RE: To treat or not to treat;that is the question! 44 minutes ago

Looks Isolated Class V to me and with segmental deposits, sub-gram proteinuria, not sure if loss of GFR can confidently be attributed to LN. I woul...

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RE: Hypokalemia In A Young Woman. 1 hour ago

What are the results of plasma aldosterone and plasma renin Activity off medications? Dies she take oral contraceptives? Sent from my iPad

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RE: Unexplained deaths related to dialysis 1 hour ago

Did these cases occur during a pandemic? If so, what percentage of your patients have been infected. What is your overall mortality rate during a p...

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Hypokalemia In A Young Woman. 5 hours ago

Hi All. I would appreciate your help with this case. 39yo white female with hx of HTN for 10yrs controlled on HCTZ 25mg daily. She was recently sta...

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RE: Tablo Machine For Impatient Dialysis 6 hours ago

Nice summary. I would add that Tablo needs heat disinfection (for dialysis machine part) at least every 72 hrs and weekly chemical disinfection for...

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RE: Tablo Machine For Impatient Dialysis 6 hours ago

Thanks much for the information !! --------------------------------- Srinivasa Iskapalli MD University of Louisville shreveport LA (810) 513-932...

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RE: Tablo Machine For Impatient Dialysis 7 hours ago

We have been using Tablo since the outbreak of Covid here in New York last March.. Think of the Tablo Machine as somewhere in the middle between th...

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RE: To treat or not to treat;that is the question! 7 hours ago

Agree- I meant Class III +V. But it does not make much difference for the choice of therapy. Sent from my iPad

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RE: To treat or not to treat;that is the question! 7 hours ago

Eighty five-year-old female with SCr of 1.6 mg 15 months ago. In an older female probably with a low muscle mass, this already represents a very ad...

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RE: To treat or not to treat;that is the question! 8 hours ago

I just don't see the class "IV" LN in the report. I only read the membranous V.  Am I missing something? The mesangial proliferation and deposits a...

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RE: excess urine output of uncerain etiology 8 hours ago

When you do the 24 hour urine, send it for a few other things that we may want later make sure you know the volume and send an aliquot for osmolali...

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RE: excess urine output of uncerain etiology 8 hours ago

The calculation of 24 hour osmolal excretion is easy. Multiply the Osmolality (in mOSM/kg of water) of al aliquot of a well mixed 24 hour Urine col...

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RE: excess urine output of uncerain etiology 8 hours ago

Fresh Frozen Plasma contains about 172mEq/L of Sodium, 3.5meq/L of Potassium and 5350mg/L of glucose and about 33gms/ L of albumin. How many ml/ ba...

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RE: excess urine output of uncerain etiology 9 hours ago

Is there a formula for 24 hour osmolal excretion rate  or is measured by lab? Patient now tells me that his excess urination is going on for years ...

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RE: To treat or not to treat;that is the question! 9 hours ago

See Kudose S, et al CJASN 2019for an analysis of the sensitivity, specificity, positive and negative predictive values of the 5 morphological crite...

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RE: Tablo Machine For Impatient Dialysis 9 hours ago

Tablo is starting at one of our hospitals next week. The main differences are maximal dialysate flow is 300 ml/ min.  The best I can tell is that a...

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RE: To treat or not to treat;that is the question! 9 hours ago

Except for the absence of tubulo-reticular inclusions and C1q deposits- this looks like Class IV + V LN- I would treat, gently with MMF and oral st...

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RE: C3GN 9 hours ago

I am not against RTX in this case, but we really need to know what we are treating, and I am not yet convinced that this is really C3GN superimpose...

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RE: FSGS case 10 hours ago

Since whatever therapy that is chosen will be empiric in this patient who is rapidly progressing towards ESRD (and will have to take "triple" post-...

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To treat or not to treat;that is the question! 10 hours ago

Hello everyone. Id love your input on a case. 85 yo WM referred to me for slowly worsening cr from 1.6 june 2019 to 2.29 sept 2020. UA +700mg/Gm pr...

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RE: excess urine output of uncerain etiology 10 hours ago

On a side note, can plasma infusion cause an osmotic diuresis? I currently have a patient who received plasma (6 bags)  for covid and now has ~3L/d...

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RE: Topvaptan in SIADH with a tracheostomy 10 hours ago

Brilliant- this is useful- Im hoping we will have her weaned off her tracheostomy soon and can decannulate so she can regulate her own intake -this...

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RE: C3GN 11 hours ago

I second Rituxan.  Antigen retrieval with pronase or other methods on paraffin will be helpful.  Monoclonal related GN is likely and can mimic diab...

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RE: FSGS case 11 hours ago

Thanks for the FU. The initially normal serum albumin makes Primary FSGS unlikely. Genetic studies are definitely indicated, as steroids and RTX ...

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RE: Acute and chronic tubulointerstitial nephritis 11 hours ago

Please describe the AIN- is it eosinophil, lymphoid or plasma cell dominant?. Is she taking any OTC meds, such as PPI or NSAID? Sent from my iPad

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RE: Acute and chronic tubulointerstitial nephritis 11 hours ago

it is hard to consider treatment of acute AIN without steroids. If this is perceived side effects, I'd show her the dialysis unit and rediscuss sid...

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Acute and chronic tubulointerstitial nephritis 11 hours ago

​ 60-year-old female with history of hypothyroidism, LDL receptor disorder, metabolic syndrome referred to me for acute kidney injury.  Baseline cr...

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RE: FSGS case 12 hours ago

Agree Dr Glassock, That's why I am asking.  Genetic testing are not available here, but she is travelling back to Emirates, I will ask her to sea...

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RE: Influenza Vaccine After Rituximab 12 hours ago

Inactivated Influenza vaccine is OK but a protective immune response will very likely be impaired so the efficacy of such vaccination is in doubt. ...

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RE: FSGS case 12 hours ago

So no clear benefits of RTX, except for "stabilization" of eGFR.  What is the serum albumin Level..  did you ever try to get genetic studies.  Lack...

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RE: excess urine output of uncerain etiology 12 hours ago

You are able to measure uOSM and pOSM, why can’t you measure the Osmolality of an aliquot of a 24 hour Urine collection? Sent from my iPad

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RE: Tablo Machine For Impatient Dialysis 13 hours ago

We've been using Tablo in hospital setting for almost 2 years- now using it for home HD and in-center HD + transitional HD as well. In hospital set...

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RE: FSGS case 14 hours ago

Do you recommend low dose CNI currently ? Given her 45% IFTA and GS ? --------------------------------- Mohamed Elrggal, MD Alexandria Egypt +20 12...

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RE: FSGS case 14 hours ago

Follow up of the case  2weeks after the second dose of Rituximab  Creatinine 1.4 and proteinuria 3 gm (stable course)  Steroids currently at 10 mg ...

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Influenza Vaccine After Rituximab 14 hours ago

Have a patient who took Rituximab 6 months ago for AAV, CD19 cells are not detected in blood tested 3 weeks ago. Can she take the infuenza vaccine ...

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RE: excess urine output of uncerain etiology 15 hours ago

Please determine 24 hour osmolal excretion rate. -- Dick Glassock Please note and save my new email address: rjglassock@gmail.com

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RE: necrotizing granulomas in a transplant recipient 16 hours ago

I think this is a repost of a case that was posted a few days ago. I have copied below what I wrote in response at that time. "Any constitutional s...

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RE: excess urine output of uncerain etiology 16 hours ago

Bun in the blood has been 7-18, recently 7-9. ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ---------------------------...

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RE: excess urine output of uncerain etiology 16 hours ago

We are not able to measure osmolality or Glucose on 24 hour urine collection. We can calculate osmolarity on 24 hour urine collection of sodium, po...

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RE: excess urine output of uncerain etiology 16 hours ago

Renal Intrasound was completely unremarkable on 20 October, 20. Last urinalysis on 24 of September showed 50 glucose but previously glucose has alw...

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RE: Unexplained deaths related to dialysis 16 hours ago

​Let's not forget the awful tainted heparin event just a few years ago as well.  Interesting that not all patients receiving the tainted heparin be...

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RE: HOME HEMODIAFILTRATION 16 hours ago

NxStage only does hemodialysis or hemofiltration, not hemodiafiltration. You could do NxStage hemofiltration with bagged dialysate as RF replacemen...

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RE: Topvaptan in SIADH with a tracheostomy 16 hours ago

I think tolvaptan is the way to go. you are following her PNa so in the event she gets behind you can easily increase her NG water transiently.   "...

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RE: PD and liver cirrhosis 16 hours ago

These are few articles addressing PD in cirrhotics. The main factor to be considered is if the patient has ascites or not. It can be done if the pa...

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Topvaptan in SIADH with a tracheostomy 17 hours ago

We have a young lady who recently suffered spinal (T1 level) and head injuries (contusions and SAH)  for which she is being slowly weaned off her v...

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necrotizing granulomas in a transplant recipient 17 hours ago

We have a 43 yr-old female s/p a kidney transplant 2 years ago, sensitized who had a kidney biopsy 14 month ago due to elevated allosure and multip...

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RE: Tablo Machine For Impatient Dialysis 17 hours ago

In one of the community hospitals that we cover, we're going to start using Tablo due to logistical reasons (including shortage of dialysis nurses)...

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RE: excess urine output of uncerain etiology 17 hours ago

Many disorders are dual, this polyuria seems like a solute diuresis, but may be confounded by a concentration defect as well. BUT a solute diuresis...

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RE: excess urine output of uncerain etiology 17 hours ago

Should also consider residual tubular toxicity of antibiotics used for perforated diverticulitis/abdominal abscesses (aminoglycosides, colistin, va...

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RE: excess urine output of uncerain etiology 18 hours ago

Persisting polyuria with recent Uosm of 396 and 423 suggests solute diuresis rather than increased free water excretion. Low SCr could be also due ...

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