RE: Tertiary Hyperparathyroidism 12 minutes ago

Dr. Wael, what treatment for CKD-MBD the patient was before initiation of Etelcalcetide? The cutoff for initiation of calcimimetics is iPTH > 300 p...

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Tertiary Hyperparathyroidism 2 hours ago

70 year old female patient on regular hemodialysis. During the routine investigations, she was found to have hypercalcemia of 11.4 mg/dl. Phosphate...

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RE: ? Amyloid,? MGRS 2 hours ago

Sorry to be late. Creatinine 199. Patient was advised to repeat Urine protein was supposed to be done but so far not done. We are tapering stero...

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RE: Severe hypocalcemia with basal ganglia calcification 6 hours ago

@Mario Rubin Agree but may be the hypophosphatemia is mild decrease from baseline and 24 h urine PO4 or PEPO4 is not done. Many algorithm for worku...

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RE: Severe hypocalcemia with basal ganglia calcification 7 hours ago

Dr Venkat  No Renal calcification by imaging studies though kidneys were small sized. Biopsy was not done. ------------------------------ Krishnas...

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RE: Global glomeurlosclerosis in 28 year old 7 hours ago

Prof. Glassock I want your thoughts on this female being an Alport carrier. Do we have enough EM studies on  Alport carriers to see if they differ ...

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RE: Need assistance for patient with multiple kidney stones 8 hours ago

We learned that pRTA is not associated with nephrocalcinosis and nephrolithiasis but, pRTA (or may be full Fanconi syndrome) plus nephrocalcinosis ...

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RE: Re: Remdesivir yours in CKD patient's with GFR less than 30 mL/minute 9 hours ago

And the learning curve continues (for all of us): N Engl J Med 2022; 386:305-315 ------------------------------ Mario Rubin, M.D. Houston TX (713)...

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RE: Need assistance for patient with multiple kidney stones 11 hours ago

Regardless of the diagnosis, I believe that the most important thing is the patient. Therefore, he should lose weight, eat a moderate protein diet ...

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RE: Global glomeurlosclerosis in 28 year old 11 hours ago

Back to square one. Glomerular Non-Nephrotic proteinuria, FGGS by LM, segmental FP effacement by EM. ? Serum albumin. - what is the disease? Very u...

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RE: Need assistance for patient with multiple kidney stones 11 hours ago

Pth level was 27. Indeed I am suspicious that patient has some form of distal RTA since his urine pH is usually 6 or 7 and he had hypocitraturia. H...

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RE: Need assistance for patient with multiple kidney stones 11 hours ago

Thank you for this article, I will keep it for future reference. ------------------------------ Jayson L. Yap, MD Renal Section Dayton VAMC Dayton...

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RE: Global glomeurlosclerosis in 28 year old 11 hours ago

serum albumin 4.1 Total protein 6.7 UPEP was not done SPEP was negative SFLC ordered ------------------------------ Naushaba Mohiuddin, MD Senior ...

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RE: Global glomeurlosclerosis in 28 year old 12 hours ago

Please also post serum albumin, serum total protein and (urine protein electrophoresis (if done) results. ------------------------------ K.K. Venk...

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RE: Immunotherapy, Fibrillary GN and AKI 12 hours ago

Thank you Dr. Venkat and Dr. Glossock. Yes, possible coincidental too.  Dr. Venkat pt was treated with prednisone in last episode for 6 weeks with ...

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RE: Global glomeurlosclerosis in 28 year old 12 hours ago

Thank you again all the ASN forum members for insights in this case 9/14/2021  Albumin/Creatinine Ratio: 2,005.9 (H), UPCR -2.23 gm/gm Creatinine,...

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RE: Need assistance for patient with multiple kidney stones 12 hours ago

The patient is obese with high intake of soft drinks with calcium, etc. The first thing to consider is that you need to lose weight. 2. You should ...

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RE: DERMS IN HD III 13 hours ago

Last platelet count was 99.000, anticoagulation on HD es 1500units only for dialysis circuit, no antiagregation or anticoagulation added. --------...

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RE: DERMS IN HD III 13 hours ago

I agree with Dr. Rodby about blisters in PCT in dialysis patients but the huge increase on Ferritin  and transferrin saturation is strongly suggest...

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RE: Severe hypocalcemia with basal ganglia calcification 13 hours ago

@Hayder Aledan None of the hypertension studies that used thiazides (ALLHAT, SHEP, MRFIT, etc.) have noted hypophosphatemia as a side effect of th...

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RE: Need assistance for patient with multiple kidney stones 13 hours ago

I would probably look at the US first.  Hyperechogenicity  of the renal pyramids  is said to be diagnostic  of MSK.  If the  US are not diagnostic,...

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RE: Severe hypocalcemia with basal ganglia calcification 14 hours ago

The hypercalciuric response to Ca & calcitriol supplementation is more in autosomal dominant hypocalcemia compared to primary hypoparathyroidism be...

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RE: Need assistance for patient with multiple kidney stones 14 hours ago

Thiazides diuretics is a cause of renal PO4 wasting as mentioned in this review. --------------------------------- Hayder Aledan MD, FASN Assistan...

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RE: Severe hypocalcemia with basal ganglia calcification 14 hours ago

Very interesting  case. The basal ganglia calcifications suggest a chronic disorder, likely due to hypoparathyroidism and chronic hyperphosphatemia...

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RE: Severe hypocalcemia with basal ganglia calcification 14 hours ago

I agree- most guidelines suggest close monitoring of serum calcium with a goal of achieving values at the lower limit of normal. -----------------...

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RE: Severe hypocalcemia with basal ganglia calcification 14 hours ago

Dr. Glassock, we learn a lot from this scientific platform. My approach for this patient is that i look for 24 hr urine Ca, if it is normal or high...

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RE: DERMS IN HD III 15 hours ago

I have seen porphyria cutanea tarda in dialysis but I think it is a bulous lesion. These look spontaneous bruises, what is platelet count, on ANY a...

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RE: Need assistance for patient with multiple kidney stones 15 hours ago

I was under the impression that many MSK patients also had an incomplete D-RTA, and his UpH is not low, but his HCO3 should at least be normal if n...

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RE: Severe hypocalcemia with basal ganglia calcification 15 hours ago

Dr. Aledan. Thanks for the post. This was a real learning opportunity for me. How would you treat this patient? Would you recommend genetic testing...

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RE: Need assistance for patient with multiple kidney stones 15 hours ago

The ultrasound and CT imaging in Medullary Sponge Kidney (MSK) with Nephrocalcinosis is fairly distinctive and can separate this cause from other f...

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RE: Need assistance for patient with multiple kidney stones 15 hours ago

Thank you Dr. Aledan. No skin signs of calcinosis cutis, but I will make sure to examine more closely next time I see him, as I did not know of thi...

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RE: Need assistance for patient with multiple kidney stones 16 hours ago

Interesting case. Any cutaneous signs of dermatomyositis? Calcinosis cutis? With presence of Raynaud’s phenomenon, BL medullary nephrocalcinosis a...

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RE: Need assistance for patient with multiple kidney stones 16 hours ago

Thank you Dr. Glassock. I have called our radiologist and asked him to go over the various CT scans he has had over the years (both with and withou...

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RE: Severe hypocalcemia with basal ganglia calcification 16 hours ago

Dr. Glassock, this is a case report of elderly patient with BG calcification in autosomal dominant hypocalcemia. --------------------------------...

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RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 16 hours ago

yes, I can accept the erroneous metabolic acidosis.  I can also accept the iatrogenic metabolic alkalosis although that actually requires some effo...

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RE: Need assistance for patient with multiple kidney stones 17 hours ago

Sounds like medullary sponge kidney to me. Do you have a kidney CT without contrast that you can share (deidentified). Any comments Dr. Goldfarb or...

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RE: Immunotherapy, Fibrillary GN and AKI 17 hours ago

The association between prednisone therapy and improvement in kidney function may have been purely co-incidental, as suggested by Dr. Venkat. ----...

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RE: DERMS IN HD III 17 hours ago

Greetings professor and thanks for you reply These are the values of ferrum metabolism  IST: 74% Ferritin.                  Hb.              ...

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RE: DERMS IN HD III 17 hours ago

I suppose that porphyria cutanea tarda associated with dialysis needs to be considered because of the location (dorsum of hand). Were any blusters ...

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RE: Global glomeurlosclerosis in 28 year old 17 hours ago

Dr. Venkat raises several important issues in this case . It is correct that Tubular proteinuria usually results in non-Nephrotic proteinuria. but ...

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RE: DERMS IN HD III 18 hours ago

It certainly could, however no recent trauma history, just lessions that appeared out of nowhere, mildly pruritic, painless ----------------------...

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RE: Global glomeurlosclerosis in 28 year old 18 hours ago

Dipstick testing positive (100 mg/dL) and total 24 hr UPr as high as 4.6 g strongly suggest glomerular rather than tubular proteinuria. SAlb level ...

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RE: DERMS IN HD III 19 hours ago

At least one of the lesions in the photograph looks like an ecchymosis/bruise. Could high venous pressure ---> capillary pressure in access extremi...

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RE: Severe hypocalcemia with basal ganglia calcification 19 hours ago

Is there any evidence of renal calcification on imaging studies? What is causing his impaired renal function? ------------------------------ K.K. ...

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RE: Immunotherapy, Fibrillary GN and AKI 19 hours ago

Good renal outcome for the patient at least in the short-term. You had originally treated the patient with prednisone 60 mg daily. However, renal f...

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RE: Global glomeurlosclerosis in 28 year old 19 hours ago

Do you have uric acid level? Any family history of idney disease? I highly recommend genetic testing. ------------------------------ Prince Anand ...

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Need assistance for patient with multiple kidney stones 20 hours ago

Requesting your assistance for this patient with kidney stones. Patient is a 52 year old male, weighs 233 lbs, and is 5 ft 6 inches tall. Referred...

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RE: Global glomeurlosclerosis in 28 year old 20 hours ago

Good point, but lack of EM abnormalities ofcGBM makes this unlikely in a young female. ------------------------------ Richard Glassock MD, FASN Em...

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RE: DERMS IN HD III 20 hours ago

I don't think those values completely rule out a metabolic cause but certainly make it unlikely. Since the access is on that side I think a fistulo...

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RE: DERMS IN HD III 21 hours ago

Greetings, sure, this patient has PTH on 486 ug/l, Ca 8.5 mg/dl, P 3.4 mg/dl If more info needed please let me know -----------------------------...

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