Sjögren's interstitial nephritis with crescents 5 minutes ago

Hello All, looking for some input on an interesting case. We are seeing a 21 year old woman who presented initially with persistent  fever and acut...

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RE: A puzzling case of hypercalcemia 2 hours ago

Agree but while the iPTH levels are not suppressed , they really aren't that high for that level of Ca.  And the borderline 1-25 seems pretty high,...

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RE: Starting RAAS inhibitors in Advance CKD 2 hours ago

​ These cases need to be managed individually. We will not get a generalized rule for everybody in that level of eGFR. However, Cardiovascular mor...

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RE: A puzzling case of hypercalcemia 5 hours ago

I'm a little late to the game, but an unsuppressed PTH in the setting of hypercalcemia is highly suggestive of primary hyperparathyroidism and nega...

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RE: A puzzling case of hypercalcemia 5 hours ago

Thanks for follow up, I’d keep her on cinecalcet and off any form of vitamin D indefinitely. Still, probably a long shot, but I have seen plenty of...

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RE: Chicken Pox In Hemodialysis 6 hours ago

Esrd pts are immunocompromised. Acyclovir is safe if dosed appropriately. I would probably give 400 mg a day and give after dialysis on dialysis da...

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RE: A puzzling case of hypercalcemia 6 hours ago

The Patient still in the hospital for other issues. Calcium is down to 10.1 with IVF NS, calcitonin and cinacalcet. CXR and CT chest showed no lymp...

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RE: A puzzling case of hypercalcemia 6 hours ago

If you ignore the pth , it really isn’t very high, I’d also wonder about sarcoidosis --------------------------------- Roger Rodby MD, FASN Profess...

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RE: Denosumab in CKD Stage 4 6 hours ago

At 90 years of age and with the huge risks of hypocalcemia, I'm not sure denosumab is the best option.  There's also some other things to consider:...

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RE: A puzzling case of hypercalcemia 11 hours ago

Dear Dr. Essam, What is the fillow up with this patient, kindly update us about her condition. --------------------------------- Wael Jebur MD, FAS...

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Chicken Pox In Hemodialysis 14 hours ago

Dear All I wish to share a patient and request you to guide me on Best Treatment strategy, your experience if any . A 30 year old male, HT, CKD 5 o...

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RE: Denosumab in CKD Stage 4 18 hours ago

Hypocalcemia may occur and be severe and prolonged in advanced ckd with this specific agent. https://www.revistanefrologia.com/en-relaccionados-den...

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RE: Denosumab in CKD Stage 4 19 hours ago

Corrected calcium and ionized calcium levels? Diabetic with PTH level that is not high and normal alkaline phosphatase level. Can this be adynamic ...

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RE: Membranous Nephropathy -Take off Tacrolimus or not? 22 hours ago

I would control both BP and volume first. The concern is recurrence of disease after stopping or reducing CNI.  If both are not controlled then one...

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RE: Starting RAAS inhibitors in Advance CKD 22 hours ago

the  questionable follow up is a real problem for starting RASI at this stage If you do, I would start at just 2.5 to 5 mg. I would stop hydralazin...

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RE: Starting RAAS inhibitors in Advance CKD 22 hours ago

K is wnl, in mid 4s. Volume is not an issues. eGFR in high teens. Alb/Cr of ~ 2 gram. Already on CCB, loop diuretic, Hydralazine, clonidine, metopr...

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RE: treatment of calcineurin inhibitor induced hyperkalemia 23 hours ago

THe aldosterone paradox...involves Calcineuron drugs and hyperkalemia ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Cente...

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Denosumab in CKD Stage 4 1 day ago

90 year old male, DM, Hypertension, Gout, CKD stage 4 with egfr range 19-23.  Limited mobility but has caregivers at home  to prevent falls.  BMD T...

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RE: Dialysis and Biologicals 1 day ago

Yes. She was on Calcitriol. Thank you for sharing that information. ------------------------------ Vinayak Purandare MD, FASN Ormond Beach FL (386)...

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RE: HyperCalcemia In HD 1 day ago

Then I would definitely go with pamidronate ------------------------------ Stuart Sprague DO, FASN Chief, Division of Nephrology and Hypertension N...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

Reviewed CT scan with radiologist. No new findings  On HD since 12/29. Making urine but still needing HD. Na 133-136. -----------------------------...

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RE: HyperCalcemia In HD 1 day ago

Thank You for replies Dr Desai, Dr Rodby, Dr Venkat, Dr Mellas and Dr Sprague.  Calcimimetics were tried before, but did not help. ----------------...

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RE: Dialysis and Biologicals 1 day ago

Did you try  Calcitriol, because 1.25(OH)D3 deficiency could aggravate her dermatological disease ------------------------------ Wolfgang Boettcher...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

I don't see how you can avoid steroids, Rituxan can be used chronically but acutely you will need prednisone. One thing to consider is that IgG4 di...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

Pathologist called with diagnosis of IgG4 interstitial nephritis.  await full official report.  ------------------------------ Sachin -----------...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

Regarding:   https://www.nejm.org/doi/full/10.1056/NEJMoa053107 The findings of this study from China may not be applicable to other populations. I...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

Even though Protonix is on home med list, pt says she does not recall that medicine or taking it. She does not know why it was on her home med list...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

Hi Abdul, This is a good question that is often encountered. I do think blood pressure control is imperative to this situation to diminish untoward...

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RE: Dialysis and Biologicals 1 day ago

Thank you, Dr. Rodby. I will give it a try with very careful monitoring. ------------------------------ Vinayak Purandare MD, FASN Ormond Beach FL ...

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RE: Dialysis and Biologicals 1 day ago

Epocrates says cut dose in half for gfr I don’t think you will find an answer to your question, Apremilast v a biologic. I suspect biologics are le...

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RE: treatment of calcineurin inhibitor induced hyperkalemia 1 day ago

Thanks Dr Venkat for your valuable comments. Dr  Ali states that the patient has volume contraction on exam. If patient is volume overloaded or hyp...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

Recent publication suggest that stopping RAAS inhibitors in patients with advanced CKD might be associated with worse outcome. https://jasn.asnjour...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

for an affirmative answer:  https://www.nejm.org/doi/full/10.1056/NEJMoa053107 That study had a mean eGFR of around 25. If the patient's eGFR was c...

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RE: Dialysis and Biologicals 1 day ago

Thank you, Dr. Rodby for your prompt response. I am worried about the prolonged half-life and subsequent side effects, especially in this elderly f...

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RE: Dialysis and Biologicals 1 day ago

Biologics are generally antibodies against some inflammatory mediator. They should be too large to be dialyzed. Dosage on HD is undefined. --------...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

I do not but I think I am wrong. --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicag...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

Thank you for the answer.I understand if they are already on it, but if they are not, would you initiate? ------------------------------ Abdul Wali...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

RAASi has been shown to slow progression even in advanced ckd. So in fact it is the opposite of what you propose, you use it to slow things and sto...

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RE: lovenox dosing in AKI with COVID 19 and atrial fibrillation and rising K and Mg 1 day ago

We found lovenox prevented CRRT circuit clotting much better than heparin in COVID-19, we presented it as an abstract last year kudney week. so we ...

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Starting RAAS inhibitors in Advance CKD 1 day ago

In someone with advanced CKD (late Stage IV or Stage V) with proteinuria and/or uncontrolled blood pressure, would you start RAAS blockade or would...

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RE: treatment of calcineurin inhibitor induced hyperkalemia 1 day ago

CNIs cause salt and water retention, and volume expansion. Yes, Florinef will help with hyperkalemia, but requires pharmacologic doses because of r...

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RE: lovenox dosing in AKI with COVID 19 and atrial fibrillation and rising K and Mg 1 day ago

What should be target PTT in this case? Sent from my iPhone

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RE: Membranous Nephropathy -Take off Tacrolimus or not? 1 day ago

Envarsus-XR does not offer safer option compared to the shorter acting Tacrolimus.  Increasing risk of malignancy with time is something to conside...

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Dialysis and Biologicals 1 day ago

Dear colleagues  I apologize for this post if this was discussed before. I have an 80 yrs old W/F on HD. She has severe symptomatic psoriasis. She ...

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RE: lovenox dosing in AKI with COVID 19 and atrial fibrillation and rising K and Mg 1 day ago

Given AKI lovenox should be changed to unfractioned heparin which can be adjusted with serial PTT. •For those with a CrCl ≤30 mL/min, use of unfrac...

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RE: Family With Unknown Cause Of Low C3 And CKD 1 day ago

There is relation between alport and alternative pathway mutations? This family have not any problem with hearing.... -----------------------------...

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RE: lovenox dosing in AKI with COVID 19 and atrial fibrillation and rising K and Mg 1 day ago

Based on that, will be safe to reduce Lovenox and how to renally adjusted Lovenox in this patient with COVID-19? I would be reluctant to reduce lov...

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RE: lovenox dosing in AKI with COVID 19 and atrial fibrillation and rising K and Mg 1 day ago

Correction: 19th January was meant to be ninth of January ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ---------------...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

Last hospital admission in August, 2020 On discharge - 8/14/2020 - Na 127, BUN 14 Cr 1.00 On admission -  8/11/2020 Na 117, BUN 12, Cr 0.8 --------...

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RE: Can IgAN coexist with ANCA GN? 1 day ago

Thank you so much for your input! Greatly appreciate it. This patient has no drug use and has never taken hydralazine or Allopurinol. Started her o...

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