RE: fsgs And Progressive Renal Dysfunction 2 hours ago

I have included the biopsy report and EM copy ------------------------------ Mohammed Ashraf MD, FASN Lynchburg Nephrology Physicians Lynchburg VA ...

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RE: Persistent hyperkalemia 2 hours ago

Is there really a role of K/cr ratio in hyper K? Isn't stable non pseudo hyper K always a renal tubular disease? --------------------------------- ...

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RE: CRRT for fluid removal in pulmonary hypertension 2 hours ago

I agree but as bad as ESRD and HD are, I find the QOL improves over admissions every few weeks, diuretics on diuretics off, frequent out pt labs. A...

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RE: CRRT for fluid removal in pulmonary hypertension 4 hours ago

This is a tough problem . I have had about 3-4 patients with severe pulmonary hypertension , refractory to diuretics , develop progressive AKI With...

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RE: advanced renal failure with electrolytes derangement 4 hours ago

I am attaching the European Clinical Practice Guidelines on Hyponatremia (2014) which give the measurement of ADH levels a 2D recommendation (i.e. ...

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RE: Renal Sympathetic denervation 5 hours ago

Is there data that renal denervation works?  I thought SYMPLICITY-3 was a bust trial in this regard. Do we have the data for  Pivotal OFF MED? Refe...

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RE: Persistent hyperkalemia 5 hours ago

This may be far out , but patients with fragile red cell membranes due to RBC enzymatic defects may develop hyperkalemia due to RBC “leakage” ex vi...

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RE: Persistent hyperkalemia 5 hours ago

The Urine K:Cr ratio that I calculated is 0.08 mmol K per mg Cr → 84 mmol K per gram Cr.  If my calculation and unit conversions are correct (doing...

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RE: CRRT for fluid removal in pulmonary hypertension 5 hours ago

In considering further diuresis and especially putting the patient on dialysis, I would make sure there still is left sided overload.The report not...

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RE: CRRT for fluid removal in pulmonary hypertension 5 hours ago

With hyperkalemia and hyponatremia, volume overload may be suspected and increasing urine flow rate with combination of diuretics (adding thiazides...

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RE: CRRT for fluid removal in pulmonary hypertension 6 hours ago

At this stage we could increase lasix to 10 mg/hr. We generally try one dose of metolazone 5 mg if output doesn't improve in the next hour or so. I...

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RE: advanced renal failure with electrolytes derangement 6 hours ago

It is not exactly true that you can't concentrate urine without AHD. The Brattleboro rat with total ADH absence can concentrate urine when volume...

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RE: advanced renal failure with electrolytes derangement 6 hours ago

Regarding the role of vasopressin measurement, this is what the European Best Practice Guidelines say " Although there was no systematic evaluation...

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Persistent hyperkalemia 7 hours ago

Hi everyone, I would appreciate some assistance with this case. 61 yoF with persistent hyperkalemia for several years, ranging from 5.4 to 6.1, pre...

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RE: Membranous Nephropathy 7 hours ago

Thanks for the responses. Greatly appreciated. Sudhir Khanna, MD, FRCP

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RE: Renal Sympathetic denervation 7 hours ago

Mostly this is being done by interventional radiologists. There is no reason for the interventional nephrologist not to do it. In fact at Nadiad, G...

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RE: Membranous Nephropathy 7 hours ago

In India we use a lot of biosimilars. In fact the original brand which was marketed as Mabthera is now manufactured by an Indian company. I have us...

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RE: Diabetic nephropathy with ? IRGN + ANA positivity 7 hours ago

Would be interesting to know the current c3 value, if it has normalised. This does look like c3 GN and a persistently low c3 would be against a dia...

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RE: CRRT for fluid removal in pulmonary hypertension 7 hours ago

Can Thiazides be used with persistent mild hyponatremia sodium in early 130s and measured osmolarity of the blood 316 and even after removing the c...

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RE: Diabetic nephropathy with ? IRGN + ANA positivity 8 hours ago

WHAT ABOUT ACCURACY OF E/M WITH PARAFFIN SECTION;THE YIELD VALUE? ------------------------------ Ahmed Yassin MD, FASN Saudi German Hospital Madina...

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RE: PD in a liver transplant patient 9 hours ago

Nothing to lose in this patient because he is already on HD and increase in proteinuria  Is not a relevant concern. In a patient not already on dia...

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RE: Diabetic nephropathy with ? IRGN + ANA positivity 9 hours ago

EM will be very helpful. I understand you can send out the specimen to Mumbai for EM evaluation. Although not ideal, paraffin sections can be repro...

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RE: fsgs And Progressive Renal Dysfunction 10 hours ago

The prevalence of Parvovirus B19 IgG antibody in the healthy adult population is 30-60 %. The best test to diagnose active Parvovirus B19 infection...

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RE: advanced renal failure with electrolytes derangement 10 hours ago

" I find labels often not helpful. For example, I find the "I" in SIADH distracting as it seems to introduce a teleologic element: is the ADH appro...

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RE: fsgs And Progressive Renal Dysfunction 10 hours ago

Moderate to severe arteriolonephrosclerosis makes secondary FSGS more likely than primary. Normal SAlb and lack of edema also favor secondary FSGS....

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RE: advanced renal failure with electrolytes derangement 10 hours ago

Perhaps the term "Free water excretion deficit" may be more appropriate ------------------------------ Donal Reddan MBChB Galway University Hospita...

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RE: PD in a liver transplant patient 10 hours ago

What do you have to loose as long as liver team is ok with conversion ? --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] [Past...

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RE: PD in a liver transplant patient 10 hours ago

Regarding switching from CNI to a mTOR-I in this patient: 1. UPr 2.3 g/day. mTOR-I may cause or aggravate proteinuria.      2. Already dialysis-dep...

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RE: Toluen exposure and ckd 10 hours ago

A limitation of using the UAlb/Cr vs. UPr/Cr on same sample of urine to distinguish tubulointerstitial from glomerular disease must be kept in mind...

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RE: advanced renal failure with electrolytes derangement 10 hours ago

I agree with Dr. Hirsch about the confusion regarding the letter I in SIADH. If inappropriate is defined as ADH release when it is not required by ...

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RE: PD in a liver transplant patient 11 hours ago

Interesting case.  Pd should be OK provided there are not significant adhesions or hernia(s) along the OLTx incision.  The latter was usually the r...

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RE: polycystic kidney and liver disease 12 hours ago

MMF v Aza for maintenance in SLE. the ALMs follow-up trial found MMF superior to Gaza for maintenance While the European MAINTAIN trial , follo...

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RE: MCD + IgA nephropathy 12 hours ago

In my opinion, a typical relapse of MCD is most often accompanied by hypoalbuminemia - Sent from my iPhone

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RE: polycystic kidney and liver disease 13 hours ago

Thank you. Would MMF dose of 500 mg bid be a reasonable maintenance dose for long term? Both women have had their children and practicing reliable ...

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RE: polycystic kidney and liver disease 14 hours ago

I will let others address your question about liver cysts in ADPCKD. AZA and MMF are considered roughly equivalent for maintenance of a remission I...

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RE: fsgs And Progressive Renal Dysfunction 14 hours ago

I am always very curious about APOL1 genotype in this setting. Not that it would likely change anything you would do.  High risk genotype doesn't s...

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RE: polycystic kidney and liver disease 14 hours ago

There are some phase 3 trials using vaptans that are supposed to be on-going this year.  Some of them will be looking at liver cyst growth as well....

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polycystic kidney and liver disease 14 hours ago

I have a 65 yo obese female with ADPCKD. Her major complaints have been related to liver cyst. She is S/P 2 partial liver resections beginning at 3...

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RE: Diabetic nephropathy with ? IRGN + ANA positivity 15 hours ago

This much lupus GN without other Ig deposition seems very odd pointing to more of a C3 GN IMO. These smoldering IRGN appearing cases are often C3GN...

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RE: Diabetic nephropathy with ? IRGN + ANA positivity 17 hours ago

Hard to say without EM. This might be relapsing Lupus Podocytopathy or a C3GN (with auto-antibodies to CfH.). Additional serology might help. Sent ...

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Diabetic nephropathy with ? IRGN + ANA positivity 17 hours ago

A middle aged female patient , diabetic of 5 years duration well controlled on Metformin presented with decreased urine output and edema. Creatinin...

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RE: Membranous Nephropathy 23 hours ago

I have no personal experience but they should work as well as any Anti-CD20 MoAb of the Rituximab Class. Of course, there are no head to head RCT a...

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Membranous Nephropathy 1 day ago

There is no reason to believe that it should not work but does anyone have experience with Rituxan biosimilars—Truxima or Ruxience? I recently call...

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RE: fsgs And Progressive Renal Dysfunction 1 day ago

Thank you so much Dr Glassock for your input Biopsy did not reveal any diabetic nephropathy I will post the biopsy report and try to get Em copy --...

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RE: fsgs And Progressive Renal Dysfunction 1 day ago

In my opinion, bilateral small vessel Arteriolonephroscrerosis would not likely produce this severE proteinuria in the absence of “malignant Hypert...

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RE: fsgs And Progressive Renal Dysfunction 1 day ago

The presence of Nephrotic range Proteinuria and normal serum albumin, makes Primary (permeability factor Related ) FSGS quite unlikely. The positiv...

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RE: fsgs And Progressive Renal Dysfunction 1 day ago

This patient never really fulfill the definition of nephrotic syndrome , although he has significant proteinuria 12 gm initially , no edema , hyper...

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fsgs And Progressive Renal Dysfunction 1 day ago

Hello all I will appreciate help regarding my patient with FSGS pattern of Gn with progressive ckd 64 year old AA man with history of type 2 dm sin...

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RE: Toluen exposure and ckd 1 day ago

The result of proteinuria of 970 mg/g, with microalbuminuria of 728 mg/g suggests glomerular disease. Usually laboratories in Brazil show reference...

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RE: CRRT for fluid removal in pulmonary hypertension 1 day ago

Remember that hypoalbuminemia in the critically ill patients may be an acute phase reactant or may results from capillary leaks. I’ve tried adding ...

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