RE: Persistent NAG Metabolic Acidosis 3 hours ago

Thank you for the update. The PTH is still very high for someone with a stage 3A CKD. It is critical to see if the improvement in PTH levels is ass...

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RE: Persistent NAG Metabolic Acidosis 3 hours ago

blood level of parathyroid hormone is improved to 443 in July, 2022 from 678 in April, 2022 which correlates with improvement in the level of 25-hy...

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RE: Hypokalemia with Elevated BG, possibly DKA, Patient at home in Remote area 4 hours ago

Thank you everyone for the responses. Especially useful were the comments reminding me to pass on volume repletion as a cornerstone of treatment at...

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RE: Hypokalemia 5 hours ago

The 24 urine sodium do not reconcile with the early number of Na and Cl [More]

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RE: Peritoneal Dialysis and Feline/Cat as a pet. 5 hours ago

Thank you, Dr. Rodby! ------------------------------ T. Kaur, MD Nephrologist ------------------------------

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RE: Peritoneal Dialysis and Feline/Cat as a pet. 6 hours ago

"In conclusion, P. multocida peritonitis is rare in PD patients, and only 22 such cases have been reported. Its transmission almost always involves...

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RE: A 60 year old kidney donor with diabetes 6 hours ago

This is not easy. Even though he does not have pathological proteins detected in his urine, he could still have sufficient DN +/- hyperfiltration i...

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RE: Continuous kidney replacement Therapy 6 hours ago

Greetings, We have a good experience with combined CRRT machine with ECMO with the same vascular access basically inserted for ECMO. We are connect...

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Peritoneal Dialysis and Feline/Cat as a pet. 10 hours ago

Hello Everyone, A PD patient just acquired a cat in the last 2 - 3 weeks after her dog died and is pretty resistant to giving it up. Usually, I a...

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RE: Continuous kidney replacement Therapy 11 hours ago

Thanks a lot ! Sent from my iPhone

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RE: Continuous kidney replacement Therapy 12 hours ago

Here is a more detailed explanation on the problems of combining the CRRT and ECMO into the same circuit Integrated approach The integrated approa...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 12 hours ago

In my opinion, the real question is whether the mRNA vaccines can trigger antibody formation against more than just the m spike protein in some cas...

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RE: Continuous kidney replacement Therapy 12 hours ago

Mowaffaq - we don't do this at our institution, I think to minimize technical complexity. I have attached a recent review on performing CRRT during...

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Continuous kidney replacement Therapy 14 hours ago

Hello all , I wonder what is the community experience with incorporating the Continuous KRT into the ECMO circuit rather than using a dialysis cath...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 16 hours ago

During a pandemic a lot of individual physicians are going to see one or possibly two cases of "COVID -associated " kidney disease. Many, indeed mo...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 16 hours ago

" a few weeks of a NOAC is not that big a deal"-compared to warfarin. Probably true, but never formally proven in patients with Nephrotic Syndrome....

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 21 hours ago

Thank you for sharing I agree that the risk of thromboembolism is lower in MCD/FSGS as opposed to other GN such as membranous but still it is not ...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 22 hours ago

Less than 10 yrs ago, I had a physically active 56 yo AA male executive with obesity class I, hyperlipidemia and negligible microalbuminuria (less ...

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RE: Persistent NAG Metabolic Acidosis 22 hours ago

Thanks Dr Solemani for the references I think the discussion was in reference to CKD withy or without other factors, not ESKD clearly "horses...

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RE: Persistent NAG Metabolic Acidosis 23 hours ago

By "laughs," I mean that when I bring up baking soda, the team thinks I'm joking. Then, we do the calculations, and they see that I am not joking. ...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

The post by Dr. Cohney (above) may be in response to the management of hyperkalemia in ESRD patients, to which, I would like to indicate the follow...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

Thank you, David. It is plausible that the insulin resistance in uremic patients may actually be due to enhanced circulating levels of cardiotonic ...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

I dont know about laughs But, when I receive calls late on a friday about hyperkalaemia - its a lot easier to tell patients to take baking soda and...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

SCZ 10gms 3xdaoly x 48 hrs --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancre...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 1 day ago

Thank you for sharing the information ------------------------------ Rocio Eleid MD Yuma AZ ------------------------------

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

Great point Manoocher. Another possibility is that the patient is insulin resistant; history of DM not included in the case description. I think th...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

The term "multi-factorial" maybe very pertinent to the cause of non-gap acidosis in this patient. No single abnormality can explain the etiolog...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Your math is pretty much on the mark. I get laughs (and queries from pharmacy) whenever I recommend baking soda. The molecular weight of sodium...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 1 day ago

My exact thoughts No matter how low look at it , warfarin is a huge pain Noacs have changed the decision tree a bit This is MCD Tip lesion Albu...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 1 day ago

Dr. Rodby: Thanks for your recommendations. Since severe nephrotic syndrome/hypoalbuminemia caused by MN has the strongest association with venous ...

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RE: Recalcitrant FSGS case 1 day ago

Probably not. CYC is generally not effective in steroid-resistant presumed Primary FSGS. ------------------------------ Richard Glassock MD, FASN ...

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RE: A 60 year old kidney donor with diabetes 1 day ago

Many thanks. Nice to see that most of the community is in favour of accepting this potential donor as long as we control his diabetes and have goo...

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RE: Simultaneous diagnosis of lung carcinoma and MPO-ANCA positive crecentic GN 1 day ago

Other issues : ? To what extent prognosis of lung cancer & molecular markers determine treatment and ? consideration of PD1 inhibitors Is Lung...

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RE: Recalcitrant FSGS case 1 day ago

would no one consider Cyclophosphamide monotherapy ------------------------------ Shlomo Cohney FASN, PhD, FRACP, MRCP, MBBS Associate Professor ...

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RE: SGLT2 inhibitors and Urine sodium Osm 1 day ago

Have seen a handful of cases where there was a temporal relationship and esp when patient on ARB (or presumably ACEi) Case last week with patien...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

I noticed that the K+ shift by insulin was not robust in this patient, despite receiving a good dose of insulin. The sub-therapeutic response of K+...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

Check my math: 1 TBS Of NaHCO3 is 380 mmol? A teaspoon has 127 mmol? Tells you how much inert filler is in a NaHCO3 tablet -----------------...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

You generally have excellent pt judgement, what do you think? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush U...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

Personally with serum albumin 2, tip variant , MCD, I might not anticoagulate. If steroids are a big problem I would use a CNI and rituximab. S...

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RE: 78 yO F With Immune MPGN 2 days ago

diagnostic & therapeutic issues dictated by availability expense likelihood of best possible outcome with any of these manoeuvres Quality of...

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RE: A 60 year old kidney donor with diabetes 2 days ago

Clearly very difficult In principle, I would generally feel reasonably comfortable accepting donation from a patient of this age with well con...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

with respect to providing more bicarbonate Baking Soday cheap easy just need to find something for patient to mix with to make it palatable....

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

I am surprised to see so many advocating indefinite maintenance with rituximab (a) cost (b) renal limited (c) vaccination & PJP issues Im very int...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

He does not want to get dialysis more than twice a week and has to restrict his potassium in the diet that he does not like so requesting something...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

This is his latest result:It has been all negative since July, 2020 when cANCA was 11.8 ANTINEUTROPHIL CYTOPLASMIC ATB PROFILE BLOOD/GOLD SERUM ...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

Patient Did not develop immunity after hepatitis B vaccination and is being revaccinated. We are also monitoring his hepatitis B surface antigen an...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

Patient is feeling a lot of benefit by Rituximab and insists on continuing it. He actually wishes to get it more frequently but we are giving it on...

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Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

I wish to obtain recommendations on the following patient. Questions: Given severe nephrotic syndrome and marked hypoalbuminemia, should anticoa...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

I suspect the ileostomy is a big part of this, metabolic acidosis, volume depletion (Decreased distal Na delivery and thus K excretion). as for t...

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RE: 78 yO F With Immune MPGN 2 days ago

Agree Dr Gharib and this concept of “mini”renal vascular has been taught for decades. But stopping ARB will not imply automatically reversal of the...

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