RE: is it primary hyperaldosteronism? 6 minutes ago

De Lerman: "the fly in the ointment regarding this case is Urine K is 6 meg/24 hours-suggest repeat 24 hr urine k and sodium" Bingo! Obviously, u...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 hour ago

I don't offer these patients antibiotic suppression / prophylaxis unless it's possible to eliminate the bacteria from the urinary tract. For anyone...

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RE: is it primary hyperaldosteronism? 1 hour ago

Is it usual to have this level of massively suppressed PRA (almost undected ) only because of B blocker application?? ----------------------------...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 hours ago

I assume the high urine PH is from urease effect hence supraphysiologic. I admittedly am not keen for potassium citrate as expect urine PH to rise....

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 hours ago

She has never had oxalate stone. MSU never grown any organism and stone culture was not done when she had surgery, though likely colonisation in vi...

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RE: is it primary hyperaldosteronism? 3 hours ago

I would think best to stop the agents above. Repeat ARR off above meds. Use Hydralazine or Prazosin for BP pending repeat tests. I assume CT adrena...

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RE: is it primary hyperaldosteronism? 9 hours ago

I would prefer to stop the atenolol and repeat ARR after three weeks.. ------------------------------ Richard Glassock MD, FASN Emeritus Professo...

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RE: is it primary hyperaldosteronism? 11 hours ago

Given all this interesting discussion, there's ample reason to get imaging of the adrenal glands which could resolve the diagnosis. ------------...

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RE: is it primary hyperaldosteronism? 15 hours ago

The suppressed PRA is likely due to Beta Blockers. The elevated ARR is a false positive. Just an opinion ------------------------------ Richard G...

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RE: Renal Autologous cell therapy 15 hours ago

Fine analysis Dr. Friedman! Negative study. Period. No good reason to pursue Intravenous MSC for renal regeneration . Just an opinion. ----------...

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RE: is it primary hyperaldosteronism? 16 hours ago

Have you measured urine sodium ? Spot or 24 hr urine ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Med...

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RE: Renal Autologous cell therapy 16 hours ago

Primary analysis didn’t show difference when GFR treated as continuous numerical variable. Baseline vs. 6-month ITT medians shifted from 35.1 to 36...

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RE: Renal Autologous cell therapy 18 hours ago

Thanks- did any of the infused (viable) MSC reach the kidneys? The placebo control was NS not dead MSC. Hard to interpret the findings. ---------...

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RE: is it primary hyperaldosteronism? 21 hours ago

Thank you for all your replys. The patient is compliant with her medications, but not with her diet sodium intake. Her K is always in the range of ...

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RE: is it primary hyperaldosteronism? 22 hours ago

the fly in the ointment regarding this case is Urine K is 6 meg/24 hours-suggest repeat 24 hr urine k and sodium. If urine Na is <~100 mmol/day (or...

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RE: Renal Autologous cell therapy 23 hours ago

The trial was concluded last year in Armed Forces Bone Marrow transplant centre JCPSP Jcpsp remove preview JCPSP Department of ...

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RE: Renal Autologous cell therapy 1 day ago

Stage 5 CKD would be an exclusion form the PROACT 1 trial. It is also limited to DKD ------------------------------ Richard Glassock MD, FASN Eme...

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RE: Renal Autologous cell therapy 1 day ago

The results if the PROACT1 randomized sham controlled Phase 2/3 trial of Riparencel (Autologous cell therapy ) in advanced CKD due to T2DM are due ...

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Renal Autologous cell therapy 1 day ago

One of my patient who is Chronic kidney disease stage 5 on conservative management. She is interested in the Renal Autologous Cell Therapy-REACT a...

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Renal Autologous cell therapy 1 day ago

One of my patient who is Chronic kidney disease stage 5 on conservative management. She is interested in the Renal Autologous Cell Therapy-REACT ...

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RE: Fibrillary GN 1 day ago

So the deposits are not monotypic after all. Now the case is more typical of FGN. I would stick with RTX, maybe combined with a short course (8 wee...

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RE: Fibrillary GN 1 day ago

@Richard Glassockif the IgG staining was polyclonal by subclass would you still consider anti CD38 Moab, or stick with anti CD 20. ---------------...

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RE: is it primary hyperaldosteronism? 1 day ago

The original question in this Thread was- does this patient have Primary Hyperaldosteronism? Is the Answer -YES, NO or IMPOSSIBLE to TELL (based on...

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RE: is it primary hyperaldosteronism? 1 day ago

Is there anything harder to cleanly assuredly diagnose than PA? This thread clearly exemplifies this opinion… and now we are told that PA is not ra...

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RE: is it primary hyperaldosteronism? 1 day ago

Yes, these findings are highly suggestive of primary aldosteronism. The markedly suppressed plasma renin activity ( 200). Although aldosterone pr...

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RE: Fibrillary GN 1 day ago

I agree with Dr. Friedman. Very tare and atypical case of FGN. Needs IgG subclass staining. Therapy is completely unknown due to rarity of the cond...

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RE: Fibrillary GN 2 days ago

Seems to be rare, true monotypic DNAJB9-positive FGN; strictly speaking, need IgG subclass staining. Despite that, > 90% lack a detectable clone. D...

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Fibrillary GN 2 days ago

A forwarded message.inputs appercepted Dear Dr Dastoor, I really appreciate your thought on this case as fibrillary GN is very rare, 37 female, ...

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RE: Use rituximab or not 2 days ago

My primitive logic says "don't wait, carve it out." Emergent surgery needed now. ------------------------------ Sinasi Salman MD, FASN Owner Nort...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

" I see this patient is on the 4 pillars of care, RAASI, SGLT2i , aldo antagonist and GLP1a. " Prof Rodby I agree with his A/P In our neck of t...

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RE: is it primary hyperaldosteronism? 2 days ago

Despite i have no evidence but i think the supressive effect of B blockers on renin is more potent than the removal of inhibitory effect of angiote...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

My AI (Claude) gives a very equivocal answer to this Question. More data is needed. Very tricky issue because of acute effects of SGLT2i on GFR and...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Good question. I really do not know. uPEP might pick up urine LC missed by UPCR . ------------------------------ Richard Glassock MD, FASN Emerit...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

With a normal UPCR, would a UPEP have the mcg-scale sensitivity needed to yield a reliable tubular pattern & the mathematical precision to separate...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Interesting and convincing argument. I wonder if a urinary electrophoresis would not give the same information concerning a light chain related tub...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Degradation in acidic urine is one of the reasons why I parenthesized β₂M. Without having to withdraw SGLT2i, I went back & forth with AI & ultim...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Since SGLT2 inhibitors tend to decrease proximal tubule reabsorption of filtered Beta 2 microglobulin, any increase is such excretion will be diffi...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Interesting suggestion. An increased urine B2 microglobulin excretion might be a biomarker of proximal tubule injury in this case. Be sure to alkal...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

I will reach out to our laboratory personnel. May I know whether it adds clinical information in addition to serum beta-2 microglobulin? --------...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 days ago

Can lab identify which of mixed enteric is urease +ve? If so, can you then try prolonged isolate-directed antibioRx? I’d restart NaHCO₃, doubt you ...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Can you check a urine α₁M/Cr (or urine β₂M)? --------------------------------- Oded Friedman ---------------------------------

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RE: is it primary hyperaldosteronism? 3 days ago

I agree with Dr. Campese. Does this patient have any spontaneous hypokalemia or metabolic alkalosis.? ------------------------------ Richard Gla...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

Thank you Dr Hirsch for the comments. I am implementing the approach you described. Thanks Dr Lerman. I have been in correspondence with the haem...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

would consider switching off Pantoprazole as well as other suggestions. the Kappa/lambda ratio 7.75 is high for creat 190umol/l-given unexplained l...

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RE: is it primary hyperaldosteronism? 3 days ago

Thank you. Confidentiality Notice: This electronic message, including any and all attachments hereto, is intended solely to be used by the individ...

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RE: is it primary hyperaldosteronism? 3 days ago

I agree that there are compelling reasons to suspect primary Aldo in this patient. However, given the absence of critical information, such as seru...

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RE: is it primary hyperaldosteronism? 3 days ago

Hi, Dr. Campese, Question about your advice not to start spironolactone. Are you concerned that it would spuriously elevated PRA? Dr. Jebur d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 3 days ago

I see no issue with using citrate to treat the hypocitraturia and prevent oxalate stone . Have you considered using UROMUNE vaccine , to prevent r...

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RE: is it primary hyperaldosteronism? 3 days ago

@Vito Campese the use of an ARB should have no effect on Aldosterone levels , as it is autonomous , but may increase Renin levels. I prefer not to...

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RE: is it primary hyperaldosteronism? 3 days ago

I would also discourage starting soironolactone: This would make the lab data uninterpretable. ------------------------------ Vito M Campese Pr...

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