RE: MAP or BP goals for renal perfusion 8 hours ago

As an electrical engineer and electrophysiologist, it is always nice to see circuits used to help explain physiology. As Dr. Mellas alludes to, the...

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RE: FSGS CASE 11 hours ago

This Table has been updated in KDIGO-GN (2021). --------------------------------- Richard Glassock MD, FASN Emeritus Professor David Geffen Schoo...

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RE: ANCA positive/ Renal biopsy with low platelet count 11 hours ago

Not so rapidly progressive GN, hematuria (? Acanthocytes), Mild proteinuria and + anti-MPO probably means Vasculitis - percutaneous Biopsy relative...

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RE: ANCA positive/ Renal biopsy with low platelet count 11 hours ago

What is his WBC Count? How do the present hemoglobin and platelet counts compare to past values? If no leukopenia, and/or  recent worsening of anem...

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RE: ANCA positive/ Renal biopsy with low platelet count 12 hours ago

He appears to have an AAV, rising creatinine, albeit with mild hematuria and proteinuria,  MPO 80, C4 low plts low (from liver disease?) Rituxan al...

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ANCA positive/ Renal biopsy with low platelet count 12 hours ago

74 yr old male with hx of HTN, DM-2 >20 years, cirrhosis sec to NASH with varices , chronic thrombocytopenia seen in renal clinic for AKI. Reports ...

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RE: Unusual Sensory Symptoms In A Dialysis Patient 13 hours ago

Dr. Balan, thank you for your suggestion. I have just started him on Aripiprazole. Hoping for a good result. ------------------------------ Supriya...

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RE: FSGS CASE 14 hours ago

This table may help distinguish permeability-factor FSGS from other causes (secondary): Image is courtesy of @Edgar Lerma and tweeted at the 2018 B...

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RE: MAP or BP goals for renal perfusion 15 hours ago

@John Mellas , interesting. I have to spend some time muling this over thanks ​​​ ------------------------------ Roger Rodby MD, FASN Professor of ...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 18 hours ago

I have never encountered, or even heard of, trichomonas as a cause of PD peritonitis.  I wonder if it is causative or just an incidental finding.  ...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 21 hours ago

The leucocyte count has decreased from 1080 to 190. When there is no clinical need I would not remove the catheter now. Given the immobility of the...

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RE: FSGS CASE 21 hours ago

With a normal serum albumin and progressive decline in eGFR this is most-likely not Primary (permeability factor related) FSGS and immunosuppressiv...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 1 day ago

These two figures to to show the shift o leucocyte formula overtime. Trichomonas are read as monocytes from Dasit XN ------------------------------...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 1 day ago

Recovery of trichomonas peritonitis not in a PD setting: I intended clinical and lab recovery in 50% of patients not only on the leucocyte count si...

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FSGS CASE 1 day ago

80 yo AA male, Hx HTN, CAD, BPH and hyperlipidemia developed AKI , baseline Cr around 1.5 and increased gradually within the last year to 3.5, most...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 1 day ago

@Raymond Krediet @Joanne Bargman See above. I'm concerned I'm giving perhaps a bit too much advice without personal experience on this specific...

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RE: Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 1 day ago

“a 50% recovery after a week of Metronidazole therapy, can we assume this duration as sufficient?” Does this mean only a 50% cell count reduction? ...

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Woman 80 y.o. on CAPD, E.Coli and Trichomonas peritonitis 1 day ago

20 years ago, nephrolithiasis, nephrectomy of a kidney filled with pus; for 15 years now, paraplegia, associated neurogenic bladder dysfunction and...

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RE: hypercalcemia and hypophophatemia 1 day ago

I assume the 24h urine phosphate was also collected following the zoledronic acid administration.  Although renal PO4 wasting seems likely, I would...

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RE: MAP or BP goals for renal perfusion 1 day ago

Diagram attached ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 3145372356 ---------------------...

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RE: MAP or BP goals for renal perfusion 1 day ago

But, David, loop diuretics also block the ability for the macula densa to sense Cl-, so in essence, I thought loops do NOT activate TGF and thus do...

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RE: MAP or BP goals for renal perfusion 1 day ago

Thus is very very interesting and I have not thought about it before! Do you have an article with a figure demonstrating this, or even draw one? --...

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RE: MAP or BP goals for renal perfusion 1 day ago

In regards to the effect of SVR on renal perfusion; If the kidney circulation is in series with the systemic circulation then a lower SVR would res...

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RE: hypercalcemia and hypophophatemia 1 day ago

I do believe the pth effect is best explanation for hypercalcemia, hypophos and relative increase in urinary pho's. Probably right that pth related...

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RE: hypercalcemia and hypophophatemia 1 day ago

Hi, Calculate Fractional excretion of Phos, if high in the face of normal iPTH check PTHrP. ------------------------------ Osama Osman MD, PhD Lehi...

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RE: MAP or BP goals for renal perfusion 1 day ago

There is considerable data that much of the aki is actually from activation of TGF from increased delivery of chloride to distal tubule with diuret...

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RE: hypercalcemia and hypophophatemia 1 day ago

A parathyroid adenoma with hypercalcemia, hypophosphatemia but suppressed pth from hypercalcemia? You really want to “have your cake and eat it too...

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RE: hypercalcemia and hypophophatemia 1 day ago

See Bhadada SK, et al. Clinical Endocrinology 2008.  You hypothesis of intact PTH suppression by hypercalcemia  in a patient with a parathyroid  ad...

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RE: hypercalcemia and hypophophatemia 1 day ago

Sorry, pth rose to 260 when measured with low calcium. And probably still being suppressed to some extent if 1,25 is real and by hypophosphatemia. ...

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RE: hypercalcemia and hypophophatemia 1 day ago

I propose pth was high causing hypercalcemia but momentarily dropped when ca reached 15 plus  and in the face of high 1.25. Of course this assumes ...

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RE: hypercalcemia and hypophophatemia 2 days ago

If the 1,25 Dihydroxy  Vitamin D level is real, is this not incompatible with a FGF23 mediated  Disease  process.  Please explain. suprressed PTH a...

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RE: hypercalcemia and hypophophatemia 2 days ago

I agree with most of the comments and concerned this may be FGF23 induced, the urine phosphate is clearly abnormal in the face of hypophosphatemia....

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RE: MAP or BP goals for renal perfusion 2 days ago

Yes, Dr. Mellas. This is what I see every day, this is a very common situation and by no means the exception, but only if you choose to see it that...

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RE: Atheroembolic Plaque? 2 days ago

Very interesting case. Was the patient started on anticoagulants in the peri-operative periods? (minority of CCE is associated with initiation of a...

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RE: eGFR 2 days ago

The MDRD GFR and the eGFR were designed to determine the GFRs of groups not individual patients. It is wrong to tell a patient  your GFR is 23 or w...

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RE: Unusual membranous nephropathy case 2 days ago

Thank you! I could not find anything in literature but thank you for Dr Friedman for sharing article. ------------------------------ Dana Rizk MD U...

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RE: Unusual membranous nephropathy case 2 days ago

Thank you for sharing your thoughts Dr Glasscock. We do not have IgG subtype done. She did not receive any treatment for her PAP other than lavages...

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RE: Unusual membranous nephropathy case 2 days ago

Thank you! Super helpful. Very little in the literature. ------------------------------ Dana Rizk MD University of Alabama at Birmingham Birmingham...

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RE: hypercalcemia and hypophophatemia 2 days ago

Primary hyperparathyroidism with initial level severely depressed by extreme hypercalcemia and possibly elevated 1,25 although unclear etiology of ...

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RE: hypercalcemia and hypophophatemia 2 days ago

Dear Dr. Safdar,  24 hr urine calcium was 68mg.  This 24 hr urine was done when the serum calcium was down to 6.5mg/dl already. Could this have bee...

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RE: MAP or BP goals for renal perfusion 2 days ago

Good point. Clinically though, I see diuretics improving renal function when MAP is adequate and when the patient has congestion.  The creatinine g...

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RE: Atheroembolic Plaque? 2 days ago

will keep my fingers crossed. Hopefully he is all recovered. ------------------------------ Naveen Trehan MD Arkansas Renal Group Hot Springs AR (3...

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RE: hypercalcemia and hypophophatemia 2 days ago

Another point you mentioned 24 hour urine phosphorus was low but in the presence of hypophosphatemia it was high any phosphorus more than 100 mg in...

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RE: hypercalcemia and hypophophatemia 2 days ago

Was there a 24 hour urine calcium Did I miss it should repeat 125 vitamin D because I have seen it many times it comes back high when you repeat it...

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RE: MAP or BP goals for renal perfusion 2 days ago

@Steven Coca . "- in humans, no evidence for downward slope on Starling Curve -" Deja vu my residency 1983! The only reason I have kept an open ...

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RE: hypercalcemia and hypophophatemia 2 days ago

If po4 with wasting continues the money is there. Either FGF 23 or Pth-rp. The later woukd explain the initial hyper Ca. --------------------------...

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RE: MAP or BP goals for renal perfusion 2 days ago

For the sake of a chuckle: Dr Melllas's case reminds me of one I saw many years ago when isolated ultrafiltration was (briefly) a fad. A cardiologi...

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RE: hypercalcemia and hypophophatemia 2 days ago

Thanks for the comment Dr Soleimani. i thought about the effect of the bisphosphonate but was hung up on the initial low phos. He denied taking tum...

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RE: MAP or BP goals for renal perfusion 2 days ago

To Dr Wahba's point, I am presently seeing such a patient with COPD, cor pulmonale who was admitted with AKI, anuria SBP 90-100 mm Hg on diltiazem ...

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RE: hypercalcemia and hypophophatemia 2 days ago

yes pth was drawn at admission --------------------------------- Tom Yang MD, FASN Visalia CA ---------------------------------

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