RE: Acute Kidney Injury 26 minutes ago

BUN/CR 86/6.4 --> 73/5.5 with IVF renal duplex pending With such low titers of antibodies, should one check anti histone ab? ----------------------...

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RE: Congenital Chloridorrhea 31 minutes ago

Dr. Buhary     A very rare and interesting diagnosis. My previous chief of medicine Dr. John Fordtran at Baylor University Medical Center was the f...

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RE: Acute Kidney Injury 32 minutes ago

Just to be the devils advocate why do Doppler in a patient with diabetes and nephrotic range proteinuria unless hypertension is refractory to medic...

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RE: Acute Kidney Injury 40 minutes ago

Are dysmorphic rbc seen with microscopy ? Can you obtain Doppler duplex of renal arteries? ------------------------------ Michael Rudnick MD Univer...

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RE: Acute Kidney Injury 5 hours ago

Taken together, the trend is for a decrease in tge size of the ,right kidney over  5 years, and relative stability in the size of the left kidney. ...

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RE: Acute Kidney Injury 10 hours ago

Thanks for the reply. This patient had quite a few renal US in recent years. There is disparity in kidney sizes among different renal US readings. ...

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RE: Acute Kidney Injury 11 hours ago

I can’t get overly concerned with the serological findings in this case. Looks like long standing Diabetes and hypertension with advanced diabetes ...

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RE: sterile water for hypernatremia 11 hours ago

Sterile distilled water for infusion (injection) should NOT be used as a vehicle for administration by a constant IV infusion of antibiotics (or ot...

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Acute Kidney Injury 12 hours ago

65 years old AAM with CKD Stage 4, Cr in low 4s, DM, HTN, Dementia, schizoaffective disorder, nursing home pt had AKI on CKD 4 in 3/2021 with Cr 4....

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RE: Congenital Chloridorrhea 13 hours ago

Has the mutation in the DRA gene been identified? Have you excluded Villous Adenoma of the Colon, by detailed and exhaustive colonoscopy. Would any...

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RE: sterile water for hypernatremia 13 hours ago

Hi I know it is not related to the main discussion But can I know is it safe to use SWFI for continuous infusion of antibiotics like meropenam, taz...

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RE: 82 year old with crescents 13 hours ago

Makes sense. Thank you ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: 82 year old with crescents 14 hours ago

Good question. I am not sure that I have a good answer. The B-Cells responsible for IgA1 production apparently have a slight bias for assembling th...

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RE: 82 year old with crescents 14 hours ago

@Richard Glassock I was always puzzled by the common finding of lambda staining in IgA but have not been able to find the reason. Is it known why i...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 15 hours ago

I agree with you 100%. This is the way it used to be till the " education/administration innovators " (wherever they were/are) changed it several y...

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RE: 82 year old with crescents 15 hours ago

Moo and pr-3,levels are pending Should come back later today I will update as soon as it is available Thanks Unni pillai Sent from my iPhone

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RE: sterile water for hypernatremia 15 hours ago

Michael- Great response. Many thanks. No reason as far as I can tell to use IV distilled, sterile water. Other safer and effective solutions are re...

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RE: 82 year old with crescents 15 hours ago

i have almost a similar case,  72  years old on dialysis now and the biopsy showed IgA Nephropathy with active crescents 70 % , severe acute tubula...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 16 hours ago

One thing that may be easer to change is to insist on nephrology being a required rotation for all medical students and medical residents. I believ...

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RE: HRS in malignant ascites? 17 hours ago

was patient on NSAIDs? ------------------------------ Pankaj Ram MD, FASN California Nephrology Consultants Fresno CA (559) 320-0701 --------------...

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RE: sterile water for hypernatremia 17 hours ago

Attached is the article by Ramaswamykanive which reports   "safe" administration of sterile water via central veins and as Dr Hirsch notes, some cr...

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Congenital Chloridorrhea 17 hours ago

Just saw a case as consult with above diagnosis. Diagnosis is established already. My question is about Rx. He persists with progressing CKD, Hypok...

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RE: sterile water for hypernatremia 18 hours ago

Many years ago Jim Knochel used IV distilled water (I think via a central line) to treat several patients with severe persistent hematuria due to s...

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RE: 82 year old with crescents 18 hours ago

I would treat like ANCA Crescentic GN- either with RTX or oral CYC (in reduced dose) or a combination of the two, with a rapid steroid taper (outli...

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RE: 82 year old with crescents 18 hours ago

K and L positive makes MGRS unlikely even if they are not the same amount of staining so this is ANCA+ IgAN or IgAN with an atypical ANCA, do you h...

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RE: 82 year old with crescents 22 hours ago

Dear Dr Glassock, Dr Desai and DrRodby Got some update  Anca antibody -1/80(normal <1/20) perinuclear pattern regarding biopsy immunoflurosence  ka...

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RE: MPGN with unusual deposits of striated structures 22 hours ago

you mentioned kappa only, if the deposits are like the ones I showed,  I still have to wonder if this isn't a MGRS (even though you haven't definit...

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RE: curious case of Hypercalcemia: Need Help 22 hours ago

Thanks for the follow up and I am not surprised. I have had a couple patients and have very good luck using ketoconazole, though you may have to ti...

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RE: curious case of Hypercalcemia: Need Help 22 hours ago

Thanks for the follow up. Always nice to get the answer  for the cases presented in this forum. You might consider using fluconazole as treatment, ...

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RE: MPGN with unusual deposits of striated structures 22 hours ago

Thanks for the  response.  In light of the massive proteinuria, modest hypoalbuminemia and only segmental foot process effacement-  the next step w...

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RE: curious case of Hypercalcemia: Need Help 23 hours ago

@Roger Rodby @Richard Glassock @David Goldfarb @Stuart Sprague @John Asplin Hello everyone Thank for all for actively running this forum. This is o...

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RE: 82 year old with crescents 1 day ago

At the risk of being completely wrong, I'll offer this:  the response rates aren't the best with aggressive immunosuppressive therapy in this data:...

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RE: HRS in malignant ascites? 1 day ago

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

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RE: HRS in malignant ascites? 1 day ago

I have seen a number of these, severe intravascular depletion causing AKI from malignant ascites. You give NS or albumin and it gets slightly bette...

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RE: HRS in malignant ascites? 1 day ago

Lfts nl.  Underlying CKD 3b. Relative hypotension Post paracentesis with development of oliguria and progressive AKI. Urine Na low and UA bland. No...

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RE: MPGN with unusual deposits of striated structures 1 day ago

Dear experts, Thank you for your great insights. Roger> Do these deposits look crystalline? (Crystalglobulinemic gn , but IF should be +) Yes, they...

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RE: 82 year old with crescents 1 day ago

Were the kappa LC stains negative?  If monotypic, you have to consider a IgA PGNMID at this age, even though it is quite uncommon.  Do you have an ...

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RE: 82 year old with crescents 1 day ago

KDIGO requires 50% crescents for “crescentic Iga” and the aki seems a bit out of proportion to the lesion, but it is acting like RPGN. I like your ...

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RE: HRS in malignant ascites? 1 day ago

Are LFTs normal? Urinalysis findings/FENa? Was renal function normal immediately prior to paracentesis and worsen only after large volume paracente...

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RE: HRS in malignant ascites? 1 day ago

I have never seen  HRS triggered by paracentesis of the peritoneal seeding type of "malignant ascites" in the absence of extensive hepatic metastas...

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RE: HRS in malignant ascites? 1 day ago

Thank you Dr. Glassock; secondary to peritoneal seeding ------------------------------ Ira Meisels MD New York NY (212) 523-3530 ------------------...

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82 year old with crescents 1 day ago

82 year old  south East Asian descent,who had well controlled hypertension for last couple of years , recently found to have worsening hypertension...

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RE: HRS in malignant ascites? 1 day ago

Do you mean "malignant ascites" due to peritoneal seeding or ascites in the presence of extensive hepatic metastases or portal vein thrombosis in a...

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HRS in malignant ascites? 1 day ago

Hi Was wondering about the possibility of HRS after a large volume tap  in malignant ascites without cirrhosis;  is this a known entity? any eviden...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

Considering the life- long cumulative earnings potential (pre-tax, not inflation adjusted) of between  $10 and $12M on average for a career in neph...

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RE: The Virtue of Honesty and Humility 1 day ago

Joanne, the phrase that I hear from house staff when asked about something about a patient (that drives me nuts but I am used to)  is "not that I k...

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RE: sterile water for hypernatremia 1 day ago

Thanks for your answers. As a nephrologist, we stumbled recently with some  ICU physicians that use sterile water in the setting of severe obese (I...

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RE: sterile water for hypernatremia 1 day ago

This is a common and annoying problem, particularly with diabetics in whom the administered D5W requires that more insulin be given-- even via cont...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

Very sad but very realistic statement. These are the times! ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------...

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RE: The Virtue of Honesty and Humility 1 day ago

Actually Joanne, they will try to find the answer in their IPhone first! ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539...

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