RE: Acute proliferative GN with C3-dominant deposits 14 minutes ago

I would think that if GN is fairly common with Pemigenatib that it would have been reported by now. With Cholangiocarcinoma and an “ infection-rela...

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RE: Raised Aldosterone with Normal Renin Levels 1 hour ago

Dr Glassoxk I see where you are going. She is young, BP is controlled but not to recommended levels of 50 years of age. I would favor giving her...

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RE: Raised Aldosterone with Normal Renin Levels 2 hours ago

Yes, but what happens when high levels of aldosterone persist in the absence of receptor blockage , but with well controlled BP. That is the questi...

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RE: Raised Aldosterone with Normal Renin Levels 2 hours ago

My answer to that question Dick is to cite the RALES trial which showed that 25 mg of spironolactone, a dose that we didn't take seriously as a "di...

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RE: Raised Aldosterone with Normal Renin Levels 3 hours ago

I guess that a legitimate question that might be asked— is continued hyperaldosteronemia in the absence of an elevated systemic arterial pressure b...

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RE: Acute proliferative GN with C3-dominant deposits 5 hours ago

Infection always needs to be ruled out but one thing I have learned about this emerging field is From Kenar, "but anything is possible with these...

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RE: Raised Aldosterone with Normal Renin Levels 5 hours ago

Agree, I woukd avoid going down the rabbit hole of PHA and all that entails when her BP is reasonably well controlled on 5 amlodipine and her k isn...

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RE: Raised Aldosterone with Normal Renin Levels 8 hours ago

I would not. I am not convinced she has primary hyperaldosteronism. Never even on an aldo blocker. Do we no longer do the equivalent of the Melby t...

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RE: Raised Aldosterone with Normal Renin Levels 9 hours ago

Spironolactone and PCOS both increase the PAC.  Would anyone do Adrenal MRI imaging or renal vein PAC in this case? ------------------------------...

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RE: Acute proliferative GN with C3-dominant deposits 9 hours ago

Oh my bad. I must have read it wrong. Not crescentic. Kenar Jhaveri

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RE: Acute proliferative GN with C3-dominant deposits 9 hours ago

One glomerulus with a segmental necrotizing lesions anD occasional red cell casts in tubule lumens made  me think of crescentic GN (unsampled)-but ...

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RE: Acute proliferative GN with C3-dominant deposits 9 hours ago

@Kenar Jhaveri Thank you for your inout. Just curious as to why you are calling this a crescentic GN when the report does not mention crescents as...

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RE: Acute proliferative GN with C3-dominant deposits 11 hours ago

Hi all Interesting case Jay. Sounds like crescentic GN with C3 predominant and some component of TMA The TMA part likely from prior gemcitibine...

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RE: Raised Aldosterone with Normal Renin Levels 12 hours ago

PAC is in the upper third of normal range while renin is suppressed. This makes primary hyperaldosteronism high possibility if no confounding facto...

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RE: Acute proliferative GN with C3-dominant deposits 15 hours ago

Hyperphosphatemia, dry eyes, fatigue, diarrhea, retinal detachment , but not TMA or GN, are recognized side effects of the FGF receptor inhibitors....

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RE: Lupus nephritis 16 hours ago

Dr. Rodby-  thanks for posting the reference.  As noted by the Authors , thus is an exploratory  post-Hoc analysis of a very short FU (only 6 month...

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RE: Lupus nephritis 19 hours ago

Multitargeted therapy may have helped but I doubt that would be a difference maker @Richard Glassock regarding your mention of MMF resistance in ...

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RE: Acute proliferative GN with C3-dominant deposits 19 hours ago

I believe vegf inhibition is one of the mechanisms of TKI which is typically htn and proteinuria and a TMA but there may be more, see table 3 http...

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RE: Lupus nephritis 19 hours ago

Interesting case discussion and thank you. I believe combination lesions ( 3 or 4 and 5 ) do not do well to steroid MMF or to cyclophosphamide. Wou...

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RE: Lupus nephritis 19 hours ago

Puzzled by normalization of complement and decreased anti-DS-DNA antibody titer. Makes me wonder if there is some other cause for recent deteriorat...

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RE: Acute proliferative GN with C3-dominant deposits 20 hours ago

I looked up pemigatinib. Its mechanism of action is said to be tyrosine kinase (TK)-inhibition, specifically inhibition of TK activation via the FG...

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RE: Acute proliferative GN with C3-dominant deposits 20 hours ago

Different types of glomerular lesions have been described in association with anti-angiogenesis drugs (such as VEGF and TKI inhibitors), not just T...

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RE: Acute proliferative GN with C3-dominant deposits 1 day ago

Can you tell us a bit more about the patients country of origin. In SE Asia, Cholangiocarcinoma is often related to chronic infection with liver fl...

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Acute proliferative GN with C3-dominant deposits 1 day ago

79 y/o man with metastatic cholangiocarcinoma presented with AKI (BUN 63, creat 3.3 - labs 4 weeks prior showed BUN 22 and creat 1.0) on routine f/...

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RE: Raised Aldosterone with Normal Renin Levels 1 day ago

thanks for this, few things are more complicated to sort out when you not only count on absolute levels but ratios ------------------------------...

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RE: Lupus nephritis 1 day ago

if you are opting not to accelerate therapy, then I would leave the MMF alone for now. If you put her on dialysis I would taper it off over 6 month...

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RE: Lupus nephritis 1 day ago

Thank you for the reply To clarify- she always had positive anti ds dna(initially at >100 IU/ml and now in 21 range High anti smith antibodies(repo...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

I was taught, in the 1980's, and continue to believe that the Cl is a passive ion, either associated with a cation or replacing an anion. I have ne...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

Agree, the hardest thing to change is an algorithm.  It is an impediment to independent thinking as new data come out. Its virtue is that it saves ...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

No doubts here, but these things take on a life of their own, and especially with surgeons , critical care docs, ER docs, and once they seem to thi...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

you have doubts? ------------------------------ Anatole Besarab MD ABesarab Consulting Bend OR (734) 417-4793 ------------------------------

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RE: Lupus nephritis 1 day ago

According to the ALMS trial about 30-40% of A-A subjects with Class III/IV +V LN are resistant to MMF therapy at 6-12 months. Compliance may also b...

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RE: Hyperkalemia 1 day ago

i agree to the point of stopping b blockers and wait and watch the response. no other action required. Hba1c - 6.2 with normal renal functions is n...

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RE: Raised Aldosterone with Normal Renin Levels 1 day ago

The ARR with different lab unit is shown in rugs figure  ------------------------------ Hayder Aledan MD, FASN Assistant Professor Basra Nephrol...

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RE: Raised Aldosterone with Normal Renin Levels 1 day ago

Interestingly, the ARR is increased with oral contraceptives only when  PRC, and not PRA, is used to calculate the ratio. (See Ahmed AH, et al J Cl...

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RE: Raised Aldosterone with Normal Renin Levels 1 day ago

Does the patient take contraceptives for her menstruation? Because these( esp Estrogen containing)  could rise Aldo and the ARR leading to false po...

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RE: Lupus nephritis 1 day ago

As pointed out unlikely that Class 3 is resistant to Cellcept. My first approach would be to look at both biopsies myself. Class 3 can sometimes be...

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RE: Lupus nephritis 1 day ago

I assume that her proteinuria has been > 2gm/d throughout her illness. Belimumab has no good record efficacy in such patients. With a SCr of 8mg/dL...

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RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 1 day ago

My top 5 are Hypertriglyceridemia Hypertriglyceridemia Hypertriglyceridemia Hypertriglyceridemia Paraproteinemia See attached (shamelessly qu...

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RE: Lupus nephritis 1 day ago

What were her serologic and urine data initially and now? c3C4 dS dna, urine sediment. And I would have to see the biopsy myself but the creatin...

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Lupus nephritis 1 day ago

Greetings. I have a 31  yr old African American female with proteinuria and hematuria. Had hx of discoid lupus. Biopsied her and found her to have ...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

What bothered me most about this pseudo condition was the term hyperchloremia, which is not a thing. When the Cl is high it is high bc the Na is hi...

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RE: Hyperkalemia 1 day ago

He has been losing weight however says somewhat intentionally. CT pending. BS 102  122  146  140  138 K    5.6   4.8   5.6   5.1   5.7 --------...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

The unsubstantiated Cl nephrotic theory spread like wildfire mainly among our surgical colleagues. However, only time will tell if evidence-based m...

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RE: Finally, the question has been answered!!! Follow the link 1 day ago

Amen to that!! At least it tells us that the Chloride ion is non-toxic, if anyone really beloved that hypothesis. --------------------------------...

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RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 1 day ago

Thank you Dr. Glassock. We will have her do home urine dip sticks weekly to monitor for microhematuria. ------------------------------ Balaji Srin...

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RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 1 day ago

Are you going to send her a package of urinary dipsticks to check her urine 2+ or more hematuria at home once a week.  If hematuria develops,  I wo...

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RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 2 days ago

Thank you all for your input. This patient is very reliable. She is not on any medications which will cause a positive MPO Ab. I will see her in cl...

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RE: Raised Aldosterone with Normal Renin Levels 2 days ago

What is the normal range for ARR when the units for both PAC and direct PRC are given in pg/ml.? ------------------------------ Richard Glassock M...

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RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 2 days ago

Commonest causes  of "psuedohypobicarbonatemia " are hypertriglyceridemia and  monoclonal gammopathy -  see earlier threads on this site. --------...

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