RE: hyponatremia with AKI 38 minutes ago

If water restriction and loop diuretics don't suffice , can urea next be added ? And later tolvaptan for which will need to remove water destructio...

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RE: Hyponatremia Case 1 hours ago

Is the HCO3 really 39? Do you have an ABG? Does he have bad CO2 retention, I suspect so as you mentioned bipap. I can't put that together with his ...

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RE: Hyponatremia Case 1 hours ago

Thank you much for your input Dr Glassock The urine Electrolytes from last night U Na was 22 U K was 10 U Cl was 26 U Osm this morning is 181 We do...

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RE: Hyponatremia Case 2 hours ago

According to the data you shared the patient is experiencing polyuria due to a mixed we’re and osmotic diuresis- (the Cosm is greater than 3mOsm pe...

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Hyponatremia Case 4 hours ago

I would like input of the forum on the following patient management : 32-year-old male with history of bipolar disorder Schizophrenia, presented wi...

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RE: hyponatremia with AKI 10 hours ago

1. I don’t think low UNa should come as any surprise here given septic AKI, especially since non-oliguric. IOW, this isn’t predictive of fluid resp...

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RE: Membranous? 12 hours ago

Surprisingly the result of tissue PLA2R staining came back positive ! this was completely out of my DDx with his history.   -----------------------...

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RE: urgency of biopsy in new onset nephrotic syndrome 13 hours ago

Blood level of albumin improved to 2.8, so switching warfarin to 325 mg daily of aspirin. ------------------------------ Sadeem Ali MD Bridgeport W...

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RE: hyponatremia with AKI 14 hours ago

"I think it is difficult to ascertain the volume status from urine Na concentration in case of AKI because the urine Na then will be low due to low...

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RE: hyponatremia with AKI 17 hours ago

I think it is difficult to ascertain the volume status from urine Na concentration in case of AKI because the urine Na then will be low due to low ...

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RE: hyponatremia with AKI 17 hours ago

Edema with a low U Na suggests hypervolemia  with a low effective blood volume and renal hypoperfusion. This is suspicious for infection, vasodilat...

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RE: prophylaxis on prednisone 17 hours ago

What was PTH,1,25 VIT D, evidence for granulomatous disease? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] [Medical Director K...

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RE: prophylaxis on prednisone 17 hours ago

Pjp prophylaxis is recommended for prednisone > 20 mg/d in rheumatologic diseases. https://www.pharmacytimes.com/contributor/alexander-kantorovich-...

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RE: ApoL1 genetic testing 18 hours ago

Having seen a patient of mine, a younger black man develop ESRD after donating his kidney to his brother, long before we knew anything about APOL1 ...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 18 hours ago

Yes we did, there were no auto-antibodies against ADAMST 13 And yes, we are planning maintenance therapy with RTX as soon as CD19-CD20 or ANCA rise...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 19 hours ago

Thanks for the follow up.  Although this is not the usual combined ANCA and anti-GBM Case (due to the thrombopenia ASN low ADAMST13 levels) it shou...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 19 hours ago

Yes, it had features of post-plasmapheresis acquired PTT I presume ------------------------------ Juan Santacruz MD Hospital Universitario La Paz M...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 19 hours ago

The ADAMS 13 was after plex? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL...

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RE: hyponatremia with AKI 19 hours ago

Two opposite conclusions based on low urine Na+ concentration. This parameter cannot distinguish between hypovolemia, Primary renal Na+ retention, ...

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RE: ANCA assocciated vasculitis and TTP (Thrombotic Thrombocytopenic Purpura) 20 hours ago

Hello Dr Glassock and everyone else who participated in this case.  I want to continue follow-up and tell everyone that nowadays this patient has r...

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RE: ApoL1 genetic testing 20 hours ago

Please read a very timely article. Ann Intern Med. 2019;171:655-658. doi:10.7326/M19-2162  Regarding potential African-American living kidney donor...

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RE: hyponatremia with AKI 20 hours ago

Since urine sodium is low it means either decreased sodium intake or hypovolemia / hypoperfusion to the kidneys. If patient is hypovolemic then we ...

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RE: BKV nephropathy/ Acute Rejection 21 hours ago

Agree with your decision-as biopsy shows continued significant inflammation without ptc assume C4d and DSA was negative and appears reversible. In ...

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RE: prophylaxis on prednisone 22 hours ago

At this dose of steroids the risk of inducing peptic ulceration is quite low. Your prescription in adequate in my opinion. Sent from my iPad

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prophylaxis on prednisone 22 hours ago

For hypercalcemia in 87 years old man suspected to be due to granulomatous disease, ionized calcium 8.7 that came down to 6.1 by hydration, and 25 ...

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RE: BKV nephropathy/ Acute Rejection 22 hours ago

Thank you for your kind responses, sirs! Repeat biopsy ( done 7 days after first biopsy) also showed severe interstitial inflammation and tubulitis...

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RE: Timing Of PD catheter Replacement 22 hours ago

I think you’re good. From UTD: “...for refractory peritonitis...or peritonitis associated with intra-abdominal pathology...there should be a minimu...

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Timing Of PD catheter Replacement 22 hours ago

I had a pt taken off pd with catheter removal on September 26th 2019 for pantoea agglomerans and enterococcus fecalis peritonitis after fortaz , va...

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RE: hyponatremia with AKI 22 hours ago

Agree with all comments. With water restriction the hyponatremia should be manageable. Because of hypervolemia, diuresis with loop agents are indee...

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RE: hyponatremia with AKI 23 hours ago

Venous insufficiency in the lower extremities makes it difficult to decide if edema can be equated to total body hypervolemia or is only due to loc...

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RE: BKV nephropathy/ Acute Rejection 23 hours ago

Eagerly awaiting findings on repeat biopsy and your decision about further treatment (because of or despite the biopsy results). ------------------...

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RE: hyponatremia with AKI 23 hours ago

Agree with 100% ll the points above, sounds overloaded and with high ADH state (for any one of several reasons) and needs loop diuretic and restric...

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RE: BKV nephropathy/ Acute Rejection 1 day ago

Repeat serum BKV Is negative, urine BKV 640 IU/mL, creat stuck at 4.30 mg/dL. Repeat biopsy we will get by today --------------------------------- ...

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RE: Membranous? 1 day ago

What a bizarre history! Fortunately the clinical presentation is benign enough to not mandate immunosupressive treatment at this time. I'll be quit...

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RE: hyponatremia with AKI 1 day ago

Hyponatremia is a water overload issue not a Na deficiency issue. Volume can increase water restriction if pt volume depleted but your patient has ...

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RE: hyponatremia with AKI 1 day ago

I agree with Dr. Wehbe. Fluid restriction and diuretics should suffice. Sent from my iPad

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RE: Membranous? 1 day ago

This is not likely to be Primary MN, but I would reserve judgement until we know the results PLA2R antibody and PLA2R antigen staining. If negativ...

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RE: hyponatremia with AKI 1 day ago

Looks like hypoosmolar, hypervolemic hyponatremia. Volume status- hypervolemic ? - 4 plus edema, on oxygen, low urine Na Do u have any weight trend...

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hyponatremia with AKI 1 day ago

Gentleman age 68 , with obesity, sleep apnea, history of recurrent DVT and PE and chronic venous insufficiency, presented on November 12 after a fa...

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Membranous? 1 day ago

41 year old white male with PMHx as below significant for HTN, Nephrotic syndrome diagnosed when he was 3-4 years of age , he reported it was calle...

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RE: Hypophosphatemia with Hypokalemia 1 day ago

any glycosuria?  Can we have his full BMP and urine pH? rr ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Universit...

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RE: BKV nephropathy/ Acute Rejection 1 day ago

I would not suggest ATG in this patient. I would follow the advice of Dr Venkat and wait for improvement in renal function. If improvement in renal...

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RE: Hypophosphatemia with Hypokalemia 1 day ago

An FGF 23 disorder will not explain the hypokalemia in the presence of CKD IIIB. Thus this looks more like a proximal tubular disorder. Does he hav...

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RE: BKV nephropathy/ Acute Rejection 1 day ago

Since SCr has decreased from peak of 5.6 mg to 4.20 mg following 3 methylprednisolone boluses, my approach will be as follows: 1. Increase oral pre...

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RE: HOCM and hyponatremia 1 day ago

​ The hypertonic saline is giving him ever increasing volume and he already has problems with that. At 60 ml/hour of 3% saline he is receiving 738 ...

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RE: ApoL1 genetic testing 1 day ago

I wish to state the following (at the risk of being considered annoyingly repetitive): With a genetic test result of uncertain implications and wit...

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RE: Abrupt decrease Urine output 20 hrs after kidney transplant 1 day ago

I must admit that the initial tacrolimus levels you have posted are not sufficient to invoke CNI-nephrotoxicity to explain the abrupt decline in ur...

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RE: Appropriate induction for 2nd kidney transplant after hx of PTLD following the first renal tx 1 day ago

Two HM sibling donor, zero-PRA after a late C4d -negative and DSA-negative, late (probable) AMR. I would be comfortable to go without any induction...

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RE: Complications while on dialysis 1 day ago

The hypotension event is clearly of concern. Possibly more severe than thought in a patient with some component of prior CNS injury. --------------...

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RE: AKI with Myeloma cast nephropathy vs other ? Candidate for Biopsy 1 day ago

Dexamethasone is such a common part of myeloma treatment that I wonder if you could ask onc to prescribe a short empiric course. Should ensure no P...

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