RE: Hypercalcemia in a patient with SLE/MCTD 1 hour ago

Still, I would like to see an ACE level. Likely to have some form of granulomatous inflammation. ------------------------------ Sinasi Salman ...

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RE: Acidosis vs proteinuria 6 hours ago

It would be of great interest to study the 24 hour urine excretion of Na and Cl and creatinine in your cases. It is highly unlikely that NaHCO3 alo...

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RE: Hypercalcemia in a patient with SLE/MCTD 6 hours ago

Dr. Venkat - fascinating case. The hypercalcemia is most liklely due to 25-hydroxy Vitamin D intoxication (exogenous) .. Hydroxychloroquine (HCQ) i...

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RE: Acidosis vs proteinuria 7 hours ago

Thx for the comments. I'm surprised no one else has seen this. I'm not an academician but I know the value of clinical trials and published reports...

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Hypercalcemia in a patient with SLE/MCTD 9 hours ago

I wish to obtain the opinion of Forum participants regarding the cause of hypercalcemia in this patient with SLE/MCTD. I am sorry about the lengthy...

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RE: Mpo Vasculitis Case 9 hours ago

The finding of immune complex deposits in many sites along with full house Ig and C deposition is of significant concern, independent of the + anti...

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RE: Are KDIGO 2025 TSAT and Ferritin Targets (TSAT ≤40%, Ferritin ≤700 ng/mL) for Dialysis Anemia Management Evidence-Based? 12 hours ago

All sites in the PIVOTAL trial were in the UK thus generalization of thec findings to all dialysis patients everywhere should be made with due caut...

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RE: Are KDIGO 2025 TSAT and Ferritin Targets (TSAT ≤40%, Ferritin ≤700 ng/mL) for Dialysis Anemia Management Evidence-Based? 14 hours ago

Any comments or opinions Dr. Besarab? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------...

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RE: Mpo Vasculitis Case 19 hours ago

Agree with above I would watch closely for now ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University ...

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RE: Acidosis vs proteinuria 19 hours ago

Proteinuria increase with NaHCO3 rx? I have not seen this nor have I seen it written anywhere (see attached) I have to think that prote...

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RE: Acidosis vs proteinuria 19 hours ago

Sodium Chloride may raise BP in many CKD patients and increase proteinuria--a low NaCl diet is an effective way to increase the effect of RASI on p...

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Are KDIGO 2025 TSAT and Ferritin Targets (TSAT ≤40%, Ferritin ≤700 ng/mL) for Dialysis Anemia Management Evidence-Based? 21 hours ago

KDIGO 2025 suggests maintaining TSAT up to 40% and ferritin up to 700 ng/mL in dialysis patients with anemia. These targets appear to be largely ba...

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RE: Acidosis vs proteinuria 22 hours ago

Addendum- it would be of interest to know howyou are assessing changes in proteinuria. If it is UPCR a ruse in "proteinuria" after correction if ac...

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RE: Acidosis vs proteinuria 1 day ago

Your experience is at variance with the published data on the effects of Bicarbonate therapy of CKD. See Hultin S et al KI Reports 2021 6: 695-706 ...

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RE: high anti-GBM titers on dialysis 1 day ago

Not all anti-GBM antibodies are capable of provoking lung hemorrhage. Thus as been explained on the basis of epitope specificity , not assessed wit...

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RE: Mpo Vasculitis Case 1 day ago

Thanks for the Folllw-Up. The anti-MP0 antibody (by ELISA) was either a "false positive" or the kidney biopsy did not provide an adequate sample.. ...

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Acidosis vs proteinuria 1 day ago

It is my experience that adding sodium bicarbonate to a CKD patient's regimen will often worsen proteinuria, as well as increasing BP and lowering ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

I agree with Dr. Jorge Roman's post. I would perhaps add that if you do an averaged CCr + CUN with a 24 hour urine collection, you could perhaps b...

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RE: Mpo Vasculitis Case 1 day ago

More info about biopsy Current conclusion is: Conclusion: Native renal biopsy: On light microscopy one glomerulus shows a focal abnormality r...

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high anti-GBM titers on dialysis 1 day ago

92 year old, functional as baseline, baseline creatinine at 0.8-0.9 mg/dl from January 2025 w/ bland UA, non smoker. Came in for fall w/ decrease P...

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RE: Lab potassium normal range 1 day ago

Ted: To this extremely interesting discussion, I hesitate to add, 2 slides I had come across sometime ago, more in keeping with the predicament tha...

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RE: Lab potassium normal range 1 day ago

Eagerly awaiting the follow up data. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 --------...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

Totally agree. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------------------

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

And here we are well over 1/2 a Century after chronic dialysis become common and we still check Urea and Creatinine, not able to define much less m...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

His calculated Nitrogen balance based on those values is = 19g negative nitrogen balance, in favor of significant catabolism. His illness but also ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

UNLIKE other capillaries elsewhere; Kidney capillaries FOLD twice: 1. GLOMERULAR folding 2. periTUBULAR folding = vasa recta Serum FILTRATEs tw...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Interesting cases. Hard to evaluate the significance without knowing the denominator. Is thus 10% or some other number( larger or smaller) of the p...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

This conventional wisdom has been my understanding for years up until recently. I presently care for 2 females of African American ancestry with ES...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

I usually stop Hydroxychloroquine as well. As far as I know there is no evidence to support or deny that this decision is the "correct" one. Anothe...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

Unfortunately, the Tc99 DPTA nuclear scan (Gates method) is not very accurate and is not a replacement for a mGFR. see Xie, P, et al PLOS One, 20...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

In these kind of cases I use a Technetium nuclear study that provides a GFR independently of muscle mass and age. However, I rather use a "mosaic" ...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Do you all stop the hydroxychloroquine or continue that in esrd patients? --------------------------------- Srilekha Sridhara MD Tucson AZ (314...

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RE: Lab potassium normal range 2 days ago

Dr. Filler, Thank you for that incredibly thorough and thoughtful response. You have touched upon every issue that we are dealing with in our ins...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 days ago

Also, recurrence of lupus nephritis in the transplant kidney is quite uncommon, especially in patients transplanted after being on dialysis, even i...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 3 days ago

Extra-renal manifestation of Lupus tends to decrease with increasing duration of HD or PD treatment for ESKD. Inly about 1 in 8-10 patients still h...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 3 days ago

This is a topic that has been of interest for years. I remember it as a controversy as an early attending in the 1990s. SLE is not limited to the k...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 3 days ago

What is the current absolute free light chains levels? Did the initial biopsy show light chains tubulopathy? ------------------------------ Ash...

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Immunosupressants withdrawl in SLE patients with ESRD 3 days ago

Good evening I want to ask about any evidence or statement that recommend immunosupressants withdrawl in SLE patients with ESRD who are on dialy...

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RE: Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 3 days ago

I take care of a patient with SAM. He is special as he also has hemophilia A. He presented years ago with right sided renal infarction (typical pai...

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RE: Lab potassium normal range 3 days ago

I agree with Dr. Hirsch. A causal direct association between a K level > 5.0mmmol/L in CKD and poorer outcomes remains unproven. It might represent...

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RE: Lab potassium normal range 3 days ago

"Persistent values >5.0 mmol/L-even if common in CKD-are associated with worse outcomes, suggesting that a lenient "CKD-normal" upper threshold may...

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RE: Lab potassium normal range 3 days ago

Thank you for the interesting discussion. I would like to offer a few thoughts. 1. Plasma vs. Serum Potassium Plasma potassium (P-K) and serum po...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 3 days ago

It depends. If you are asking about FDA approved indications, then no. FISH by itself does not have any bearing although hopefully soon, venetoclax...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Friday, May 9 @ 12:17 AM

For sake of completeness check stool OB ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Center Beverly Hills CA (310) 657...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Thursday, May 8 @ 5:26 PM

Dr. Cancarini. I Don' t disagree with your hypothesis that CCr + C urea /2 might be a more "accurate " estimate of GFR than creatinine or Cystatin ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Thursday, May 8 @ 4:35 PM

My guess GFR is much less than you think, closer to that suggested by hign BUN, like not enough. May be ask lab what of meds may be interfering wit...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Thursday, May 8 @ 4:07 PM

4 eGFR and urinary clearances and I still have no idea what this patients kidney function really is. Itvis time for a measured GFR. -------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? Thursday, May 8 @ 3:36 PM

Did you ever perform a bone marrow FISH to examine clonality of PC in marrow and as a possible indication for Daratumumab? ---------------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? Thursday, May 8 @ 1:40 PM

A year ago, the use of daratumumab for active relapse had been brought up by Drs. Glassock and Leung, thank you. Given the effectiveness of Darat...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. Thursday, May 8 @ 12:53 PM

Very true. Good idea. Thank you. _________________________________________ Ashraf El-Meanawy, MD, MS, PhD, FASN Professor of Medi...

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