RE: is it primary hyperaldosteronism? 4 minutes 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 38 minutes 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....

View Discussion

RE: is it primary hyperaldosteronism? 1 hour 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...

View Discussion

RE: is it primary hyperaldosteronism? 2 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...

View Discussion

is it primary hyperaldosteronism? 2 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 4 hours 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...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 5 hours 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...

View Discussion

RE: IgA nephropathy--repeat biopsy at this point? 5 hours ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 6 hours 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 10 hours 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...

View Discussion

RE: Primary Aldosteronism on Medical Management 11 hours 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. ---...

View Discussion

RE: Proteinuria 11 hours ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 12 hours 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...

View Discussion

RE: Proteinuria 15 hours 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). ...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 15 hours ago

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

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 17 hours 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...

View Discussion

RE: Use rituximab or not 18 hours ago

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

View Discussion

RE: IgA nephropathy--repeat biopsy at this point? 19 hours ago

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

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 19 hours 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...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 20 hours ago

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

View Discussion

IgA nephropathy--repeat biopsy at this point? 21 hours 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...

View Discussion

RE: Use rituximab or not 21 hours 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...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 21 hours 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...

View Discussion

RE: Unclear cause of kidney function reduction in a single kidney 22 hours 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...

View Discussion

RE: finerinoneh 22 hours ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 22 hours 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...

View Discussion

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: ...

View Discussion

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...

View Discussion

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...

View Discussion

RE: Use rituximab or not 1 day ago

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

View Discussion

RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day 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...

View Discussion

RE: ?Mitochondrial disorder 1 day 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...

View Discussion

Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

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

View Discussion

RE: finerinoneh 1 day 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...

View Discussion

RE: Urine Sodium In Hyponatremia 1 day ago

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

View Discussion

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

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

View Discussion

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

View Discussion

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

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

View Discussion

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

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

View Discussion

RE: Dosing Of Rituximab In Pd Patient 1 day ago

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

View Discussion

Unclear cause of kidney function reduction in a single kidney 1 day 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...

View Discussion

RE: Dosing Of Rituximab In Pd Patient 1 day ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day ago

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

View Discussion

RE: Primary Aldosteronism on Medical Management 1 day 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...

View Discussion

RE: Dosing Of Rituximab In Pd Patient 1 day 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...

View Discussion

RE: Use rituximab or not 1 day ago

If the 9x4 mm vegetation is very mobile or shows any extension into a paravalvulsr abscess , then surgery needs to be reconsidered. A short course ...

View Discussion

RE: Use rituximab or not 1 day ago

Based on a very strong suspicion of bicuspid aortic valve Bartonella endocarditis and GN, I would treat with appropriate antibiotics and observe. W...

View Discussion

Use rituximab or not 1 day ago

21 yo male sent to ED by primary MD with new finding of SCr 5 mg/dl associated with blood tinged urine for several days. Patient in good health exc...

View Discussion

Dosing Of Rituximab In Pd Patient 1 day ago

Patient is on PD and having flare of Vasculitis Having maintenance dose after induction Regime APD Is there a need to alter 2x1 g or do the same?...

View Discussion

RE: Primary Aldosteronism on Medical Management 2 days ago

Dr Hassan; is HCO3 22 or 32 mmol/L? Can you post deidentified results report for renin and aldosterone as many units are used in measurements which...

View Discussion