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RE: Crescentic IgA - Thoughts and advice 1 day ago

I would give pulse steroids (500/d X 3 d) and give PO cyclophosphamide (1.5 mg/kg/d max) and lower dose steroids (30/d?) for 2-3 months, after Bloo...

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RE: 26 yo with IgAN since 2016 on CsA. sCr 2.2. 1 day ago

I suppose nothing to lose, still need yearly retinal exams ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Universi...

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RE: 26 yo with IgAN since 2016 on CsA. sCr 2.2. 1 day ago

Would you consider adding HCQ ? Is there anything to loose in this patient heading for RRT ------------------------------ Dr Mohamed Buhary MBBS, ...

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RE: Crescentic IgA - Thoughts and advice 1 day ago

Adult-onset IgAV (HSP) sine purpura with resp, GI & renal (multi-system) involvement? Note also the C2 lesion with glomerular fibrinogen & equal la...

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RE: PLA2R 1 day ago

According to Bobart’s 2019 algorithm, if IFA + with no secondary causes, preserved renal function & ELISA >/= 2, MN may be diagnosed without biopsy...

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RE: interesting possible toxic alcohol case 1 day ago

Steve Marcus at the NJ PCC reported a case of a 17 year old woman who drank a bottle of vodka (XL? or Grey Goose?) and had a level of about 700 mg/...

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PLA2R 1 day ago

Hello all, Is there an entity of a false positive serum PLA2R by IF? That is, if the IF is positive but the ELISA WNL (eg 5, nl < 14) can you pres...

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Crescentic IgA - Thoughts and advice 1 day ago

66 y/o man with 6 year history of Type II DM without retinopathy or neuropathy. 6 months prior to admission developed SOB/DOB and was referred to ...

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RE: interesting possible toxic alcohol case 1 day ago

It's a huge concern. Apologies, that was a bit glib. Acute ethanol toxicity is almost all airway, though - like other sedative-hypnotics, the vast ...

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RE: Creatinine clearance estimation in AKI 1 day ago

Excellent question which deserves careful attention in this forum. I started looking at this topic over 15 years ago, largely related to physician ...

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