RE: Amy work up needed for High renin despite being on midodrine ? 4 hours ago

Is the patient on midodrine and verapamil currently?​ ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 266-7083 ------...

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RE: Post-infectious GN 4 hours ago

Thanks Drs. Venkat, Glassock and Rodby; UA is bland; kidney ultrasound is unremarkable with right kidney 9.5 x 5.8 cm and left kidney 11.5 x 5.2 cm...

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RE: Post-infectious GN 7 hours ago

I agree but at such a young age I think it is worth a try. The EMs with deposits in many locations is the tie breaker for me to try IS, assuming th...

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RE: Post-infectious GN 11 hours ago

With 35 glomeruli, this is a very adequate biopsy with a lot of glomerulosclerosis and IFTA, and hardly any active proliferative/inflammatory/necro...

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RE: Post-infectious GN 19 hours ago

Except for the light chain discrepancy, this scenario has sone features suggesting PIGN.  I agree with Dr. Rodby about doing Probase Digestion and ...

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RE: Denosumab in CKD Stage 4 1 day ago

I would agree with the comments to avoid Denosumab in this patient, the risk of hypocalcemia, marked hyperparathyroidism, as well as potentially in...

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RE: Amy work up needed for High renin despite being on midodrine ? 1 day ago

The renin not high enough to get excited about, you sure he us not still a bit volume depleted? Besides the Aldo is not high. I'd ignore. If K rema...

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RE: Amy work up needed for High renin despite being on midodrine ? 1 day ago

Verapamil may increase renin levels without significantly altering aldosterone level (please see reference below). Also, hypokalemia may have suppr...

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Amy work up needed for High renin despite being on midodrine ? 1 day ago

Gentleman age 70 with history of alcoholic cirrhosis, in which because of Hypertension and Hypokalemia, renin and aldosterone were checked on the s...

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RE: Post-infectious GN 1 day ago

Thank you Dr. Rodby. I will discuss with nephropathologist regarding pronase digestion on speimen. ------------------------------ Pongstorn Pitiran...

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RE: Post-infectious GN 1 day ago

"Pee Dee Nephrology"?   I won't ask. The C3 is not low enough for me to consider this a hypocomplemetemic GN, the humps are interesting but are par...

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Post-infectious GN 1 day ago

HI all 28- year-old asian male who was in good health until 2 months ago when he developed some weakness and headaches. He was evaluated by PCP and...

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RE: A puzzling case of hypercalcemia 1 day ago

ACE level correlates with whole-body (not lung only) granuloma since produced by epitheloid cells, multinucleated giant cells, and macrophages with...

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RE: Starting RAAS inhibitors in Advance CKD 1 day ago

I would for sure start RAAS and monitor the patient closely for onset hyperkalemia​ ------------------------------ Antonio Joseph MD NYU Langone La...

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RE: A puzzling case of hypercalcemia 1 day ago

Roger et al: I've also had a collection of renal-limited, and renal+hepatic sarcoidosis, without any lung findings, but my understanding (correct m...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 1 day ago

So what HD prescription did you end up using ? ------------------------------ MD Los Angeles CA ------------------------------

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RE: Sjögren's interstitial nephritis with crescents 2 days ago

"Kidney biopsy returned showing brisk tubulointerstitial infiltrate with 2 crescents, other glomeruli normal in appearance." Will be helpful to k...

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RE: A puzzling case of hypercalcemia 2 days ago

sorry, I missed the PTH-rp.​ ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 266-7083 ------------------------------

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RE: A puzzling case of hypercalcemia 2 days ago

" Serum and urine immunofixation showed no M-band and she has normal K/L light chains. iPTH-rP < 2" ------------------------------ Roger Rodby MD, ...

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RE: A puzzling case of hypercalcemia 2 days ago

Has PTHrp been checked.  I would also check vitamin A which can also cause non-PTH mediated hypercalcemia.​ ------------------------------ Nelson L...

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RE: Sjögren's interstitial nephritis with crescents 2 days ago

SS can have many renal lesions, AIN (lymphocytic like you found in lymph nodes) D-RTA, MPGN (not seen) usually associated with cryoglobulinemia tha...

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RE: A puzzling case of hypercalcemia 2 days ago

I appreciate all the feedback. I will add ACE level before discharge that is planned today. Calcium is stable at 10. I think hypercalcemia was just...

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Sjögren's interstitial nephritis with crescents 2 days ago

Hello All, looking for some input on an interesting case. We are seeing a 21 year old woman who presented initially with persistent  fever and acut...

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RE: A puzzling case of hypercalcemia 2 days ago

Agree but while the iPTH levels are not suppressed , they really aren't that high for that level of Ca.  And the borderline 1-25 seems pretty high,...

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RE: Starting RAAS inhibitors in Advance CKD 2 days ago

​ These cases need to be managed individually. We will not get a generalized rule for everybody in that level of eGFR. However, Cardiovascular mor...

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RE: A puzzling case of hypercalcemia 2 days ago

I'm a little late to the game, but an unsuppressed PTH in the setting of hypercalcemia is highly suggestive of primary hyperparathyroidism and nega...

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RE: A puzzling case of hypercalcemia 2 days ago

Thanks for follow up, I’d keep her on cinecalcet and off any form of vitamin D indefinitely. Still, probably a long shot, but I have seen plenty of...

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RE: Chicken Pox In Hemodialysis 2 days ago

Esrd pts are immunocompromised. Acyclovir is safe if dosed appropriately. I would probably give 400 mg a day and give after dialysis on dialysis da...

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RE: A puzzling case of hypercalcemia 2 days ago

The Patient still in the hospital for other issues. Calcium is down to 10.1 with IVF NS, calcitonin and cinacalcet. CXR and CT chest showed no lymp...

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RE: A puzzling case of hypercalcemia 2 days ago

If you ignore the pth , it really isn’t very high, I’d also wonder about sarcoidosis --------------------------------- Roger Rodby MD, FASN Profess...

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RE: Denosumab in CKD Stage 4 2 days ago

At 90 years of age and with the huge risks of hypocalcemia, I'm not sure denosumab is the best option.  There's also some other things to consider:...

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RE: A puzzling case of hypercalcemia 2 days ago

Dear Dr. Essam, What is the fillow up with this patient, kindly update us about her condition. --------------------------------- Wael Jebur MD, FAS...

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Chicken Pox In Hemodialysis 2 days ago

Dear All I wish to share a patient and request you to guide me on Best Treatment strategy, your experience if any . A 30 year old male, HT, CKD 5 o...

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RE: Denosumab in CKD Stage 4 2 days ago

Hypocalcemia may occur and be severe and prolonged in advanced ckd with this specific agent. https://www.revistanefrologia.com/en-relaccionados-den...

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RE: Denosumab in CKD Stage 4 3 days ago

Corrected calcium and ionized calcium levels? Diabetic with PTH level that is not high and normal alkaline phosphatase level. Can this be adynamic ...

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RE: Membranous Nephropathy -Take off Tacrolimus or not? 3 days ago

I would control both BP and volume first. The concern is recurrence of disease after stopping or reducing CNI.  If both are not controlled then one...

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RE: Starting RAAS inhibitors in Advance CKD 3 days ago

the  questionable follow up is a real problem for starting RASI at this stage If you do, I would start at just 2.5 to 5 mg. I would stop hydralazin...

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RE: Starting RAAS inhibitors in Advance CKD 3 days ago

K is wnl, in mid 4s. Volume is not an issues. eGFR in high teens. Alb/Cr of ~ 2 gram. Already on CCB, loop diuretic, Hydralazine, clonidine, metopr...

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RE: treatment of calcineurin inhibitor induced hyperkalemia 3 days ago

THe aldosterone paradox...involves Calcineuron drugs and hyperkalemia ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Cente...

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Denosumab in CKD Stage 4 3 days ago

90 year old male, DM, Hypertension, Gout, CKD stage 4 with egfr range 19-23.  Limited mobility but has caregivers at home  to prevent falls.  BMD T...

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RE: Dialysis and Biologicals 3 days ago

Yes. She was on Calcitriol. Thank you for sharing that information. ------------------------------ Vinayak Purandare MD, FASN Ormond Beach FL (386)...

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RE: HyperCalcemia In HD 3 days ago

Then I would definitely go with pamidronate ------------------------------ Stuart Sprague DO, FASN Chief, Division of Nephrology and Hypertension N...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 3 days ago

Reviewed CT scan with radiologist. No new findings  On HD since 12/29. Making urine but still needing HD. Na 133-136. -----------------------------...

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RE: HyperCalcemia In HD 3 days ago

Thank You for replies Dr Desai, Dr Rodby, Dr Venkat, Dr Mellas and Dr Sprague.  Calcimimetics were tried before, but did not help. ----------------...

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RE: Dialysis and Biologicals 3 days ago

Did you try  Calcitriol, because 1.25(OH)D3 deficiency could aggravate her dermatological disease ------------------------------ Wolfgang Boettcher...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 3 days ago

I don't see how you can avoid steroids, Rituxan can be used chronically but acutely you will need prednisone. One thing to consider is that IgG4 di...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 3 days ago

Pathologist called with diagnosis of IgG4 interstitial nephritis.  await full official report.  ------------------------------ Sachin -----------...

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RE: Starting RAAS inhibitors in Advance CKD 3 days ago

Regarding:   https://www.nejm.org/doi/full/10.1056/NEJMoa053107 The findings of this study from China may not be applicable to other populations. I...

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RE: Severe hyponatremia with Na 104 BUN 208 Cr 8 3 days ago

Even though Protonix is on home med list, pt says she does not recall that medicine or taking it. She does not know why it was on her home med list...

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RE: Starting RAAS inhibitors in Advance CKD 3 days ago

Hi Abdul, This is a good question that is often encountered. I do think blood pressure control is imperative to this situation to diminish untoward...

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