Severe metabolic alkalosis in male with Kidney pancreas Tx 1 hour ago

​ Dear colleges I need advice regarding treatment of metabolic acidosis in I 60 years old male with T1DM and kidney, pancreas Tx for 21 years ag...

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RE: non-anion gap acidosis 2 hours ago

Thank you for all of your replys. In fact the patient is not yet on chemotherapy. Her serum Albumin is 3.7 gm/dl. I thought low urinary ammonia sec...

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RE: non-anion gap acidosis 3 hours ago

Hello Wael, UAG  Urinary (Na + K - Cl) 122+ 14 -129 = 7  Results near-zero (ie, between +20 and -20) cannot be reliably interpreted.  What is serum...

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RE: Membranous Nephropathy with Nephromegaly 3 hours ago

Follow up on the case: Ordered a PET Scan on him which is did not show any abnormal FDG uptake. Since patient had proteinuria and hypoalbuminemia f...

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RE: What might my patient be taking? 7 hours ago

If you get a chance, measure his serum IgM Level. Hyper-IgM can cause pseudohyperbicarbonatemia Sent from my iPad

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RE: What might my patient be taking? 8 hours ago

No, Dr. Rodby, I still do not understand my patient's electrolytes. Despite the fact that his dialysate bicarbonate is 26 to 28 meq/liter and he br...

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RE: Megacalycosis 10 hours ago

thanks for your responses which echo my concerns/questions I have seen the patient only once and have not had access to the films  I will endeavour...

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RE: eplerenone in CKD Stage 4 10 hours ago

Hello Dr Desai.  Thank you for the useful information  My only concern was a decline in kidney functions vs Benefits of reducing effects long term ...

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RE: eplerenone in CKD Stage 4 10 hours ago

Thank you Dr Hirsch.  A-V sampling was suggested by the endocrinologist to evaluate for adrenalectomy- if it was predominantly localized to one gla...

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RE: What might my patient be taking? 10 hours ago

@Michael Linsey , did you ever solve this mystery? ​ ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medi...

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RE: Is renal function decline inevitable with age ? 11 hours ago

See Hollenberg NK, et al Nephron. 1999; 82: 131-138. Today, would use plasma disappearance of Iohexol For a mGFR. eGFR based On serum creatinibec n...

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Is renal function decline inevitable with age ? 12 hours ago

Age related decline in GFR in the context of CKD has been a frequent topic on this forum. It has not been settled whether this decline in GFR with ...

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RE: eplerenone in CKD Stage 4 12 hours ago

Limited evidence that mineralocorticoid receptor antagonism can halt progression to ESRD in advanced CKD. Slide courtesy of Dr. Sosa Haridan from t...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 13 hours ago

​To be fair, the birefringence is not the same as the apple-green that you get in amyloid.  The congo red stain is also slightly lighter but it wou...

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RE: eplerenone in CKD Stage 4 14 hours ago

I agree with Dr. Hirsch. Eplerenone (or Spironolactone) is worth a try. Whether it will lengthen the time to RRT (or KRT inbtge new nomenclature ) ...

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RE: eplerenone in CKD Stage 4 14 hours ago

There is a huge (literally) difference in size and palatability of oral K vs 12.5 mg (or even 25 or 50 mg) of spironolactone, so I give the latter,...

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eplerenone in CKD Stage 4 15 hours ago

Dear ASN Community Members,  I have a 64-year-old male patient who presented to me when he has CKD stage 4. Past medical history of long-standing d...

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RE: A 63 male with hydronephrosis, acute abdomen, CVA and ++ pancreatic enzymes 18 hours ago

A 1:1 dilution with normal plasma and a repeat INR would help here. I presumed this is due to DIC with sepsis, but a d-dimer Assay and response to ...

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RE: A 63 male with hydronephrosis, acute abdomen, CVA and ++ pancreatic enzymes 18 hours ago

" INR result today was 3.3." As an aside, this is not an uncommon scenario when a patient with poor nutritional intake of vitamin K is treated with...

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RE: Hemodialysis Patient With COVID -19 18 hours ago

To add to Dr. Silberzweig's comments, and possibly provide Dr. Abdelbery some guidance: The recommendations from the CDC would offer one of two pat...

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RE: A 63 male with hydronephrosis, acute abdomen, CVA and ++ pancreatic enzymes 19 hours ago

DIC is an ominous development. I doubt that medical management in this case will succeed. Sent from my iPad

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RE: A 63 male with hydronephrosis, acute abdomen, CVA and ++ pancreatic enzymes 19 hours ago

I would suggest lowering his Urea with proper dialysis clearance before the procedure.  Maintained reasonable target organ perfusion with minimum N...

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RE: Vegetation on Vascath management 19 hours ago

Thanks for sharing your patient. Could you elaborate on: Liver function. Albumin. ESR, CPR and Procalcitonin. Urine analysis and spot pro...

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RE: non-anion gap acidosis 19 hours ago

A proximal RTA would result in an immediately alkaline urine with the infusion of HCO3. followed again by a low U pH.  The acidosis would also ne...

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RE: pt with eating disorder, severe electrolyte derangements 20 hours ago

The "swelling according her" is classic for this type of patient with altered perception of her body image. It is almost certainly a case of  surre...

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RE: non-anion gap acidosis 20 hours ago

Hi Wael Interesting case. The presence of normal AG metabolic acidosis with urinary PH of 5 with positive Urine AG is consistent with Proximal RTA....

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RE: non-anion gap acidosis 21 hours ago

The U pH of 5 suggests intact ability to generate an H gradient, between urine and blood, of > 100:1 in the distal nephron. A + U AG suggests defic...

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RE: Patient with IgA Nephropathy with elevated ANCA titers 21 hours ago

Here's a quick list of the meds that induce ANCA positivity:   https://t.co/Vp9eiLNnrs?amp=1 More here at the #NephTwitter Archives: (Keyword 1 = "...

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RE: Patient with IgA Nephropathy with elevated ANCA titers 21 hours ago

Thank you all for your quick response. We have not measured his renal clearance yet. Over the last month his Cr has increased from 6 to 23 mg/dL su...

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RE: Vegetation on Vascath management 21 hours ago

IF the blood cultures are consistently negative, there is no reason to suspect that this is a "vegetation" - implying infection. This should be con...

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RE: non-anion gap acidosis 21 hours ago

I don’t believe so unless it is an incomplete dRTA (pic below). Here is a nice thread on RTAs by @Arvind Conjeevaram from the 2017 ISN meeting in M...

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RE: A 63 male with hydronephrosis, acute abdomen, CVA and ++ pancreatic enzymes 21 hours ago

Thanks for your inputs. Patient Updates: urine output around 800 ml/24 hours. vitally stable with levophed 5 mics/min. Creat 5 mg/dL and Urea 200 m...

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RE: non-anion gap acidosis 22 hours ago

Thank you for your reply. But is it possible to have a urine Ph of 5 in distal RTA? --------------------------------- Wael Jebur MD, FASN drwaellat...

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RE: non-anion gap acidosis 22 hours ago

Interesting case. This is “diarrhea” in the absence of a colon, which may make a difference in the expected UAG. I cannot find any experience of UA...

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RE: non-anion gap acidosis 22 hours ago

The urinary anion gap is an indirect measure of an unmeasured cation nh4+, and when elevated typically indicates (when acidemic) lack of adequate n...

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RE: Patient with IgA Nephropathy with elevated ANCA titers 22 hours ago

False positive ANCA (P-ANCA or anti-MPO>> C-ANCA or anti-PR3) are seen in about 10% or so of patients on HD > PD, usually in low titer. I the absen...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 23 hours ago

I suspect fibrillary GN is usually Congo red negative but this disease caveat throws a wrench into the specificity of Congo red and amyloid. Fibril...

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RE: Patient with IgA Nephropathy with elevated ANCA titers 23 hours ago

Getting anca vasculitis on top of a lifelong IgAN wouldn’t be impossible since his IgAN is present for so long it almost doesn’t play into the Occa...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 23 hours ago

Oh interesting. I always thought Fibrillary was congo red negative in most cases. this AJKD paper is really interesting. Thanks for sharing this pa...

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RE: Patient with IgA Nephropathy with elevated ANCA titers 23 hours ago

How much residual kidney function does he have (clearance)? His May 2020 kidney ultrasound does not suggest advanced scarring to me though he was a...

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Patient with IgA Nephropathy with elevated ANCA titers 1 day ago

I have been following a  42-year old Caucasian male for over 6 years. He had been told when he was 14 years old that he had protein in his urine, b...

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non-anion gap acidosis 1 day ago

i would like  to share this case with you , for an opinions and thoughts. 65 year old lady who was diagnosed with ca. colon ,underwent  total colec...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

I agree with above, staining for  DNAJB9 is specific for Fibrillary GN. Congo red positivity is described in FGN, as the AJKD article describes.  h...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

Indeed, some fibrillary GNs can be congophilic (reference attached). I would suggest repeating IF on paraffin sections after protease digestion,...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

This is where I got the info from: https://twitter.com/Arunkr_Dr/status/1083986019790147584 no citation, however ------------------------------ T...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

Fibrillary to my knowledge is usually congo red negative It can however show linear staining on IF similar to anti gbm or diabetic neph sometimes ...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

Both amyloid and fibrillary GN can stain congo red positive.  Use mass spectrometry to distinguish the two apart. You could also use staining for D...

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RE: Hydralazine and ANCA vasculitis 1 day ago

Thanks for your feedback. Will post progress in couple of weeks. ------------------------------ Tahsin Masud MD Emory University Atlanta GA -------...

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RE: Distinguishing Between Renal Amyloid And Fibrillary Gn 1 day ago

Sounds like primary fibrillary GN given the specific staining. I assume mayo did mass spec and that is more sensitive than congo red. Why is your ...

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RE: maintenance therapy for C1q nephropathy 1 day ago

Since he usually remains in remission for "12 to 18 months" after each dose of rituximab, and since he was last treated in early 2020, you may want...

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