RE: Alkaline urine in primary hyperaldosteronism 6 minutes ago

I believe that aldosterone mediated increase in pendrine abundance in distal tubules could help to explain the alkaline urine. There is good eviden...

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RE: Alkaline urine in primary hyperaldosteronism 14 minutes ago

IN Primary hyperaldosteronism , distal tubule Na+ for H+ exchange should generate enough urinary H+ to keep the urine on the acidotic side. Experim...

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RE: Alkaline urine in primary hyperaldosteronism 52 minutes ago

I suspect the renal HCO3 generation can persist as a consequence of H secretion regardless of the serum concentration of HCO3 or urine pH. This may...

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RE: Screening for CKD 1 hour ago

I am concerned that all this would do is identify more mild non-progressive CKD in older patients, that seem to be filling my clinic as a result of...

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Screening for CKD 1 hour ago

A lot of interest in screening asymptomatic subjects for CKD is being expressed on SoMe. Do you think that population -based screening of adults ) ...

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RE: Plasma Cell Rich TCMR 16 hours ago

Would it be worth trying Anti-plasma cell treatments like Bortizomib in this situation if the viral and drug induced causes have been ruled out? ...

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RE: Alkaline urine in primary hyperaldosteronism 22 hours ago

If K+ depletion effect on PCT cell pH dominates, intracellular acidosis leads to increased ammoniagenesis. Indeed, many pts with PA are hypocitratu...

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RE: Alkaline urine in primary hyperaldosteronism 22 hours ago

Thanks for these replies. I thought about this, but this would be incompatible with maintenance of the metabolic alkalosis (presuming the typical a...

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RE: Alkaline urine in primary hyperaldosteronism 23 hours ago

I think Dr. Rodby may be correct - the bicarbonaturia regularly seen in Primary Aldosteronism may be a phenomenon of increased filtered load of HCO...

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

well I think you should remove that table from your lecture. I am being a bit facetious, but the problem with teaching physiology often is just thi...

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Alkaline urine in primary hyperaldosteronism 1 day ago

I gave a lecture on urinalysis to medical students with a table listing causes of alkaline urine, including primary hyperaldosteronism. Many studen...

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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago

Just curious. I would like to hear from the experts concerning the indications for testing for the serum level of FGF23. Also, when ordering a FGF2...

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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago

This patient has CKD stage 3B- isn't the elevated IPTH the result of CKD? Akso, I thought that serum FGF23 was increased in primary Hyperparathyroi...

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RE: Undetectable FGF23 found when hypophosphatemia normalized 1 day ago

Inappropriately high phosphate excretion in this case Urinary phosphate excretion above 100 mg/day or a FEPO4 above 5 percent is indicative of rena...

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RE: Plasma Cell Rich TCMR 1 day ago

Rarely, IgG4-related disease can occur in the allograft. It can manifests as plasma cell rich inflammation and tubulitis. Plasma cells stain for Ig...

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RE: Plasma Cell Rich TCMR 1 day ago

If other causes of a plasma cell infiltrate as mentioned by Dr Rubin have been ruled out, then the prognosis for this type of rejection is usually ...

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RE: AKI after start of Tolvaptan for PKD 1 day ago

The effects of AVP peptide(vasopressin) includes activation of V2 receptors which stimulate the formation of cyclic AMP (cAMP) and phosphorylation ...

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RE: Lupus nephritis and Pregnancy 1 day ago

It is clear that this lady has active lupus nephritis and with a fairly advanced pregnancy. I find the thought that tacrolimus would cause abnormal...

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RE: AKI after start of Tolvaptan for PKD 1 day ago

in the discussion so far there has been no mention of the solute load generated by the patient that determines the amount of water the patient has ...

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RE: Plasma Cell Rich TCMR 1 day ago

It appears that this patient is months to years out from transplantation. Questions: 1. Current UAlb/Cr or UPr/Cr? 3. Has SCr been stable around 4...

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RE: AKI after start of Tolvaptan for PKD 2 days ago

Agree, but the question remains: Why or how does talvaptan cause a hemodynamic change big enough to lead to a significant drop in GFR? That seems u...

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RE: Plasma Cell Rich TCMR 2 days ago

This is the reference for the use of IVIG in this situation: Adrogue HE, Soltero L, Land GA, Ramanathan V, Truong LD, Suki WN. Immunoglobulin thera...

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RE: Plasma Cell Rich TCMR 2 days ago

As you know a plasma cell rich infiltrate can be seen in rejection (which tends to be very resistant to treatment) but also in viral nephropathy (s...

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Plasma Cell Rich TCMR 2 days ago

A 30 years old woman with kidney transplant (ESKD due to SLE). She is in TAC 1 mg bid, MMF 500 mg bid and prednisolone 5 mg od. Developed slowest i...

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RE: AKI after start of Tolvaptan for PKD 2 days ago

Agree- this is very likely not Acute Kidney "Injury" but "just" a hemodynamic adjustment . ------------------------------ Richard Glassock MD, F...

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RE: AKI after start of Tolvaptan for PKD 2 days ago

Acute drops in eGFR with tolvaptan has been previously described: One study looked at acute hemodynamic changes with tolvaptan. Median eGFR drop w...

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RE: Lupus nephritis and Pregnancy 3 days ago

Hi Gurwant, I don't think this is tacrolimus effect esp when it has been subtherapeutic. What were the earlier fetal growth scan. Does fetus have I...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

Sheldon, let me "phone a friend" on the effect of tolvaptan on Na excretion @JuanCarlosVelez ------------------------------ Roger Rodby MD, ...

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RE: Treatment of Renal limited anti GBM disease 3 days ago

Thank you both for your valuable input. ------------------------------ Jaideep Hingorani MD Charlotte Nephrology Associates, P.A. Port charlotte ...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

thank you and happy to let group know next BMP on Tolvaptan but off the thiazide ------------------------------ Alan Friedman MD Kidney Medical ...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

To Dr Balan: Good point but may not apply to a patient on talvaptan (or those on forced water drinking) To Dr Rodby: That's the classic teaching an...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

I was taught that diuretics are relatively contraindicated in adpkd due to the fact that progression of CKD is faster if a diuretic is used to cont...

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Lupus nephritis and Pregnancy 3 days ago

Seeking expert opinion on LN in pregnancy 30.2 w POG G1P0. Question: Is tacrolimus really needed esp. if remains sub-therapeutic? 27 F, adopted, ...

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RE: Proteinuria in IgA nephropahy 3 days ago

If I understand correctly from above discussion, since patient is already on Benazepril, next drug to add would be SGLT2i - Dapagliflozin Only if ...

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RE: Treatment of Renal limited anti GBM disease 3 days ago

I agree with Dr.Friedman that this is irreversible kidney disease so it would be futile to expect any recovery of kidney function with re-treatment...

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RE: Proteinuria in IgA nephropahy 3 days ago

The newer drugs ( sparsentan and budesonide) were studied on patients on RAASi alone not RAASi with SGLT2i, so it is unclear what effect they may h...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

I suspect it is the thiazide more than anything. Water loss represents so little intravascular volume. If it were significant, you should see hype...

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RE: AKI after start of Tolvaptan for PKD 3 days ago

Some patients do not realize the water intake committment needed to be on Jynarque. Hopefully, you patient has reversible volume and hypotension re...

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RE: AKI after start of Tolvaptan for PKD Thursday, May 25 @ 10:12 AM

thank you ------------------------------ Alan Friedman MD Kidney Medical Associates Bronx NY ------------------------------

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RE: Proteinuria in IgA nephropahy Thursday, May 25 @ 10:09 AM

Dear Dr Glassock I thought mmf was studied in Chinese population Do you still suggest to use of mmf in Caucasian population --------------------...

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Lupus nephritis and Pregnancy Thursday, May 25 @ 9:59 AM

Seeking expert opinion on LN in pregnancy 30.2 w POG G1P0. Question: Is tacrolimus really needed esp. if remains sub-therapeutic? 27 F, adopted,...

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RE: Proteinuria in IgA nephropahy Thursday, May 25 @ 9:53 AM

I agree that this patient is a good candidate for SGLT2i therapy, if high-grade hematuria is also present I might consider MMF as well. I am uncert...

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RE: Psychiatric Patients and Dialysis Thursday, May 25 @ 9:09 AM

Privilege is a special right, advantage, or immunity granted or available only to a particular person or group: It is singular. A right may be inal...

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RE: AKI after start of Tolvaptan for PKD Thursday, May 25 @ 8:54 AM

yet to see it, but I must admit I have not always checked sCR/GFR, 2 weeks after starting Tolvaptan as diligently as you have. I will do it next ti...

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AKI after start of Tolvaptan for PKD Thursday, May 25 @ 7:42 AM

40 yo woman know PKD (no genetic testing) with strong +FH (mother, uncle) started on starting dose of Jynarque/Tolvaptan two weeks ago BP well cont...

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RE: Unusual GN with "full house" and Hepatitis D Thursday, May 25 @ 6:51 AM

Why don’t GI/ID offer to treat the HBV too with a renally-friendly/adjusted NA like entecavir despite suppressed HBV DNA (in blood; expected with H...

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RE: Psychiatric Patients and Dialysis Thursday, May 25 @ 6:44 AM

Dr. Salman's comments and questions are very important and germane. In response to his question about healthcare being a human right, I would sugge...

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RE: Unusual GN with "full house" and Hepatitis D Thursday, May 25 @ 1:23 AM

Thanks Dr Glassock. Her current creatinine is around 3, improving a bit from resolution of the ATN component. Currently around 3 g proteinuria. Yes...

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RE: Treatment of Renal limited anti GBM disease Wednesday, May 24 @ 11:12 PM

Given severe clinical/pathological initial presentation (creat 15, dialysis-requiring, > 90% crescents) with (therefore expected) ongoing dialysis-...

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RE: Psychiatric Patients and Dialysis Wednesday, May 24 @ 11:04 PM

I understand where you ate coming from, Dr Hirsch. As an immigrant from Post WWII , my family initially lived in an inner city community of Philade...

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