RE: A case of nephrocalcinosis 2 hours ago

Great pathophysiological explanations, but how confident are we that K citrate will be beneficial (and not harmful ) in incomplete distal RTA with ...

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RE: Diagnosis of ADPKD 3 hours ago

Assuming a height of 1.7m and HtTKV of 750 ml he is Class IB by the Mayo System at not at risk for rapid progression and therefore not eligible for...

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RE: Diagnosis of ADPKD 5 hours ago

Thank you all for your replies.Just for my clarification, would he be class II on the Mayo classification because of the paucity of cysts?

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RE: Diagnosis of ADPKD 5 hours ago

I agree that even if genetic testing confirmed ADPKD (without a family history) he would not be a candidate for Tolvaptan therapy. --------------...

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RE: Diagnosis of ADPKD 8 hours ago

His eGFR is 98 ml/min and is stable since 03/2019. He has no known family history as I mentioned earlier. ------------------------------ Syed Ali...

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RE: Diagnosis of ADPKD 9 hours ago

That's a huge left kidney for only two cysts. I guess the two cysts must be quite large. Does he have a family history? Genetic test is required i...

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RE: Diagnosis of ADPKD 9 hours ago

What is the current eGFR and its trajectory over the 12 previous months ? ------------------------------ Richard Glassock MD, FASN Laguna Woods C...

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Diagnosis of ADPKD 9 hours ago

Hello I have a 47 year old male and I am suspecting he has ADPKD. The issue is that he only has 1 cyst in the right kidney and 2 cysts in the lef...

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RE: sero negative Anti-GBM disease 10 hours ago

Addendum- A connection between RCC and anti-GBM Disease has been noted in the literature. Does your patient have metastatic RCC? (See Rivedal ...

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RE: sero negative Anti-GBM disease 10 hours ago

I will express my opinion on this interesting case. It is NOT "Atypical Anti-GBM disease, The patient has RPGN with extensive crescents and DAH. Th...

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sero negative Anti-GBM disease 10 hours ago

Esteemed colleagues, I would like you opinion on an interesting case. I have a 62 year old male with a PMH of RCC s/p R nephrectomy, CKD III (bl...

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RE: A case of nephrocalcinosis 11 hours ago

My understanding is this: The nephrocalcinosis/stones from D-RTA is because of a daily positive H+ balance and a resultant negative HCO3 balance....

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RE: A case of nephrocalcinosis 11 hours ago

The current literature does not support the use of K Citrate to prevent Calcium Phosphate nephrolithiasis. Is K citrate beneficial in Nephrocalcino...

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RE: A case of nephrocalcinosis 12 hours ago

Thank you everyone for your replies. @John Asplin, I apologize the pictures didn't show up. I edited the post to add the images again and it's sup...

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RE: A case of nephrocalcinosis 16 hours ago

Is K Citrate an effective therapy for Calcium Phosphate medullary nephrocalcinosis due to incomplete Distal RTA?. That is the question in this case...

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RE: A case of nephrocalcinosis 16 hours ago

@John Asplin Lets assume this is D-RTA, and while mild (perhaps incomplete as suggested, may be harder to tell bc HCO3 may be a bit lower than fr...

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RE: A case of nephrocalcinosis 17 hours ago

I like Dr Rodby's analysis. I don't see any 24 hr urine data in the attachment (only radiology images). Perhaps I am missing something. Just a qu...

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RE: A case of nephrocalcinosis 1 day ago

Nice analysis Dr. Rodby. How would you go about "proving " that this is an incomplete distal RTA secondary to Primary Biliary Cirrhosis. Any "dia...

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RE: A case of nephrocalcinosis 1 day ago

I suspect the medullary sponge diagnosis comes from the nephrocalcinosis, but we have another potential etiology. Diarrhea should have a lower U...

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RE: AL Amyloid & Serologic tests 1 day ago

AL (lambda) amyloid should show staining for lambda only by IF. If there is additional staining for other immunoglobulins, then I wouldn't trust it...

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RE: AL Amyloid & Serologic tests 1 day ago

Interesting discussion The sensitivity of bone marrow clone detection for AL amyloid is 100%, I think the question of the biopsy pathophysiology ...

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RE: AL Amyloid & Serologic tests 1 day ago

Dr. Cornell- thank you for making an important point about the pitfalls present in the use of standard IF for making a confirmed diagnosis of AL Am...

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RE: positive anti Ro 60 1 day ago

Might be I have to learn how to deal with massive info ------------------------------ Zvi Barnea MD ------------------------------

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RE: positive anti Ro 60 1 day ago

Sorry , I think you mean the other patient I , posted today with monoclonal iGM , yes I thought that she may have her ckd due to monoclonal deposit...

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RE: positive anti Ro 60 1 day ago

As far as I remember , her Cr is around 1 mg/dl. Protein in urine not that high. What about Serum & urine protein EF And you can give her a small...

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RE: positive anti Ro 60 1 day ago

Thanks for your time if the biopsy come diagnostic of lupus nephritis mostly class 3 or 4 I will give both MMF and steroid . if it shows interst...

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RE: positive anti Ro 60 1 day ago

Watch her clinical & lab status closely, react to abrupt change . What can a biopsy bring in terms of treatment that you do not do now? Sincerely...

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RE: positive anti Ro 60 1 day ago

What you suggest sir for next step ------------------------------ Ahmed Abdelfattah MD, MBChB, MSc Assistant professor (Internal medicine hospita...

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RE: positive anti Ro 60 1 day ago

She will have no benefit from a biopsy ------------------------------ Zvi Barnea MD Senior Physician, Nephrology Barnea -----------------------...

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RE: AL Amyloid & Serologic tests 1 day ago

I think makings diagnosis on biopsy & blood test is good to a certain point (especially if the disease read the textbook). In rare cases, I am not ...

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A case of nephrocalcinosis 1 day ago

A 47-year-old female patient with PMHx of primary biliary cirrhosis was referred to me for suspected medullary sponge kidney and nephrocalcinosis s...

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RE: monoclonal IgM kappa in ckd patient 1 day ago

Thanks for your time , I will follow up her with Flc , and update ------------------------------ Ahmed Abdelfattah MD, MBChB, MSc Assistant prof...

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RE: monoclonal IgM kappa in ckd patient 1 day ago

Thank you for your reply , I refred her to hematologist for work up . I will follow her and update thanks ------------------------------ Ahm...

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RE: monoclonal IgM kappa in ckd patient 1 day ago

According to the latest criteria for FLC levels adjusted for eGFR ( Long TE, et al Nature -Blood Cancer Journal 2022 12: 133) this patient FLC rati...

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RE: AL Amyloid & Serologic tests 1 day ago

I am concerned that this is NOT AL type amyloidosis. According to the immunofluorescence report, "There is capillary loop staining with IgG (2+), I...

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RE: monoclonal IgM kappa in ckd patient 1 day ago

at 80, with a stable creatinine for the most part minimal albuminuria and proteinuria, nl k/l ratio I would not so a renal biopsy her, at le...

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RE: Metabolic alkalosis 1 day ago

Laxative and diuretic abuse is so hard to diagnose, patients are clever and not going to be forthright. Sometimes the only way to prove it is ...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

excellent thought. Hopefully @Mustafa Saidi can get genetic testing for this (as well as other tubular diseases). HNF1B is included in Natera'...

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RE: Metabolic alkalosis 1 day ago

Would the low renin not be expected given metoprolol? I wonder whether she’s abusing laxatives (‘chronic diarrhea…normal colonoscopy’). UCl may n...

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RE: case of hypokalemia and hypomagnesemia 1 day ago

Would the low aldo not be expected given hypoK + lisinopril (‘was on lisinopril’ I assume included when aldo was checked)? The hypoMg severity + ...

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monoclonal IgM kappa in ckd patient 1 day ago

An 80-year-old woman with a history of essential thrombocytosis is currently on a medication regimen that includes 500 mg of hydroxycarbamide, 20 m...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

Dr. Saidi: Was hyponatremia documented before or after starting amiloride? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -...

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RE: Budenoside for IgA Nephropathy 2 days ago

Very limited Data , and no RCT, but generic delayed release Budesonide seems to reduce proteinuria ink Primary IgAN. No long term eGFR slope studie...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

The PRA is at the lower limit of normal and the serum aldosterone is definitely suppressed. Hypomagnesemua can be observed in licorice induced pseu...

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RE: positive anti Ro 60 2 days ago

Thanks for the information- with hematuria, proteinuria and progressive loss of nephrons now is the time to make a decision on empiric treatment (w...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

Dr. Glassock to correct myself, there is a urine spot chloride of 33 mmol/L ------------------------------ Mustafa Saidi MD Nephrology Departm...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

Dr, Madan, bicarb ranges from 27 to 35, so does have some alkalosis The hypomagnesemia irritated me too. We do not have an ABG Aldo was supp...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

Dr. Rodby she is not on PPI ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia PA -------------...

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RE: case of hypokalemia and hypomagnesemia 2 days ago

I was not aware that these can also cause a low mag. The renin activity was not suppressed, was in nl range. The Aldo and renin were drawn at 5 a...

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RE: positive anti Ro 60 2 days ago

Thanks for time. He has a history of occasional right parotid enlargement, but there is no clinical evidence of parotid swelling. I recommended a ...

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