RE: positive anti Ro 60 1 hour ago

Might be I have to learn how to deal with massive info ------------------------------ Zvi Barnea MD ------------------------------

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RE: positive anti Ro 60 2 hours ago

Sorry , I think you mean the other patient I , posted today with monoclonal iGM , yes I thought that she may have her ckd due to monoclonal deposit...

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RE: positive anti Ro 60 2 hours ago

As far as I remember , her Cr is around 1 mg/dl. Protein in urine not that high. What about Serum & urine protein EF And you can give her a small...

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RE: positive anti Ro 60 3 hours ago

Thanks for your time if the biopsy come diagnostic of lupus nephritis mostly class 3 or 4 I will give both MMF and steroid . if it shows interst...

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RE: positive anti Ro 60 3 hours ago

Watch her clinical & lab status closely, react to abrupt change . What can a biopsy bring in terms of treatment that you do not do now? Sincerely...

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RE: positive anti Ro 60 3 hours ago

What you suggest sir for next step ------------------------------ Ahmed Abdelfattah MD, MBChB, MSc Assistant professor (Internal medicine hospita...

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RE: positive anti Ro 60 3 hours ago

She will have no benefit from a biopsy ------------------------------ Zvi Barnea MD Senior Physician, Nephrology Barnea -----------------------...

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RE: AL Amyloid & Serologic tests 3 hours ago

I think makings diagnosis on biopsy & blood test is good to a certain point (especially if the disease read the textbook). In rare cases, I am not ...

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A case of nephrocalcinosis 4 hours ago

A 47-year-old female patient with PMHx of primary biliary cirrhosis was referred to me for suspected medullary sponge kidney and nephrocalcinosis s...

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RE: monoclonal IgM kappa in ckd patient 5 hours ago

Thanks for your time , I will follow up her with Flc , and update ------------------------------ Ahmed Abdelfattah MD, MBChB, MSc Assistant prof...

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RE: monoclonal IgM kappa in ckd patient 5 hours ago

Thank you for your reply , I refred her to hematologist for work up . I will follow her and update thanks ------------------------------ Ahm...

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RE: monoclonal IgM kappa in ckd patient 5 hours ago

According to the latest criteria for FLC levels adjusted for eGFR ( Long TE, et al Nature -Blood Cancer Journal 2022 12: 133) this patient FLC rati...

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RE: AL Amyloid & Serologic tests 5 hours ago

I am concerned that this is NOT AL type amyloidosis. According to the immunofluorescence report, "There is capillary loop staining with IgG (2+), I...

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RE: monoclonal IgM kappa in ckd patient 5 hours ago

at 80, with a stable creatinine for the most part minimal albuminuria and proteinuria, nl k/l ratio I would not so a renal biopsy her, at le...

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RE: Metabolic alkalosis 5 hours ago

Laxative and diuretic abuse is so hard to diagnose, patients are clever and not going to be forthright. Sometimes the only way to prove it is ...

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RE: case of hypokalemia and hypomagnesemia 5 hours ago

excellent thought. Hopefully @Mustafa Saidi can get genetic testing for this (as well as other tubular diseases). HNF1B is included in Natera'...

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RE: Metabolic alkalosis 7 hours ago

Would the low renin not be expected given metoprolol? I wonder whether she’s abusing laxatives (‘chronic diarrhea…normal colonoscopy’). UCl may n...

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RE: case of hypokalemia and hypomagnesemia 7 hours ago

Would the low aldo not be expected given hypoK + lisinopril (‘was on lisinopril’ I assume included when aldo was checked)? The hypoMg severity + ...

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monoclonal IgM kappa in ckd patient 8 hours ago

An 80-year-old woman with a history of essential thrombocytosis is currently on a medication regimen that includes 500 mg of hydroxycarbamide, 20 m...

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RE: case of hypokalemia and hypomagnesemia 18 hours ago

Dr. Saidi: Was hyponatremia documented before or after starting amiloride? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -...

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RE: Budenoside for IgA Nephropathy 22 hours ago

Very limited Data , and no RCT, but generic delayed release Budesonide seems to reduce proteinuria ink Primary IgAN. No long term eGFR slope studie...

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RE: case of hypokalemia and hypomagnesemia 23 hours ago

The PRA is at the lower limit of normal and the serum aldosterone is definitely suppressed. Hypomagnesemua can be observed in licorice induced pseu...

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RE: positive anti Ro 60 23 hours ago

Thanks for the information- with hematuria, proteinuria and progressive loss of nephrons now is the time to make a decision on empiric treatment (w...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Dr. Glassock to correct myself, there is a urine spot chloride of 33 mmol/L ------------------------------ Mustafa Saidi MD Nephrology Departm...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Dr, Madan, bicarb ranges from 27 to 35, so does have some alkalosis The hypomagnesemia irritated me too. We do not have an ABG Aldo was supp...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Dr. Rodby she is not on PPI ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia PA -------------...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

I was not aware that these can also cause a low mag. The renin activity was not suppressed, was in nl range. The Aldo and renin were drawn at 5 a...

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RE: positive anti Ro 60 1 day ago

Thanks for time. He has a history of occasional right parotid enlargement, but there is no clinical evidence of parotid swelling. I recommended a ...

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RE: positive anti Ro 60 1 day ago

thanks for your time , He only gives a history of occasional right parotid enlargement, but clinically no parotid swelling. I referred him for bucc...

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RE: positive anti Ro 60 1 day ago

Any clinical manifestations of Sjogren Syndrome (dry eyes, reduced saliva production, hyoergamnaglobulinemia, high Rheumatoid factor)?. In the abse...

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RE: AL Amyloid & Serologic tests 1 day ago

Thanks for these detailed, interesting comments. The issue in the posted case is really whether the detected positive serological tests are pathoge...

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RE: CPRS EHR 1 day ago

Be careful. It is not really 'free". Implementation costs and down time will be about $50,000 per MD with 3 months to be able to use it and one yea...

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RE: AL Amyloid & Serologic tests 1 day ago

SORRY FOR REPLY IN A FILE FORM - FOR SOME REASON MICROSOFT DOESNT GIVE ME TO COPY TEXT. ------------------------------ Zvi Barnea MD Senior Physi...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Dr venkat ..hyponatremia may be from amiloride --------------------------------- Alaa Nabih Abdalla nephrology fellow Egypt --------------------...

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positive anti Ro 60 1 day ago

A 50-year-old male with a history of hypertension and dyslipidemia for more than 5 years. He has been following up with nephrology services at anot...

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RE: Metabolic alkalosis 1 day ago

------------------------------ Ahmed Abdelfattah MD, MBChB, MSc Assistant professor (Internal medicine hospital ALHUSSIEN CAIRO -------------------...

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RE: Metabolic alkalosis 1 day ago

BUN 3 creat .5 looks looks an eating disorder. The timing of the urine studies, renin and aldo levels is important, e.g. if obtained during a recov...

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RE: AL Amyloid & Serologic tests 1 day ago

Unfortunately, in the single case report described the patient had Hypertension (medications used for therapy not described) and COVID19 so the ass...

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RE: Budenoside for IgA Nephropathy 1 day ago

From what I understand it's different delivery system and designed to stay in ileum longer with Nefecon other preparations deliver to other part...

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RE: Interesting Case 1 day ago

really need the full report with full IF Sub epi sub endo, nodular. could be many things. ANA? C3 C4? lupus like ANA neg, also kinda depend on ...

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RE: Metabolic alkalosis 1 day ago

forgot to attach this explains this cortisol cortisone axis very well, of course it does, I wrote it... :) -----------------------...

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RE: Metabolic alkalosis 1 day ago

I always question supplements but this on is supposed to lower BP if anything Her Urin K/Cr ratio was low now indicating ectarenal K loss, but wa...

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RE: Metabolic alkalosis 1 day ago

Agree with Dr Saidi hypokalemia of this degree can cause metabolic alkalosis ------------------------------ Arvind Madan MBBS, MD Partner Cen...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

What's the bicarbonate and better yet ABG PH ------------------------------ Arvind Madan MBBS, MD Partner Central Florida Kidney Specialists Orl...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

pt taking a PPI? they are available OTC. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

"She had mild hyponatremia of low 130s" Dr. Saudi: Was hyponatremia repeatedly documented during both hospitalizations and do you have any other ...

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RE: AL Amyloid & Serologic tests 1 day ago

You are correct- i finally found a report of the first case displaying thus in rare phenomenon. See Cobb JK et al Cureus 2023; 15: e47667.. It real...

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RE: AL Amyloid & Serologic tests 1 day ago

If this patient has an underlying Multiple Myeloma as a cause of AL Amyloidosis then CAR-T therapy might be considered (if the patient proves to be...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Agreed! But I am not sure of a "response" to Amiloride as this is not mentioned in the post- it only states that Amiloride has been prescribed. -...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

strong family history , suppressed renin/aldosterone levels and response to amiloride is highly suggestive of liddle.. is metabolic alkalosis prese...

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