RE: Nephrogenic diabetes insipidus 2 hours ago

thanks! I get the point now (I am several decades removed from didactic Genetics!). Lyonization, being limited to the X-chromosomes, should not i...

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RE: Nephrogenic diabetes insipidus 3 hours ago

In an autosomal recessive disease all cells are affected equally. In a female with a heterozygous X-linked disorder only some cells are randomly af...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 3 hours ago

I agree with with Dr. Nadasdy's very germane comments. RF is often elevated in infection-related GN. ------------------------------ Richard Glasso...

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RE: renal tubular acidosis 3 hours ago

Mutations in Several genes be associated with Distal Renal Tubular acidosis (which is what the patient likely has) inherited as autosomal dominant ...

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RE: osteoporosis in Dialysis pt 3 hours ago

I think that Dr. Venkat has summarized the issue of Osteoporosis scanning by DEXA scans in dialysis treated ESKD patients very nicely. Using Denosu...

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renal tubular acidosis 5 hours ago

I would like to comment on a case of a 29-year-old woman who presented to the emergency department of our institution with hypokalaemia approximate...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 6 hours ago

Crescentic GN with C3 and IgG: consider infection before you start heavy immunosuppression. The normal C3 and negative blood cultures do not exclud...

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RE: fe urea 7 hours ago

An article about the revised classification and definition of hepatorenal syndrome: News in Pathophysiology, Definition and Classification of Hepa...

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RE: fe urea 9 hours ago

Nicely stated and concur. Whatever we call it one still has the task of determining the pathophysiolgy which is the true art of nephrology. ------...

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RE: osteoporosis in Dialysis pt 10 hours ago

The problem with bone density measurement in ESKD patients is the following - low bone density in this population is not proof of osteoporosis of t...

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RE: fe urea 10 hours ago

Leading to....For a terrific meticulous updated discussion of what we've historically called pre renal failure...see Dr Molinaris, https://cjasn.a...

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RE: Nephrogenic diabetes insipidus 11 hours ago

“.. If she has the X-linked form of the disease, and is an obligate heterozygote, Lyonization of the X- chromosome will mean than some nephrons wil...

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RE: Hypercalcemia In Hemodialysis Patient 11 hours ago

Calcium of 18 mg/dL seems a little too high for hyperparathyroifism (tertiary more likely than primary). Given age of 70, malignancy has to be kept...

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c3 GN 21 hours ago

62-year-old male with history of hypertension, diabetes and hyperlipidemia who presented to the ER in May 2022 with left-sided numbness. His blood ...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 23 hours ago

We don't have EM yet. Takes around a week to get EM. ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HS...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 23 hours ago

Blood Cx negative. Complement normal ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HSC Temple TX ----...

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RE: fe urea 1 day ago

This is obviously a super controversial topic. My 2c is that, in the hands of an experienced nephrologist (e.g., most of the people on this pos...

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RE: osteoporosis in Dialysis pt 1 day ago

No, No, Yes. Please see the extensive prior discussions on the Open Forum regarding this topic. ------------------------------ Richard Glassock MD...

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RE: Hypercalcemia In Hemodialysis Patient 1 day ago

Serum calcium of 18 mg/dL seems too high for hyperparathyroidism (tertiary much more likely in this patient than primary HPT). Failure to suppress ...

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osteoporosis in Dialysis pt 1 day ago

Is there a role for doing bone density test on ESRD pts. and if osteoporosis noted on bone density test then is there evidence that prolia provid...

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RE: gross hematuria in an 18 year old man 1 day ago

This is an 18 year old, short of nephrectomy I cannot think of a test I would not do if there were any chance of a diagnosis, Agree that an angio s...

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RE: fe urea 1 day ago

Dr. Rodby: Dr. Ali's initial post in this thread was regarding AKI-on-CKD. Preexisting CKD may confound interpretation of UNa/FENa and FEurea. Goo...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 1 day ago

Good point. Also a RF might help. Do we have the EM results yet. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 38...

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RE: Hypercalcemia In Hemodialysis Patient 1 day ago

Dear Jebur What is the level of alkaline phosphatase? If alkaline phosphatase is high, I very strongly feel this hypercalcemia is due to hyperparat...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 1 day ago

We're blood cultures sent and what are her serum complement levels? ------------------------------ Daniel Kniaz MD, FASN Associates in Nephrology,...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 1 day ago

None of those. ------------------------------ Imtiyaz Hakeem MD Baylor Scott & White Health/Texas A&M COM-HSC Temple TX --------------------------...

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RE: fe urea 2 days ago

Yes, the question one needs to answer is the physiology behind inadequate renal perfusion. In the the case of excessive vasodilation the patient ne...

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RE: Hypercalcemia In Hemodialysis Patient 2 days ago

How many years your patient on dialysis? What is the result of sestamibi scan? VIT D level? I would say the patient most probably has 3ry hyperpara...

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RE: gross hematuria in an 18 year old man 2 days ago

If the bleeding was coming from the R ureter only and he had R sided colicky pain, this may have been due to clot formation. I think he needs a R s...

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RE: fe urea 2 days ago

"My personal favorite is the patient with HFpEF, on vasodilators, presents with AKI, edema, and PVC." Dr. Mellas: can't a low UNa/FENa or FEurea in...

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RE: fe urea 2 days ago

We agree on the physiology and our names are Robert Robey and Roger Rodby Am I your nom de plume? Are you mine? ;) --------------------...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

any hydralazine, allopurinol or levamisole (cocaine) use? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Universi...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

I don't have the official note on the biopsy report to share as it is not available. biopsy was done a day back and discussed with pathologist the ...

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RE: fe urea 2 days ago

Roger, we may be largely in agreement, as I too believe in the "wisdom of the kidney". I simply view urinary indices as objective markers of this w...

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RE: fe urea 2 days ago

Robert Brown, Fractional Excretion of Sodium and Urea are Useful Tools in the Evaluation of AKI: COMMENTARY, Kidney360, Publish Ahead of Print, 202...

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RE: fe urea 2 days ago

"Give me a scenario where the FENa has helped you treat an AKI? " My personal favorite is the patient with HFpEF, on vasodilators, presents with A...

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RE: gross hematuria in an 18 year old man 2 days ago

I would like to thank all of you for your replies. It has been very helpful. I called the urologist who said he did the cystoscopy during an acute...

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RE: fe urea 2 days ago

By analyzing the figure 1 it seems to me that FeUrea is a more reliable test compared with FeNa for differentiating between prerenal azotemia and A...

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RE: fe urea 2 days ago

"the UNa & FENa can sometimes provide valuable insights into the appropriateness of urinary Na handling & thereby help distinguish prerenal contrib...

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RE: PD clearance 2 days ago

I was facing similar situation with a 78 male diabetic who has been on Peritoneal dialysis for last 18 months.He had a decline in his functional st...

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RE: fe urea 2 days ago

I agree that these urinary indices have limited utility in non-oligoanuric patients, but in oligoanuric patients, the UNa & FENa can sometimes prov...

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RE: fe urea 2 days ago

A low Fe Na or urea are rather specific for a pre renal state since the absorption of both solutes requires the expenditure of energy by the nephro...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

She has an nephrotic picture. Biopsy is strongly positive for C3 and IgG. It is hard to get rituximab therapy in the hospital unfortunately. Will t...

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RE: fe urea 2 days ago

I like (Dr. Rodby, don't rely much on FENa or FEurea in clinical practice. Careful clinical assessment of the volume status, BP and cardiac functio...

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RE: fe urea 2 days ago

So fractional excretion of urea is more reliable than fractional excretion of sodium (FeNa) with underlying chronic kidney disease when FeNa is to ...

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RE: Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

Seeing the de-identified biopsy report would help. What are the levels of proteinuria and serum albumin. What is the degree of + for IgG and C3 on ...

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RE: IgA nephropathy 2 days ago

Advance CKD , with severe IFTA she will not benefit from IS medications. Only supportive management is indicated --------------------------------...

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Aki with positive MPO with Biopsy showing C3 deposits and IgG. 2 days ago

I needed input on the management of this patient with mixed picture of immune complex mediated GN with positive MPO. We have a 24 y/o his Hispanic ...

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RE: fe urea 3 days ago

I am very leary of all of the following - UNa, FENa and FeUrea for the clinical diagnosis of ATN v pre-renal renal failure. I have seen too many ca...

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fe urea 3 days ago

Can fractional exertion of urea be used in a non septic AKI on CKD patient to differentiate between ATN and prerenal ? ---------------------------...

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