RE: Bartter's syndrome vs primary hyperaldosteronism 6 minutes ago

If the actual anion gap is around 10 and the serum HCO3 of 30 is correct then it would appear to be a metabolic alkalosis with the serum Cl an erro...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 hour ago

Dr. Campese.- would a PRA of 5.1during the first trimester of a normal pregnancy be regarded a a 'suppressed " value since the PRA is reported to b...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 hour ago

Thank you for answering my inquery. Yes, we need to figure out what the urine can tell us Exactly what I was hoping for. We do depend too much on p...

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RE: Bartter's syndrome vs primary hyperaldosteronism 2 hours ago

normotensive hypokalemia metabolic alkalosis that develops in pregnancy? $$$ is it Gitelman I suppose you should check urine diuretics to...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 3 hours ago

Dr Balan You also use lower dose of mmf in your patients as compared to Caucasian population --------------------------------- Bajinder Reen MD ...

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RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago

How does the stage of pregnancy (25 weeks) alter the evaluation in terms of ipper limits" for the renin levels and other parameters. If Barters is ...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 4 hours ago

I too agree with the excellent points made by Dr Hirsch. The treatment would be maximum dose of ARB with chlorthalidone and then SGLT2i both for an...

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RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago

The serum magnesium values are low at .77 mmol/l which is in the normal range . The urine calcium excretion has also been provided in the spot urin...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago

See the full report ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago

Thanks to Drs. Glassock, Reen and Venkat for prompt comments. Patient has been getting MMF 500 mg twice daily for one year. This is a lower dose th...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 4 hours ago

Can you give us the complete biopsy report? What were the immunofluorescence findings? Did the EM show complete foot process effacement? Was a s...

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RE: Bartter's syndrome vs primary hyperaldosteronism 4 hours ago

Since both Primary Hyperaldosteronism and Barrter Syndrome cause Hypercalciuria (especially when a high NaCl diet is consumed) I doubt that a urine...

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RE: 76 Y/O patient who develops Kaposi while on treatment for MCD 4 hours ago

Kaposis sarcoma has been reported in patients treated with rituximab in both HIV positive and negative individuals. I do not think that seems bette...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 4 hours ago

> Whether they increase proteinuria or not (there is other evidence that they do), they do not decrease proteinuria. IMO, in a proteinuric patien...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 5 hours ago

What is the current urine PCR? With initial urine PCR of 1.4 g/g, SAlb of 2.8 g/dL appears lower than what would be expected from urinary protein l...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

Thank you for sharing this fascinating case and to everyone who has contributed such thoughtful input. I agree with many of the observations alread...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 5 hours ago

Reference provided by DoctorGlassock is actually Blish inCkJ on line on July 7, 2025 --------------------------------- Bajinder Reen MD Etobicok...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

More likely than not this patient has Gitelman syndrome which, on occasion, can manifest itself for the first time during pregnancy . Check serum...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

sorry, distal RTA less likely or at least confounded by the metabolic alkalosis here. but bartter-like from SLE tubulopathy with hyperaldo could st...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

This patient does not have primary aldosteronism. Renin and aldosterone levels are both high which is normal during pregnancy. This increase is ...

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RE: 76 Y/O patient who develops Kaposi while on treatment for MCD 5 hours ago

In this case, it is very likely that the MCD is secondary to the Thymoma. The role of RTX (or other CD20 antibodies ) for therapy is not well under...

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RE: Bartter's syndrome vs primary hyperaldosteronism 5 hours ago

I agree with Prof Glassock that true Bartter syndrome is very unlikely. The genetic form is usually apparent very early in life and requires massiv...

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76 Y/O patient who develops Kaposi while on treatment for MCD 7 hours ago

A 76-year-old woman with a history of hypertension, bilateral mastectomies for breast cancer 20 years ago, and hemicolectomy for a polyp with high-...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 10 hours ago

See this recent report - very relevant to this case. Jia X, et al NDT 2025; 18, July 7, combined IS is highly effective in Class I/Ii Lupus Nephrit...

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RE: Treatment of Lupus Nephritis Class II (PLUS) 12 hours ago

Is she taking the MMF? What is the prescribed dose of MMF? . Before starting additional IS, such as Belimumab, I would check a trough serum MPA lev...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 12 hours ago

Doe the increased proteinuria induced by DHP-CCBs is a theoretical concern and not clinically significant as this study showed no meaningful increm...

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Treatment of Lupus Nephritis Class II (PLUS) 13 hours ago

27 y/o female presented for nephrology consultation with c/o swelling feet and proteinuria in March, 2024. She had earlier been diagnosed having SL...

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RE: Bartter's syndrome vs primary hyperaldosteronism 21 hours ago

I agree Barrter Syndrome seems very unlikely. Would a plasma renin concentration or a saline suppression test be of value. --------------------...

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RE: Elevated BUN evaluation 23 hours ago

Using the data provided and making some simplified assumptions of urea transport and metabolism (which are crude approximations), the BUN in this s...

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RE: Bartter's syndrome vs primary hyperaldosteronism 23 hours ago

Thank you Dr. Awais. But usually the renin is very high in Bartters syndrome? The Renin is within normal limit, how may hyperaldosteronism be e...

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RE: Bartter's syndrome vs primary hyperaldosteronism 1 day ago

With this BP and Renin at upper end of normal looks like Barrters. Urine Na and Cl are high too suggesting renal wasting rather than Aldosteronism ...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

I agree with Dr Campese that the requirement for RASI is based on proteinuria (and I also agree with his excellent comments on BP). However, presen...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

In patients with diabetic kidney disease and proteinuria> 0.5 g/d the evidence is in favor of using RASi as first line. In patients without signifi...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

The combination of RAAi with DHP-CCBs lessen the increment of intraglomerular pressure observed with DHP-CCBs as it also decrease the pedal edema. ...

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Bartter's syndrome vs primary hyperaldosteronism 1 day ago

Dear colleagues and professors, I would like to share with you this case which I found puzzling. 25 year 11 weeks pregnant lady, who is a known...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

Complete agreement. Hypertension in DKD has a very prominent volume component which cannot be overlooked. Attached below is a comment by Dr Solei...

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RE: Elevated BUN evaluation 1 day ago

The sarcopenia appears to be reflected by the Cr level of .4 mg/dl (presumed baseline). As mentioned by others, in the face of AKI, due to kidney h...

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RE: Elevated BUN evaluation 1 day ago

If available, I would obtain a measured GFR in this patient. If not available, I would do a 24 hour urinary creatinine clearance. ---------------...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

RASi ate always first choice for therapy of hypertension In DKD. I prefer to combine them with diuretics (chlorthalidone) if needed and try to av...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

I think that OBI + MMF + hydroxychloroquine is the best option for this patient. Belimumab probably will not do much with this degree of proteinuri...

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DHP/Diuretics as 2nd line antihypertensive in DKD 1 day ago

2022 KDIGO guidelines recommend dihydropyridine calcium channel blockers (DHP-CCBs) or diuretics as second-line antihypertensive agents in diabetic...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

Thank you for your responses: Dr Abra: I actually like this option, between Rituxilup and the Nobility trial Dr Campese: The patient was p...

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RE: Diffuse proliferative GN 1 day ago

Agree for infective endocarditis related proliferative GN and new 2023 criteria including PCR for microbiological diagnosis, CT scan and even FDG P...

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RE: Elevated BUN evaluation 2 days ago

My assumption was both volume depletion with high protein. wondering why the sarcopenia adds to the situation. wouldn't this contribute to less end...

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RE: Elevated BUN evaluation 2 days ago

"But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if this couple with high serum cystatin-c, doesn't this indica...

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RE: Elevated BUN evaluation 2 days ago

Agree with the quintuple whammy to explain this scenario. But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if th...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 2 days ago

The information provided that this is a case of class III/V LN and not pure class V and so my choice would be MMF plus Belimumab if non-nephrotic a...

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RE: Elevated BUN evaluation 2 days ago

I have also been a big proponent of FE UN as an index of kidney status in acute situations (both for renal perfusion and catabolic rate). In this c...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 2 days ago

The patient was admitted with anasarca and AKI. I presume UACR was high and sAlb very low. In this contest, I would like to know more about the r...

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RE: Elevated BUN evaluation 2 days ago

I assume this patient is not on steroids or a tetracycline which can increase BUN level. Doxycycline is the only tetracycline with lesser effect of...

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