RE: HD consent for hospitalized patients 2 minutes ago

I work in hospitals owned by Sentara a large hospital system in Virginia. Consent is required for patients who have never dialyzed. For chronic pat...

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RE: Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 55 minutes ago

This has happened to me a few times.  I've asked my PC colleagues to discontinue the SGLT2i and we've switched the patient to a GLP-1a.  Recent dat...

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RE: The cause of cresentic GN 56 minutes ago

trans esophageal echo to exclude infective endocarditis if-ve rituximab is my choice ------------------------------ Alaa Nabih Abdalla nephrology f...

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RE: Distal RTA without AKI from ICPI 58 minutes ago

@Satish Balan , you are correct in that majority of magnesium (65-70%) is reabsorbed in the thick ascending loop of Henle, but there is little evid...

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RE: Distal RTA without AKI from ICPI 2 hours ago

@Nelson Leung Clinically, carboplatin nephrotoxicity is accompanied by hypomagnesemia suggesting proximal tubule as the site of injury.   I would h...

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RE: Hypercalcemia in a hemodialysis patient 2 hours ago

I like the idea of the drifting calcium. I have seen two patients in whom the calcium was completely independent of any pth action where the pth wa...

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RE: Hypercalcemia in a hemodialysis patient 2 hours ago

Did you end up doing the bone scan? You gave  2 doses of calcitonin  and the ALP came down[More]

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RE: Distal RTA without AKI from ICPI 3 hours ago

Hi Chintan To answer your questions: 1. I agree with no biopsy and no steroids. Given relatively mild manifestations of presumed renal toxicity fro...

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RE: Hypercalcemia in a hemodialysis patient 6 hours ago

Perhaps this hypercalcemia has nothing to do with her long past hypercalcemia? She now has a low pth. Could this now be adynamic bone disease and y...

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RE: Hypercalcemia in a hemodialysis patient 11 hours ago

Thanks Dr Balan, her calcium was ok throughout her CKD trajectory and only started becoming a problem after 1.5-2 years of dialysis. she started HD...

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RE: Distal RTA without AKI from ICPI 18 hours ago

Thank you for your valuable response Dr. Rodby. Did you mean to say carboplatin could be responsible for distal RTA in this case? As this patient r...

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RE: Distal RTA without AKI from ICPI 18 hours ago

While cis-platinum toxicity is mostly concentrated in the S3 segment, Carboplatin nephrotoxicity is less well studied.  Clinically, carboplatin nep...

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RE: Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 20 hours ago

Dr Balan is right that there is no enough data or consensus.  My Concern is that pt had h/o UTIs in the past.  Diabetic frequency has bladder dysfu...

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RE: Distal RTA without AKI from ICPI 21 hours ago

Thank you for your valuable response Dr. Rodby. Did you mean to say carboplatin could be responsible for distal RTA in this case? As this patient r...

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RE: Distal RTA without AKI from ICPI 22 hours ago

The lack of AKI doesn't rule out AIN completely, but I dont think it matters. Your approach is fine, I would probably give a short course of steroi...

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RE: AKI -Anuria 22 hours ago

Urinalysis? Medications? may need biopsy ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center C...

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Distal RTA without AKI from ICPI 23 hours ago

46 yo WF with Metastatic lung adenocarcinoma and invasive sq cell cancer of right tonsil since 3/2020. s/p 6 cycles of carboplatin/taxol/pembrolizu...

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RE: AKI -Anuria 1 day ago

Hello all,  Good learning point from this case.  Question: I have a patient 51 yr old F whose creatinine is slowly worsening. She has 1.2 cm non ob...

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RE: The cause of cresentic GN 1 day ago

Sometimes it is impossible to wedge an individual patient into the rigid confines of a classification system. This case is a good example. Low C3 a...

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RE: Challenging case 1 day ago

For false positive APL I quote up-to-date uncertainty about their clinical significance [ 7 ]. Timing of testing  -  Initial testing is usually...

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RE: Challenging case 1 day ago

The rise in ACL IgM is seen not infrequently in a recent history of thrombosis so this may just be an epiphenomenon of the clots that she had Dr Ba...

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RE: Secondary + Primary Membranous GN 1 day ago

I think that Dr. Rodby has summarized the problem and the conundrums of this case very well.  I doubt that ExostosinI/II deposition disease can co-...

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RE: Hypercalcemia in a hemodialysis patient 1 day ago

With the response to cinacalcet and generally mild hypercalcaemia, could this be a case of familial hypocalciuric hypercalcaemia? The very low pth ...

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RE: Challenging case 1 day ago

In this patient with a history of cardiac arrest and AKI likely due to hypotension, with the thrombocytopenia and 'few schistocytes' on smear, the ...

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RE: Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 1 day ago

There are only two instances where one would treat ASB. That is in pregnancy and before a urological procedure. While this is a topic that has not ...

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RE: Secondary + Primary Membranous GN 1 day ago

1) Is it Lupus Membranous Glomerulonephritis + Primary Membranous Glomerulonephritis? PLA2R antibodies have been shown in some patients with lupus ...

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RE: The cause of cresentic GN 1 day ago

Dr Nauman, you mean the majority of AAV cases don't show segmental necrosis with pauci immune picture. Can you post any evidence to read it if you ...

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RE: Hypercalcemia in a hemodialysis patient 1 day ago

Dear esteemed community members Reviving this thread almost after 2 years. But this case of hypercalcemia is really really challenging . Since 2019...

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Secondary + Primary Membranous GN 1 day ago

63-year-old male was seen by my colleague in 2009 for Nephrotic syndrome. Renal biopsy in 2009 showed near full hose staining on immunofluorescence...

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RE: Challenging case 1 day ago

Thank you for your reply Dr. Friedman.  In answer to your questions: (1) She had "few schistocytes " noted in her peripheral smear. Her indirect an...

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RE: Challenging case 1 day ago

Sorry to hear that. Two q’s. 1. Was her hemolysis autoimmune/micoangiopathic, eg do you have her blood smear & Coombs? 2. What other drugs was she ...

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RE: Challenging case 1 day ago

Thank you very much for your responses Drs. Rodby and Desai. I was not that concerned about glomerulonephritis in her – it did not seem she had l...

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RE: Challenging case 1 day ago

It sounds like an ischemic ATN from the cardiac arrest, but with the low complement and positive ANA and ANCA, we can't completely rule out a GN (r...

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RE: Challenging case 1 day ago

I have to say, the only thing that really concerns me is the VERY low C3. But that is only relevent for a GN and the urine sediment doesn't support...

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RE: Resistant hypertension in lupus nephritis 1 day ago

The development of a hypertensive crisis with MRI findings of PRES is well reported in patients with active lupus nephritis, CKD, and hypertension....

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RE: Resistant hypertension in lupus nephritis 1 day ago

I agree with Dr Rodby The patient is taking 5 medicines whose primary role is vasodilation (one way or another). Assuming she is taking them (if th...

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Challenging case 1 day ago

70 year old woman transferred from outside facility for wound care. Her chronic problems include hypertension, CKD 3b, Type 2 diabetes, diastolic C...

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Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 1 day ago

Good morning.  I have recently seen a very pleasant female patient, and on routine labs her UA had LE, so I sent a culture (she is asymptomatic, bu...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 1 day ago

Thanks Dr El Meanawy, i am planning to recheck labs including uacr and upcr with my 2nd visit with him. Meanwhile, will try to contact his hematolo...

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RE: Resistant hypertension in lupus nephritis 1 day ago

you should learn volumes with this admission, and take one major factor out of the equation.  hopefully she can stay long enough to get this figure...

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RE: Resistant hypertension in lupus nephritis 2 days ago

thank you for your question. she is being admitted and given drug under supervison as we are also decreasing sodium valproate and starting leverace...

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RE: Resistant hypertension in lupus nephritis 2 days ago

How confident are you that she is taking clonidine as prescribed?  Even missing one dose can result in rebound hypertension. ----------------------...

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RE: Resistant hypertension in lupus nephritis 2 days ago

Wonder if there is systemic sclerosis/SLE overlap in your patient. Nifedipine and lisinopril (assuming no potassium problems) doses can be increase...

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RE: Desperate and Dying for Dialysis in Disasters: Open the Door to MISSION FOUR 2 days ago

Dear Paul I fully understand your frustration and sadness. It is key that we advocate for our patients who are often the most vulnerable in disaste...

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RE: biopsying kidneys 8.2-8.8 cm for unexplained rise in creatinine and cells in urine 2 days ago

I will be appreciated if there are any updates regarding the management as I have a similar case 78y old with pr3 level >200 ,haematuria and diffic...

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RE: Progressive CKD in patient with AL amyloidosis in hematologic remission 2 days ago

Based on rough calculation and guessing percent dimerization, he can filter 14 g if FLCs in 24 hours.  Although this is below the normal tubular up...

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RE: The cause of cresentic GN 2 days ago

I mean arteritis is seen only in minority of biopsied. --------------------------------- Awais Nauman HMC Doha ---------------------------------

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RE: The cause of cresentic GN 2 days ago

“why should I consider vasculitis; however, the kidney Biopsy didn't show any picture suggestive of this?” Dr Youssef if you are alluding to absenc...

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RE: Deciding biopsy for subnephrotic proteinuria at age 81 on apixaban and hypertensive 2 days ago

The scan is suggestive but never diagnostic. ------------------------------ Ashraf El-Meanawy , MD, MS, PHD, FASN Professor of Medicine Director of...

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RE: Resistant hypertension in lupus nephritis 2 days ago

Oh yeah duh, but my point remains, euvolemia is so hard to find in CKD. You can look for renal artery stenosis etc but I'd bet anything this is ref...

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