RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 hours ago

I meant the normal CFB , elevated C5b-9,low C3 and low C4 suggest activation of Classic pathway .. but am not sure I clearly understand why the AP5...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 7 hours ago

Is this pattern, with normal CFB ,high C5b-9 and low C3/C4, exactly what you would expect in severe LN, without aHUS.? Just wondering. Does it indi...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 9 hours ago

good morning/evening Just as a follow up. This gentleman is doing well , his renal function is improving on Obinutuzumab and MMF His initial d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 13 hours ago

The cause of the NAGMA is likely the effect of bicarbonate secretion by the ileal pouch, not dRTA This is seen in an about 10-20% of patients with ...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 15 hours ago

A urine pH that high is supraphysiologic. It's most likely from bacteriuria or from bacteria growing in the urine after it leaves the body (in the ...

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RE: is it primary hyperaldosteronism? 19 hours ago

The obesity in this case represents a major confounding issue in interpretstion of the AAR. In some but not all cases of Obesity related hyperaldos...

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RE: Primary Aldosteronism on Medical Management 20 hours ago

Many, myself included, are excited about the utility of ASI for primary aldosteronism but for now it's still exploratory and "off label" in the US....

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RE: is it primary hyperaldosteronism? 21 hours ago

in the absence of spontaneous hypokalmia an aldo level > 30 , would be suggestive of Primary hyperaldo. in this case you may have to do confirmat...

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RE: is it primary hyperaldosteronism? 22 hours ago

The aldo and PRA are markedly consistent with primary hyperaldo. What is her serum K? The urine K is surprisingly low but not something I'd typic...

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is it primary hyperaldosteronism? 22 hours ago

Just wanted to share with the community the following details of a recently diagnosed hypertensive female patient of African origin with poorly con...

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RE: Primary Aldosteronism on Medical Management 1 day ago

It has been a really fruitful discussion. Currently if we decide to continue MRA, I should repeat renin levels and if that comes up, Aldactone is d...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

IMO, there are two almost competing aspects to this case. First, agree with all, we should be careful about giving medicines without clear cut in...

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RE: IgA nephropathy--repeat biopsy at this point? 1 day ago

Thank you so much Dr. Glassock--I appreciate your expertise. ------------------------------ Leah Metz MD Onalaska WI (608) 775-1673 ------------...

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RE: Primary Aldosteronism on Medical Management 1 day ago

"My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control." - v...

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RE: Primary Aldosteronism on Medical Management 1 day ago

Thank you for your answer, However, is it still indicated to change aldactone and finerenon with baxdrostat in those patients on the MRA?? giving...

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RE: Primary Aldosteronism on Medical Management 1 day ago

My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control. ---...

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RE: Proteinuria 1 day ago

This is a very challenging case. The clinical data provides a compelling story supporting Zoledronic acid nephrotoxicity provoking a partial podocy...

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RE: Primary Aldosteronism on Medical Management 1 day ago

Its really an interesting discussion. Thank you for bringing up the same . So in conclusion, we need to abandon aldactone and finerenon and replace...

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RE: Proteinuria 1 day ago

1g albumin per day is not small. I would biopsy if proteinuria persists without sign reduction after max ARB, SGLT2, and MRA (if BP tolerates it). ...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

We often encounter the scinario of unexplained renal function impairment in the context of using multiple synergistic medications , which all combi...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Interesting suggestion of "Ischemic Nephropathy due to RAS in a single kidney . The fact that the solitary kidney is almost 13cm. In length makes t...

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RE: Use rituximab or not 1 day ago

Noted and much appreciated. Will provide follow-up when available. ------------------------------ John Mellas MD Nephrology and Hypertension Spec...

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RE: IgA nephropathy--repeat biopsy at this point? 1 day ago

The original diagnosis likely should have been IgA Vasculitis not Primary IgA . Her long term course is entirely compatible with this diagnosis. Az...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Thank you, Dr Campese, Dr Rodby and Dr Venkat, I have confirmed with the radiologist who reported the MRI, and there was no evidence of renal arte...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

I totally agree with Dr. Rogby. Moreover, where is the scientific evidence that combination of all these drugs provides additive effects independen...

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IgA nephropathy--repeat biopsy at this point? 1 day ago

Hello, I have a 47 filipino nurse who follows with me for IgA nephropathy. Back in 1999, in the Philippines, she had acute glomerulonephritis. Th...

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RE: Use rituximab or not 1 day ago

Low C3,, ANCA 1:160, Pr3 Ab, 56 (H), Bartonella henselae Ab 1:2560, Hi, patient owns 10 cats) This is classic Bartonella IRGN, the PR3 is classic...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

I see this patient is on the 4 pillars of care, RAASI, SGLT2i , aldo antagonist and GLP1a. Im not sure she needs all four pillars. I have seen s...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

As mentioned by Dr. Campese, possibility of renal artery stenosis (RAS) in a solitary functioning kidney needs to be considered in this older diabe...

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RE: finerinoneh 1 day ago

Off label use of fineronone, can be used upto 40 mg per day --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head o...

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RE: Primary Aldosteronism on Medical Management 1 day ago

I may have to go with Dr. Rodby in that it could be a dysregulated hyperaldosteronism state rather than true PHA caused by APA. In the latter cases...

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RE: Primary Aldosteronism on Medical Management 1 day ago

Thanks for sharing this case. For the units, I believe 1 uIU/mL = 1 mU/L so we can use the bottom row from Endocrine Society guideline table 5: ...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

With no protein in the urine and an inactive sediment, it is not likely this patient has a glomerular or tubulointerstitial disease. i am more in...

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RE: Primary Aldosteronism on Medical Management 1 day ago

Please forgive the intrusion from a simple community nephrologist stepping into a discussion among such phenomenal experts; I am far from having th...

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RE: Use rituximab or not 2 days ago

Further context; Surgery deferred as necessary but not emergent pending resolution of infection/vasculitis. On day 3; after neg blood cultures,...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

I presume that the high urine pH is due to urea splitting organisms in the ileal conduit ( and local ammonia generation or due to Bicarbonate secre...

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RE: ?Mitochondrial disorder 2 days ago

Yes we can test I did not consider MELAS but she had no other features to support the condition. She has been referred for genetic testing so ho...

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Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

Good evening, I would be grateful for any suggestions/thoughts? 64 yo female previous staghorn struvite calculi - PCNL and complete clear...

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RE: finerinoneh 2 days ago

Thank you. I agree likely low risk and potasium can be managed with binders if needed, I wasnt sure how much greater reduction in proteinuria likle...

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RE: Urine Sodium In Hyponatremia 2 days ago

I think these parameters are consistant with salt losing nephropathy!!, any radiology reports? --------------------------------- Wael Jebur MD, F...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Thank you. I will bring this up on the next clinic. ------------------------------ Daniel Christiadi Canberra Hospital Canberra ACT -------------...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Thanks-I agree that a normal UPCR makes LCCN unlikely and thecserum electrolyte pattern is not suggestive of Tenofovir toxicity. Can you obtain gen...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

Thank you Dr Glassock, His protein/creatinine ratio and albumin/creatinine ratio were normal. I have not done the urine electrophoresis. His elec...

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RE: Unclear cause of kidney function reduction in a single kidney 2 days ago

What is his UPCR and urine electrophoreses. This might be light chain cast Nephropathy . What are the serum electrolytes considering a possible dia...

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RE: Dosing Of Rituximab In Pd Patient 2 days ago

I am very confused here. Dialysis dependent kidney failure presumably due to ANCA+ Vasculitis with elevated serum IgG4- was the ANCA Vasculitis bio...

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Unclear cause of kidney function reduction in a single kidney 2 days ago

Dear all, I am seeking wisdom from the crowd of experts. 72-year-old gentleman from Tanzania was referred for reduced kidney function. Backg...

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RE: Dosing Of Rituximab In Pd Patient 2 days ago

DIAGNOSES: CKD stage 4/5 with proteinuria following ANCA associated vasculitis. Initial immunosuppression with Cyclophosphamide and Prednisone ...

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RE: Primary Aldosteronism on Medical Management 2 days ago

Here is the deidentified renin aldo report. ------------------------------ Hassan Abdullah MBBS Resident Nephrology Shaikh Zayed Hospital Lahore...

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RE: Primary Aldosteronism on Medical Management 2 days ago

We were expecting HCO3 to be lower than 22 in RTA with the degree of hypokalemia. UOG was close to 100 or so. The blood pressure on one clini...

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RE: Dosing Of Rituximab In Pd Patient 2 days ago

Hiw long has thepatient been on PD. What was the serology of the ANCA Vasculitis?. What are the manifestations of the "flare". When was the last do...

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