RE: " Super" Severe Resistant HTN in CKD 4 patient 5 hours ago

If memory serves me correctly , I have only used bilateral nephrectomy for "resistant hypertension" twice in my 60 year career in Nephrology . Both...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 6 hours ago

Having practiced in a HTN referral center for over 15 years at UConn This case is highly unusual. The doses and numbers of drugs is exceptionally h...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 6 hours ago

Update on our rHTN (Super Severe HTN) after more digging it appears he never had a complete Complement panel for both functional and genetic ...

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RE: Aldosteroma Diagnosis 7 hours ago

Thanks Dr. Leisring- all very reasonable observations and opinions. Time will tell. A non-invasive way of diagnosing unilateral aldisteronoma (macr...

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RE: Aldosteroma Diagnosis 10 hours ago

I see this as encouraging progress, but still far away. Apparently, the primary molecule in this study requires an on-site cyclotron so it seems li...

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RE: CMS rules for hospice in advanced CKD not on dialysis 15 hours ago

I think Dr. Schell hit the nail on the head. The issue is treatment and drug coverage once a patient is in hospice. What if your patient develops a...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 16 hours ago

This patient has advanced CKD stage 4 and behavioral issues impacting BP control. He is on redundant medications and inadequate diuretic regimen, m...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

An amateurish brain storming An infection or something else turns the ignition key "complements etc" and starts TMA/HUS - micro thrombi shower to...

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Aldosteroma Diagnosis 1 day ago

Is this the end of Adrenal Vein sampling for the diagnosis of an unilateral aldosterone secreting tumor? (see Goodchild E, et al Molecular Imagin...

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RE: MPGN/Lupus/DKD - biopsy. 2 days ago

Dr. Sasongko: Dapagliflozin + Perindopril + Ozempic + mycophenolate: unclear how much of improvement in proteinuria is from immunosuppression vs a ...

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RE: Gross hematuria in a pregnant patient 2 days ago

Thank you everyone for the great discussion. The hematuria resolved on day 5. Since the patient underwent an exchange transfusion on day 2, it's un...

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RE: MPGN/Lupus/DKD - biopsy. 2 days ago

Anti-Ro auto-antibodies can be associated with abnormalities in AV conduction. I am impressed with the extent of IC deposition and the "response " ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

A case or refractory hypertension and MAHA requires a systematic approach both diagnostically and therapeutically. DIAGNOSIS 1. In this type of...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

Dear Dr Robdy thank you for sharing your opinion and Dr Chang 's take on this very interesting and not well known etiology of resistant hyperten...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

I had brought up baxdrostat a aldosterone synthase inhibitor Dr Friedman similarly brought up zilebesiran an angiotensinogen blocker both...

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RE: Diabetic nephropathy with positive congo red 2 days ago

There is a reasonably high probability that this patient has H. Pylori infection related Cryoglobulinemic Glomerulonephritis. See Almemhi A et al A...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

When/if available, zilebesiran might be a great option for the RAS-mediated element of his HTN given its VERY prolonged duration of effect without ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Agree with the many excellent comments but to mention the issue of volume, the expansion of the ECFV in most patients with hypertension is subclini...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Thanks Roger We may be at least partially talking about two different things. My comments/references were about resistant HTN in general. This ca...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Sheldon, Again just because BP responds to volume removal does not mean it is just volume I think this is a different bird than 95% of our pati...

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RE: Hyponatremia 3 days ago

Urea will work, as long as you achieve steady state you will excrete the urea you make and take, and you BUN will increased, will level off, grante...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

addendum (ugh): In reviewing the Talor article, turns out I exaggerated. Nurses were involved but treatment decisions in both groups were made by a...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

I agree with Roger that volume is not always the culprit in resistant HTN, but it very commonly is. The evidence for that is strong and it is compl...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Digging deeper RNs inform me they checking his mouth after swalliwing pills but he routinely goes to bathroom after taking pills be has bee...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

I agree with Dr. Hirsch that it would be very difficult to imagine such as huge increase in blood pressure primarily due to "volume overload". The ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Not to beat a dead horse, (overly quote an very odd case report) but our patient that eventually required nephrectomy was always controlled on IV C...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

@Jonathan Slater: is the patient refusing IV access or is it difficult to obtain IV access? If BP is easily controlled with IV medications in much ...

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RE: Hyponatremia 3 days ago

I do not think it will work very well due to the low GFR and urea will surely build up in the blood but urea per se is not toxic so IMO, the treatm...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

I suspect the TMA was during the severe TMA episode, and even if biopsy showed TMA Im not sure what you do with that. However you are correct in th...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Did you check complement gen mutations for aHuS there are good data of aHUS associated with resistant HtN and TMA . Your patient already has evid...

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RE: MPGN/Lupus/DKD - biopsy. 3 days ago

Thank you all. BMI - roughly 28. No other clinical symptoms, mild LFT derangement that is associated with her worsening of metabolic syndrome w...

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RE: MPGN/Lupus/DKD - biopsy. 3 days ago

"I would definitely continue the MMF. I might also consider adding Belimumab(off label) if the Anti- Ro antibody persists." @Richard Glassock: Gi...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

I our case report I attached earlier, renal denervation (surgical) markedly lowered the BP but it only lasted a short time, thus the decision to re...

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RE: Diabetic nephropathy with positive congo red 3 days ago

DsDNA : 0 ------------------------------ Mustafa Ahmad MD, FASN Consultant Nephrologist King Fahad Medical City Riyadh 966568310309 ------------...

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RE: Diabetic nephropathy with positive congo red 3 days ago

Thanks for the feedback. Apologies for the wrong title- it happened because I wanted to post another patient as well with diabetic nephropathy an...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

I think renal denervation is an option to consider here. ------------------------------ M.N. Alhosaini ------------------------------

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RE: Hyponatremia 3 days ago

What is the patients BMI and BSA? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

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RE: Hyponatremia 3 days ago

Is administration of urea for hyponatremic patient advised in chronic kidney disease patients? ------------------------------ Wael Jebur MD, FAS...

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RE: MPGN/Lupus/DKD - biopsy. Tuesday, March 18 @ 12:47 AM

Taken together, the findings in this case support the notion of a forme fruste of Sjogren Syndrome and not SLE , IgAN, or Mixed Connective Tissue D...

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MPGN/Lupus/DKD - biopsy. Monday, March 17 @ 9:32 PM

Hi all, Trying to discern the treatment approach for this 54yo lady of Aboriginal background w metabolic syndrome (variable DM control, HTN, obes...

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RE: Diabetic nephropathy with positive congo red Monday, March 17 @ 6:20 PM

No results for Congo red stain found in report. No features of Diabetic Nephropathy. Need more information on nature of 'organized subendothelial e...

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RE: Hyponatremia Monday, March 17 @ 5:49 PM

Pain and NSAIDS may have played a role. Often, in hospitalized patients, reduction in food (protein) intake may play a role caused by a reduction...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Monday, March 17 @ 5:39 PM

I agree with the usual attention to volume in resistant HTN but this case is beyond anything I've ever seen. You could easily have volume excess ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Monday, March 17 @ 4:49 PM

Appreviate the feedback thus far and we will definitely need to reassess the volume issue I forgot to include thst he is on bumex 2 mg bid lung...

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RE: Diabetic nephropathy with positive congo red Monday, March 17 @ 4:34 PM

"Hep B, C , HIV negative." Were HBV core antibody tests also negative? If testing for HBV and HCV was done with antibody screening only, need to...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Monday, March 17 @ 4:32 PM

Read the attached It was one of the most rewarding and most "think outside of the box cases" of my career. I could have never "pulled the...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Monday, March 17 @ 4:00 PM

Agree with Dr. Aledan that control of volume excess is very important. If clinical volume assessment is equivocal, worth checking BNP, and ultrason...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Monday, March 17 @ 3:42 PM

The main cause of HTN and difficult-to-control HTN in CKD is volume overload so the mainstay treatment should include diuretics (both combination o...

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RE: Diabetic nephropathy with positive congo red Monday, March 17 @ 2:57 PM

The tile is diabetic nephropathy with positive congo red, but the content of the case is cryoglobulinemic GN. What was serum RF? Need to rule out...

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RE: Hypokalaemia Monday, March 17 @ 1:56 PM

Urine Na and Cl are high on-diuretics and low off-diuretics. --------------------------------- Hayder Aledan MD, FASN Assistant Professor Basra Ne...

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