RE: When to call Failure of therapy in MN 3 hours ago

If I saw an increasing PLA2R Elisa level like this on therapy I would change to rituximab. It's one thing to not have a proteinuric response as tha...

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When to dialyze? 7 hours ago

65/F known multiple myeloma since 2 years- received multiple cycles of Bortezomib/ lenidomide/ dexa.. with significant ds burden on last assessment...

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RE: BKV nephropathy/ Acute Rejection 7 hours ago

Thank you for your replies !We had initiated MMF at 250 twice a day on admission and have hiked it to 500 mg BD after methylpred pulse.. I shall up...

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Kidney Transplant in Inmates 9 hours ago

Hello US Colleagues, does anyone know if kidney transplants r offered to non death row inmates in US , who r incarcerated for 10 to 20 years or so ...

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RE: When to call Failure of therapy in MN 11 hours ago

Hello Community members Update on the case, patient admitted and treated for uncontrolled volume overload refractory to oral diuretics, he received...

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RE: Hyponatremia Case 17 hours ago

To achieve a P Na of 106 a 70 kg man would have io ingest and retain around 13 liters of water. If his U osm is> 300 this amount of water would suf...

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RE: prophylaxis on prednisone 18 hours ago

I agree in regard to the PJP prophylaxis, it's also staph prophylaxis. I once had a patient with MSSA bacetermia and cervical spinal osteomyelitis ...

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RE: hyponatremia with AKI 18 hours ago

Compared to before furosemide started, urine osmolarity has came down to 444 from 571 and urine sodium now 16 compared to less than 10 before furos...

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RE: Chronic Active Antibody Mediated Rejection 19 hours ago

To add what is the DSA? --------------------------------- Hayder Aledan MD, FASN Assistant Professor Basra Nephrology and Transplantation Center Ba...

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RE: Chronic Active Antibody Mediated Rejection 19 hours ago

Sound like late acute active ABMR (PTC with C4d deposition) on chronic ABMR (TG) and B cells targeted TX is warranted so i would try IVIG and PLEX ...

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RE: Hyponatremia Case 19 hours ago

Of course, I am making an assumption that the urine volume was about 5L during the period when the Uosm was measured. A better test would be a Uo...

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RE: Chronic Active Antibody Mediated Rejection 19 hours ago

Did you get DSA? What is Tac level and dose of MMF? consider Methylprednisolone 500 mg daily x 3-5 doses, sucrose free IgG 200mg/kg every 1-2 weeks...

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Chronic Active Antibody Mediated Rejection 19 hours ago

30 year old kidney Transplant recepient for the last 4 years with normal prior allograft function, presented with abnormal renal function and prote...

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Chronic Active Antibody Mediated Rejection 20 hours ago

30 year old kidney Transplant recepient for the last 4 years with normal prior allograft function, presented with abnormal renal function and prote...

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RE: Hyponatremia Case 20 hours ago

On admission his Urinary Osmolal excretion rate was over 1500 mOsm/ d and his Cosm was 4.9ml/min- this is an osmotic diuresis, probably urea, but g...

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RE: Hyponatremia Case 21 hours ago

I’m not convinced re: solute diuresis in the “purest” sense (see further down). His OER is 941 & Cosm is 2.7, not that impressive. I’d bet he has c...

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RE: BKV nephropathy/ Acute Rejection 21 hours ago

My point was that in the absence of BK viremia you're not going to find BK viral interstitial nephritis on biopsy-agree that the presence of viremi...

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RE: Hyponatremia Case 21 hours ago

Rounding on call this am I had the chance to interview the patient again He denies ever being on Lithium Was on Ablilify / Klonopin combination Pat...

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RE: hyponatremia with AKI 21 hours ago

Yes-would repeat echocardiogram but Still worthwhile doing Venus Doppler's because if he has an acute deep venous  thrombosis on therapeutic warfar...

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RE: Hyponatremia Case 21 hours ago

Using these most recent results reported by Dr Aslam and a urine volume of 5000 ml The urine Electrolytes from last night U Na was 22 U K was 10 U ...

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RE: hyponatremia with AKI 21 hours ago

As the hyponatremia has largely resolved with furosemide dosing and water restriction. No need for urea or tolvaptan. We need to better understand ...

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RE: Hyponatremia Case 21 hours ago

The likely explanation for the hyponatremia is polydipsia plus persistent ADH release (due to his Bipolar Psychosis). The question was what is caus...

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RE: Hyponatremia Case 22 hours ago

How do we explain the initial hyponatremia at 106? with his UOSM >100 would think it's ADH mediated in presence of high hypotonic fluids intake, an...

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Patient with vasculitis rash and subnephrotic Proteinuria plus microscopic haematuria 22 hours ago

51 yr female, known diabetic for 25 yr on mixtard 30(poorly controlled), had  osteoporosis on dexa scan, and history of gastritis but never underwe...

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RE: hyponatremia with AKI 22 hours ago

Got intravenous furosemide 40 mg twice yesterday and giving once today. BNP yesterday was 416 and today 587.   This sodium level today has improv...

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RE: hyponatremia with AKI 22 hours ago

Echocardiogram from November, 2017 found: Preserved left ventricular systolic function       ejection fraction 60%, no significant wall motion abn...

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RE: Hyponatremia Case 22 hours ago

I did a rough calculation- making some assumptions. He is excretion about 36 gms of urea per day and his urea clearance is about 140ml/min. This is...

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RE: hyponatremia with AKI 22 hours ago

Suspect that loop diuretic and water restriction will resolve hyponatremia but major factor suggesting hypervolemia I'm this case is edema of lower...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 23 hours ago

The key word here is pseudo linear. Some of the entities above are distinguished by clinal staining, e.g LCDD. the pseudolinear staining in some ca...

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RE: Hyponatremia Case 23 hours ago

Agree that the he should be treated with a D5W infusion as per Dr Rodby's formula. Boluses often under treat free water needs. He also appears to b...

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RE: BKV nephropathy/ Acute Rejection 23 hours ago

Serum BK virus positivity indeed shows you that there is BK in the serum- but it does not show you whether the kidney is infected. The SV40 stain i...

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RE: hyponatremia with AKI 1 day ago

While tolvaptan has been used for hyponatremia in volume overloaded states, it really does make much sense IMO. Urea the same thing. The issue here...

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RE: hyponatremia with AKI 1 day ago

If water restriction and loop diuretics don't suffice , can urea next be added ? And later tolvaptan for which will need to remove water destructio...

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RE: Hyponatremia Case 1 day ago

Is the HCO3 really 39? Do you have an ABG? Does he have bad CO2 retention, I suspect so as you mentioned bipap. I can't put that together with his ...

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RE: Hyponatremia Case 1 day ago

Thank you much for your input Dr Glassock The urine Electrolytes from last night U Na was 22 U K was 10 U Cl was 26 U Osm this morning is 181 We do...

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RE: Hyponatremia Case 1 day ago

According to the data you shared the patient is experiencing polyuria due to a mixed we’re and osmotic diuresis- (the Cosm is greater than 3mOsm pe...

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Hyponatremia Case 1 day ago

I would like input of the forum on the following patient management : 32-year-old male with history of bipolar disorder Schizophrenia, presented wi...

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RE: hyponatremia with AKI 1 day ago

1. I don’t think low UNa should come as any surprise here given septic AKI, especially since non-oliguric. IOW, this isn’t predictive of fluid resp...

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RE: Membranous? 1 day ago

Surprisingly the result of tissue PLA2R staining came back positive ! this was completely out of my DDx with his history.   -----------------------...

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RE: urgency of biopsy in new onset nephrotic syndrome 1 day ago

Blood level of albumin improved to 2.8, so switching warfarin to 325 mg daily of aspirin. ------------------------------ Sadeem Ali MD Bridgeport W...

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RE: hyponatremia with AKI 1 day ago

"I think it is difficult to ascertain the volume status from urine Na concentration in case of AKI because the urine Na then will be low due to low...

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RE: hyponatremia with AKI 1 day ago

I think it is difficult to ascertain the volume status from urine Na concentration in case of AKI because the urine Na then will be low due to low ...

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RE: hyponatremia with AKI 1 day ago

Edema with a low U Na suggests hypervolemia  with a low effective blood volume and renal hypoperfusion. This is suspicious for infection, vasodilat...

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RE: prophylaxis on prednisone 1 day ago

What was PTH,1,25 VIT D, evidence for granulomatous disease? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] [Medical Director K...

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RE: prophylaxis on prednisone 1 day ago

Pjp prophylaxis is recommended for prednisone > 20 mg/d in rheumatologic diseases. https://www.pharmacytimes.com/contributor/alexander-kantorovich-...

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RE: ApoL1 genetic testing 1 day ago

Having seen a patient of mine, a younger black man develop ESRD after donating his kidney to his brother, long before we knew anything about APOL1 ...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 1 day ago

Yes we did, there were no auto-antibodies against ADAMST 13 And yes, we are planning maintenance therapy with RTX as soon as CD19-CD20 or ANCA rise...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 1 day ago

Thanks for the follow up.  Although this is not the usual combined ANCA and anti-GBM Case (due to the thrombopenia ASN low ADAMST13 levels) it shou...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 1 day ago

Yes, it had features of post-plasmapheresis acquired PTT I presume ------------------------------ Juan Santacruz MD Hospital Universitario La Paz M...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 1 day ago

The ADAMS 13 was after plex? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL...

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