RE: Blood pressure via Smart Watch 5 hours ago

Few years ago, I tested the Bpro device for 24h BP monitoring.  The device uses pulse wave analysis and is calibrated per patients.  It worked well...

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RE: Atheroembolic Plaque? 9 hours ago

Granular casts and acanthocytes  in a urine sediment, along with transient eosinophilia and profound C4 hypocomplementemia sounds like something mo...

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RE: Atheroembolic Plaque? 9 hours ago

They  seem like granular (not muddy brown) casts without obvious RBCs or tubular epithelial cells in them; which I think makes them non-specific. I...

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RE: Atheroembolic Plaque? 10 hours ago

please take a look at the urine micro picture posted above. seems there are casts - i cannot confidently call it a tubular cast.  Most recent UA sh...

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RE: Atheroembolic Plaque? 10 hours ago

The timing of the CTA allows for a tentative diagnosis of cholesterol emboli but the absence of peripheral signs and the only minimal and very tran...

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RE: Atheroembolic Plaque? 11 hours ago

NO Dr Glassock. We do not have the stain in our lab. I asked them about it. I however do think there are some RBCs in here. check my arrrows. Agree...

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RE: Atheroembolic Plaque? 11 hours ago

Is that an acanthocyte at 7PM? Did you stain the sediment with Sternheimer-Malbin Supra-vital stain? These are not the muddy brown casts associated...

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RE: Atheroembolic Plaque? 13 hours ago

CTA done. 2 months prior to surgery. Cr 0.9 until 5 days after bypass surg. Now slowly creeping - 2.7 , non oliguric. i saw granular casts on micro...

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RE: Atheroembolic Plaque? 13 hours ago

------------------------------ Naveen Trehan MD St John Hospital & Medical Center Detroit MI (313) 983-9608 ------------------------------

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RE: Rapid correction of severe hypernatremia 13 hours ago

My comment on correction is in regards to water deficits in hypernatremia in isolation. The problem I see with slow correction is simply that it pr...

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RE: Rapid correction of severe hypernatremia 14 hours ago

Thanks, Dr Mellas.. You write, "...The issue I usually face is that the physician caring for these patients underestimates the water deficit th...

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RE: Atheroembolic Plaque? 14 hours ago

Was an aortogram done prior to surgery and when? --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical D...

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RE: C3 GN vs MPGN type I: treat or not 15 hours ago

Nephritic factors ------------------------------ Maged Hussein King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia -----------...

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RE: C3 GN vs MPGN type I: treat or not 15 hours ago

The boundary between C3 glomerulonephritis and infection related GN is blurred, problematic and often unresolved.  C3 GN is often precipitated by a...

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RE: Atheroembolic Plaque? 15 hours ago

With these findings,  I would do a kidney biopsy for a unexplained AKI.  What does the urine sediment show now? ------------------------------ Rich...

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RE: Atheroembolic Plaque? 17 hours ago

Thanks to everyone here. Amazing discussion. Beautiful points. I'm going to add. 1. Mild jump in eosinophilia... To 4% almost correlating with bum...

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RE: Atheroembolic Plaque? 19 hours ago

I would like to be a little provocative, if I may It is not uncommon to see cholesterol emboli in retinal vessels after peripheral or renal angio p...

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RE: Rapid correction of severe hypernatremia 20 hours ago

Since neither nature (limited capacity for rapid body fluid desalination) nor iatrogenesis vis-à-vis IV/enteral water input lends itself to rapid o...

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RE: Atheroembolic Plaque? 21 hours ago

that is an excellent point, I always assumed the embolic plaques kinda leached off over time, but that makes sense and explains how  clearly the AK...

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RE: Rapid correction of severe hypernatremia 21 hours ago

My understanding is that it can still happen in children, so the phenomenon must have a pathophysiologic basis and we shouldn't "throw the baby out...

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RE: Rapid correction of severe hypernatremia 22 hours ago

Me too, in 35+ years (haha), I have never seen a case of hypernatremia correct at a rate that seemed too fast, almost always the opposite: people f...

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RE: Atheroembolic Plaque? 22 hours ago

As for timing...the classic teaching on cholesterol emboli as I understand it is very interesting: The emboli take place immediately with the proce...

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RE: a pteint known to have type1 DM ,normal Tacrolomus level . and not on orall hypoglycemic agents 22 hours ago

ok , i am collecting all the data , thin I will post it thanks ------------------------------ Faissal Shaheen MD, PhD, FASN Jeddah 96614451100 ----...

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RE: Rapid correction of severe hypernatremia 23 hours ago

Nice comments and agree with the arguments made. In 35 years I have never seen a problem in any correction rate for hypernatremia, keeping in mind ...

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RE: Atheroembolic Plaque? 23 hours ago

These are big surgeries, even modest intraoperative hypotension, in such a patient, with aortotfemoral disease can result in ATN. Too early to biop...

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RE: Atheroembolic Plaque? 1 day ago

Sometimes I get lazy reading the story, the devil is always in the details. Infrarenal should not cause renal atheroemboli, toes maybe but not kidn...

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RE: Atheroembolic Plaque? 1 day ago

If there are peripheral eos I wonder--like Dr Lerman-- if this is cholesterol emboli from a pre-op aortagram--could even have been  a couple weeks ...

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RE: Atheroembolic Plaque? 1 day ago

Bland urine C/w either ATN or renal atheroemboli - both without specific treatment- doubt biopsy would change treatment. Exclude any potential toxi...

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RE: Atheroembolic Plaque? 1 day ago

Havnt seen atheroembolic kidney in years, don't know why. Eosinophilia was most useful test in those we documented. Hypocomplementemia while descri...

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RE: Atheroembolic Plaque? 1 day ago

Any peripheral manifestations of atheroembolism in lower extremities? Any eosinophilia? Any hypocomplementemia? --------------------------------- R...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

I guess no humps were seen by LM. Did you do an ASLOT and streptozyme Test as well as a C4 Level. An infection related or monoclonal gammopathy is ...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

Absence of immunoglobulin deposition and presence of predominately C3 on IF favors C3GN from infection related GN. --------------------------------...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

history of cellulitis and exudative endocapillary hypercellularity makes post infectious gn the most possible. @Argyrios Georgalis ​ please can you...

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RE: C3 GN vs MPGN type I: treat or not 1 day ago

At this age ( > 70 ) the possibility of  a C3 GN without a monoclonal gammopathy is very small ( 5-7%). I would exclude a paraproteinemia. If scree...

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Atheroembolic Plaque? 1 day ago

Day 5 of aorto - femoral bypass.. Cr starts creeping up. No hypotension, no nephrotoxins. Clamp or whatever was infra renal.. So renal blood flow w...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

Well I am glad to hear that I wasn’t the only one concerned with this. Thank you all for the input and for sharing this case. ---------------------...

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RE: Rapid correction of severe hypernatremia 1 day ago

If the preponderance of evidence (research data and clinical anecdotes) is in favor of a benign nature in attempts to correct elevated SNa, then pe...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

"I see Hydralazine/Isordil like vermin: if you see them, get rid of them." Makes my "hate" hydralazine seem weak. ------------------------------ Ro...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

The evidence behind hydralazine and Isordil added to ACEI and MRA is from A-Heft and limited to blacks and those with EFs [More]

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RE: Post Transplant erythrocytosis 1 day ago

Sensical to connect an inactivating germline VHL mutation to spontaneous (ie in absence of EPO-producing tumour, etc) erythrocytosis but aren’t the...

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RE: eGFR 1 day ago

This thread seems to have run its course and we're likely all on the same page so I'm curious as to how everyone documents in outpatient setting up...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

Thank you @Roger Rodby , when I last looked any primary htn paper on hydralazine was many years back. Edema is a big problem ----------------------...

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RE: Post Transplant erythrocytosis 1 day ago

Agree with genetic testing especially if patient had previous clear cell RCC however not sure how would change treatment for PTE . Dr. Glassock you...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

When I was a resident in the early 80s, hydralazine was used frequently. We had B-Blockers, and alpha blockers and clonidine etc. But this was befo...

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RE: a pteint known to have type1 DM ,normal Tacrolomus level . and not on orall hypoglycemic agents 1 day ago

@Faissal Shaheen please do not forget to post lab s supporting normoglycemic ketoacidosis after kidney transplant with normal graft function. I hav...

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RE: genetic testing for kidney disease - some questions 1 day ago

Agree 100% with Dr Pollack ------------------------------ Michael Germain MD Springfield MA (413) 733-9666 RTANE ------------------------------

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

Does anyone have a good idea as to why hydrazine is still so commonly used for hypertension management? I’m often referred resistant hypertension w...

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RE: Blood pressure via Smart Watch 1 day ago

The AMA has partnered with a group of experts to validate which devices are accurate. Their website is validatebp.org ​ To address this challenge...

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RE: genetic testing for kidney disease - some questions 1 day ago

Dr. Pollak makes a very important point about genetic testing.  It has reached a stage of availability and sophistication that it needs to be consi...

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RE: genetic testing for kidney disease - some questions 1 day ago

Interesting case - if mother and daughter both have the same disease (a reasonable hypothesis but not certain), then mutations in a recessive FSGS/...

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