RE: Resistant Hypertension In Dialysis Patient 11 hours ago

One suggestion regarding his BP medications. Adalat (nifedipine-ER) maximum daily dose is supposed to be 90-120 mg. However, in ESKD patients, I ha...

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RE: Resistant Hypertension In Dialysis Patient 11 hours ago

The plot thickens- is this a benign, but secretory adenoma: a non-secretory incidentaloma or a malignant neoplasm- other than a surgical exploratio...

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RE: Resistant Hypertension In Dialysis Patient 13 hours ago

Good qstn: it has been well-shown that adrenal adenomas that secrete aldo & functionally active are more often than not, [More]

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RE: Resistant Hypertension In Dialysis Patient 13 hours ago

Seems to me there are two separate issues here re the need for surgery: 1) Is this an aldosterone secreting tumor that should be resected to help...

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RE: Resistant Hypertension In Dialysis Patient 14 hours ago

Just curious- what difference will the size of the tumor make with respect to surgical vs medical management? ------------------------------ Ri...

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RE: PGNMID Diagnosis & Treatment 14 hours ago

With failure of daratumumab and CyBorD, I doubt that RTX will do much but it may be worth a try. Dr. Leung- what about stem cell transplantation in...

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RE: Resistant Hypertension In Dialysis Patient 14 hours ago

I believe that the hang up with the cutoff value for aldo/renin ratio of "30" is misplaced in this case. This ratio is based upon measurements of p...

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RE: steroid resistance MCD ! what to do next 15 hours ago

Good idea, but are the therapeutic levels of CNI established in MCD (I do not think so) or do we do levels mainly to avoid nephrotoxicity? -----...

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RE: Resistant Hypertension In Dialysis Patient 15 hours ago

What I meant by "functioning" was that it lit up by PET scan- no proof yet that it is an aldosteronoma. - would you ever treat such a patient medic...

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RE: Resistant Hypertension In Dialysis Patient 15 hours ago

A qstn: what is the size of the mass? And are you able to post a jpg (anonymized) of the CT study? ------------------------------ Prem KG Chandra...

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RE: Resistant Hypertension In Dialysis Patient 15 hours ago

The utility of a test is only when the pretest probability of making a diagnosis or rejecting it is high. In this instance, however you check the a...

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RE: steroid resistance MCD ! what to do next 16 hours ago

If we could check TAC levels, might not be subtherapeutic? --------------------------------- Syed Mohkum Ud Din MBBS Balochistan Institute of Nep...

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RE: Non-resolution of proteinuria of native kidney origin during primary non-function of first kidney transplant and prompt resolution of native proteinuria with immediate graft function of second transplant 16 hours ago

I was thinking along the same line. Is this due to a filtration shift from native kidneys to graft kidney? How much of the total GFR on renal scan ...

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RE: Catch-22: Mycophenolate Efficacy and GI Toxicity in Recurrent C3 GN in Renal Transplant Patient 16 hours ago

Instead of MMF 750 mg BID, you may want to try 500 mg TID (assuming that patient will be compliant with increased frequency) so that peak levels wi...

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RE: Non-resolution of proteinuria of native kidney origin during primary non-function of first kidney transplant and prompt resolution of native proteinuria with immediate graft function of second transplant 16 hours ago

Thanks Dr Venkat for sharing this case. Back in the day when I was resident and one manual charts were used, for intake output, it was evident how ...

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RE: Catch-22: Mycophenolate Efficacy and GI Toxicity in Recurrent C3 GN in Renal Transplant Patient 17 hours ago

Thank you all, she is on Mycophenolate mofetil 750 mg BID, which had been reduced from 1000 mg BID. I'm going to check levels and then will titrate...

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RE: Resistant Hypertension In Dialysis Patient 17 hours ago

Dr Glassock, thank you. If by "functioning" you mean producing aldosterone that is causing resistant HTN, isn't that the question of the case? If t...

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RE: Nephrotic range proteinuria in patient with normal GFR and type 1 DM 18 hours ago

Agree. Acanthocyturia is not common in diabetic nephropathy even with microhematuria. Probably indicates a different mechanism of entry into the tu...

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RE: PGNMID Diagnosis & Treatment 19 hours ago

Current urine output on dialysis, and current serum albumin and serum protein levels? if heavy proteinuria and severe hypoproteinemia are persist...

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RE: PGNMID Diagnosis & Treatment 19 hours ago

In a small uncontrolled study (n=10) Zand and co-workers from Mayo Clinic (Zand L, et al JASN 2021) showed a lasting complete or partial remission ...

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RE: PGNMID Diagnosis & Treatment 19 hours ago

The findings are "textbook" for PGNMID but if you want a "second opinion" you could send them to Dr. Sethi at Mayo Clinic. ----------------------...

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RE: RPGN 20 hours ago

Any results of HCV virion level yet?What is happening to kidney function.? ------------------------------ Richard Glassock MD, FASN Laguna Woods ...

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RE: PGNMID Diagnosis & Treatment 20 hours ago

Thank you Dr. Glassock. We will discuss with our HemeOnc colleagues for attempting Ritux. Feel sorry for this young 33 yo productive man with young...

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RE: RPGN 1 day ago

Dr. Rodby I love that paper (we also aren't allowed by policy to mess with premade bags), I made a friendly-version for my on-call brain to use--wh...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

But this patient has a functioning unilateral adrenal Tumor- this alone requires a different approach to diagnosis and management , I think. ----...

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RE: Aortic disease and IHD 1 day ago

Interesting postulate, but I do not think that sufficient evidence is available to corroborate that it is correct. Intermittent HD us not contraind...

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RE: PGNMID Diagnosis & Treatment 1 day ago

Initial therapy of PGMID without an identifiable clone should be with Rituximab or Daratumumab, based on observational trials, No RCT. Kidney trans...

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PGNMID Diagnosis & Treatment 1 day ago

Dear experts: I have a 33 yo Hispanic male born in USA, engineer by profession, hx of hypertension, hyperlipidemia, obesity with BMI of 40, was ad...

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RE: Aortic disease and IHD 1 day ago

Thank you so much for replies. More specifically, I was concerned that aortic dissection may get worse by IHD induced SNS overactivity, hemodynam...

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RE: Nephrotic range proteinuria in patient with normal GFR and type 1 DM 1 day ago

I wonder if you can check the sediments for acanthocytes given the hematuria in your patient to help guide your prebiopsy decision-making? There we...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

------------------------------ Sinasi Salman MD, FASN Northlake Nephrology Mooresville NC (704) 858-4300 ------------------------------

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Non-resolution of proteinuria of native kidney origin during primary non-function of first kidney transplant and prompt resolution of native proteinuria with immediate graft function of second transplant 1 day ago

We and the Mayo Clinic have previously reported on the rapid resolution of proteinuria of native kidney origin within a few weeks of successful kid...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

had a thought, but not the best never mind (deleted) ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

Don’t have much to add except to wonder whether to re-measure the PAC immediately pre-HD after the long 3-day ID interval as if suppressed, wouldn’...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

I'd like to chip in but I am absolutely not an expert here, I have never evaluated for aldosteronism in ESRD, so please take all with a grain of sa...

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RE: Nephrotic range proteinuria in patient with normal GFR and type 1 DM 1 day ago

We think of eGFR > 60 as being normal. Is it truly since the regression coefficients may differ from measured GFR that are significant. The earlies...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

Well said and quite true ------------------------------ Anatole Besarab MD ABesarab Consulting Bend OR (734) 417-4793 ---------------------------...

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RE: Aortic disease and IHD 1 day ago

I am no expert. Have not the techniques to stabilize an expanding aortic aneurysm or dissection changed in the past de Grafts can be inter-position...

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RE: Primary hyperaldo/ Adrenal Vein Sampling - need help! 1 day ago

Great outcome!!! Congratulations. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

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RE: sjogren disease and kidney transplant 1 day ago

Thanks for these comments - most helpful! Tony ------------------------------ Anthony Bleyer MD Rare Inherited Kidney Disease Team Leader Wake...

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RE: Primary hyperaldo/ Adrenal Vein Sampling - need help! 1 day ago

Sorry for the delay. I thought I update once everything is concluded. Medicine was on losartan 100mg/day and amlodipine 10 mg/day and K supplemen...

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RE: Aortic disease and IHD 1 day ago

I think it would depend on the type of dissection /aneurysm, the general condition of the patient and the skill/experience if the surgeon. Not some...

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RE: Over the counter Creatine effects of CKD. 1 day ago

I believe that preparations of creatine ethyl ester will increase serum creatinine measurement but creatine mono hydrate will not. Harmful effects ...

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RE: Over the counter Creatine effects of CKD. 1 day ago

go to this thread, https://community.asn-online.org/discussion/raised-creatinine-in-young-male-patient If you scroll down you will find a refe...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

The unilateral renal mass might well be an aldosteronoma but in this setting with multiple drugs affecting both renin and aldosterone levels it wil...

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Over the counter Creatine effects of CKD. 1 day ago

Hello Nephrology community: I have some younger patients who wants to take / are taking OTC Creatine supplements and combinations of creatine a...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

There may be opposing forces affecting renin and aldosterone levels in this anuric HD patient. Volume expansion suppressing renin and aldosterone, ...

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RE: Resistant Hypertension In Dialysis Patient 1 day ago

I do not think it is possible to interpret a plasma renin-aldosterone ratio in the presence of 5 medications and dialysis -dependent ESKD. The sens...

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RE: Resistant Hypertension In Dialysis Patient 2 days ago

Thank you prof Glassock Metanephrin. sent waiting for result But I cannot understand aldosterone /renine lab result Shall I depend on the ratio ...

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RE: steroid resistance MCD ! what to do next 2 days ago

These are quite adequate glomerular sample #. I am curious, what did the podocytes and GBM look like on EM. Any podocyte detachment? Any thinning o...

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