RE: kidney stones and RTA with high CO2 levels and high urine ph 13 minutes ago

What are his NH4 and SO4 excretions while not taking alkali supplements? What are his serum and urine Mg? ------------------------------ John Asp...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 32 minutes ago

Dr. Hiremath - are you suggesting that SGLT2i slow the physiologic loss of nephrons with normal aging? Perfectly health people lose nephrons with a...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 2 hours ago

Not a dRTA. seems like he has a metabolic alkalosis due to thiazides and or citrate. Would need to repeat labs off all meds. -------------...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 4 hours ago

I would hesitate to interpret subgroups the way you are doing Dr Hirsch. Subgroups are not individually powered to show significant effects - and t...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 19 hours ago

Lactose intolerant. Takes fair bit of vitamin D (which makes me nervous given the stones) bc Vitamin D levels won't normalize. No calcium supplemen...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 19 hours ago

Hypercalciurua, stones and metabolic alkalosis . . . . ? Milk-@Alkali Syndrome? ------------------------------ Richard Glassock MD, FASN Laguna W...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 20 hours ago

Yes--but started AFTER the litholink (recently). ------------------------------ Meera Bajwa MD Marin Nephrology Greenbrae CA --------------------...

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RE: MMF Monotherapy In IgA Nephropathy? 21 hours ago

C1 or C2 lesions were not an exclusion criteria. In fact 46% of the MMF arm had C1 orC2 lesions. ------------------------------ Richard Glassock ...

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RE: C3 GN 21 hours ago

Thanks Roger. Depending on the device one uses, , references can't always be seen...a problem for ASN to sort out ------------------------------ ...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 21 hours ago

Ooh he is on K citrate, how much? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chi...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 21 hours ago

Yeah you're prob right. The think is never overtly hypokalemic again every since off the thiazide so never seen such a mild Gitelman. But you're ri...

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RE: C3 GN 21 hours ago

"Roger: Can you plz give me the reference on the clinical course plot you posted? Having trouble reading it closely. Thx" The paper was attached ...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 21 hours ago

I think a high HCO3 rules out D-RTA unless you were on high doses of HCO3 or Citrate etc. Diuretics usually force an acid urine I wonder if the st...

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kidney stones and RTA with high CO2 levels and high urine ph 21 hours ago

Do you see distal RTA with normal or even high CO2 levels? I have a middle aged pt referred to me sometime ago for hypokalemia with sx--easily at...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 23 hours ago

It seems to me there is an important piece of information that we need, and I can't find it in the NEJM article--with regard to the question of whe...

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RE: MMF Monotherapy In IgA Nephropathy? 23 hours ago

Indeed, this trial, if at all, reaffirms the KDIGO recommendation. However, @Richard Glassock - I do believe the MAIN trial excluded Crescentic IgA...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Dr Glassock., I understand what you are saying. Should this mean that when KDIGO puts out guidelines, racial differences in choice of therapy shou...

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RE: C3 GN 1 day ago

Roger: Can you plz give me the reference on the clinical course plot you posted? Having trouble reading it closely. Thx -------------------------...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

The Chinese / Non-Chinese dichotomy concerning efficacy of MMF in IgAN is impressive, long-standing and unexplained. The MAIN trials settles nothin...

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RE: C3 GN 1 day ago

Quite a contrast between clinical manifestation and histology shows how C3GN can insidiously damage kidneys. I would favour Pred+MMF since this com...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Thank you for the excellent discussion of the issue. Question.: IgA is worldwide but is immune response the samein different ethnic groups? ? In Pa...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

Thank you very much Drs. Simon, Hiremath, and Glassock ------------------------------ Ira Meisels MD New York NY (212) 523-3530 -----------------...

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RE: C3 GN 1 day ago

Thanks for posting additional information. The markedly low C3 level (in the setting of presumably longstanding proteinuria), and the immunofluores...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

For those interested - a deeper dive into the trial here http://www.nephjc.com/news/mmf-iga Swapnil --------------------------------- Swapnil Hi...

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RE: Farxiga post transplant 1 day ago

Indeed - as we showed here https://pubmed.ncbi.nlm.nih.gov/27712852/ with RASi, one should be careful with extrapolation. The pathophysiology of ki...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

As the resident Flozin-manic Flozinator, I would like to chime in. From a statistical point of view, also look at the GFR slope analysis. Picture...

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RE: C3 GN 1 day ago

C3 12 mg/ dl ( 79-152) C4 17.9 mg/dl ( 16-39) C3 neph factor c4 and c5 neph factor Ab to h ,b, c3b C5-9 Factor h , factor I , membrane cofact...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

I agree with Roger. The decision to use these meds, like all other therapies, is a risk/benefit analysis. Unless/until there is evidence to suggest...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

Thank you very much Dr Rodby ------------------------------ Ira Meisels MD New York NY (212) 523-3530 ------------------------------

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RE: C3 GN 1 day ago

Would a C3Nef assay make a difference in your choice of therapy? Would a + test for anti-fH antibody do the same ? what about serum C3/C4 levels? ...

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RE: C3 GN 1 day ago

Can you please post the full de-identified renal biopsy (including EM) report? Could this be a burnt out post-infectious GN? Any clues as to how lo...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

There is what I call Flozinmania by many of my very respected colleagues, they want it put in the water supply... . Flozins do appear to have an ef...

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RE: C3 GN 1 day ago

Good question, made me read up on this "It is also noteworthy that corticosteroids have been used along with MMF in most studies. In some studie...

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C3 GN 1 day ago

I have a 45 yr old female who was rejected from life insurance due to proteinuria . She had upc of 2 gm/ gm and macr of 1543 mg/ gm . Creat of 0.57...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

Correction : I guess the low urine albumin groups that crossed the line included the pts with higher eGFR . Still uncertain what to do thanks ---...

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SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

My apologies if this has been addressed already: Since Empa-Kidney, I have been struggling with the following: Should I put all of my CKD pts with ...

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RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 1 day ago

Totally agree This patient after starting cyclo keeping improving reached 148 --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIS...

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RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 2 days ago

Rather than any absolute platelet count (or WBC count) cutoff, I use the following factors to decide about giving cyclophosphamide to a cytopenic l...

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RE: Nephrolithiasis and Osteoporosis 2 days ago

Thank you for your input. Potassium has typically been around 3.4-3.8. Therefore, I was thinking of using potassium citrate with plan to follow uri...

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RE: Nephrolithiasis and Osteoporosis 2 days ago

Your description certainly supports a distal RTA. Out of curiosity, is the patient also hypokalemic and have you evaluated for an autoimmune dis...

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RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 2 days ago

What is the cut of for low platelets, where we can safely start cyclophosphamide --------------------------------- Syed Mohkum Ud Din MBBS Baloc...

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RE: PGNMID with no MGUS 2 days ago

no change in serum Cr and if I compare to the first time I saw this patient it has actually plateued at a higher level. Did receive a BiV pacemaker...

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RE: cresenteric Ig A case 2 days ago

I posted my earlier note 4 hours ago, before Dr. Pratik Shah posted his note saying SCr peaked at 3.0 mg and then decreased to 2.1 mg. Given improv...

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RE: cresenteric Ig A case 2 days ago

With an improving Scr after high dose steroids, I agree with holding off from starting CYC and/or PLEX. If he does not have cirrhosis I might consi...

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RE: cresenteric Ig A case 2 days ago

Dr. Glassock, I have seen the patient with Inderpreet Sekhon in the hospital (we rotate the inpatient service). Patient has normal complements...

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RE: cresenteric Ig A case 2 days ago

Were there RBC casts in the tubules on the biopsy? Since patient presented with gross hematuria, anticoagulant nephropathy-like AKI (which has been...

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RE: cresenteric Ig A case 2 days ago

As always, tough decision as hard data on efficacy is lacking. Three questions- any chance that the SOB and lung lesions are due to pulmonary hemor...

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RE: Acute Antibody Rejection With Mild Biopsy Findings 2 days ago

Before lowering tacrolimus dose/levels in such cases, tests such as DSA, cf-dd-DNA and follow-up biopsy should ideally be done to exclude evolving ...

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RE: PGNMID with no MGUS 2 days ago

80-year-old with EF of 15% and eGFR of 15-19 ml/min. Rituximab and daratumumab may be of questionable benefit and risky. How much did SCr/eGFR, UPr...

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RE: PGNMID with no MGUS 3 days ago

THank you Dr Glassock! ------------------------------ Bhavika Gandhi MD Nephrology Fellow Baylor Scott and White Bhavika[LastN[CompanyName] --...

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