RE: membranous nephropathy 34 minutes ago

biopsy: 10 glomeruli- 3 are sclerotic mild mesangial expansion, and 2 glomeruli with hypercellularity diffuse thickened capillary membranes, spike ...

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RE: membranous nephropathy 53 minutes ago

According to your description,  the patient likely has immunologically inactive Primary MN with chronic (irreversible) injury to the Glomerular cap...

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RE: Drug-Induced TMA 2 hours ago

Intracapillary thrombosis is the essential finding of  a TMA.  While TTP  has platelet aggregation as an initial injury, by the time the kidney is ...

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RE: Resistant HTN 4 hours ago

Increase torsemide.  Might be able to remove the extra volume w diuretics rather than HD, and 20mg torsemide is a fairly low dose for someone with ...

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membranous nephropathy 5 hours ago

Hi,  I tried to search previous threads on membranous so I am not asking something redundant and if it was already posted, can someone send me link...

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RE: hyponatremia 6 hours ago

so athena labs does not test for this particular gene  and came back neg for diabetes inspidus but genetic counselor said we have have a control to...

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RE: hyponatremia 7 hours ago

Sorry for the delayed response . However , lets try to analyze this scenario The normal response to Hyponatremia would be a suppression of ADH and ...

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RE: Why do we check serum Na but not serum Osm when we worry about OSMOTIC demyelination syndrome in hypoNa cases? 8 hours ago

Your scenarios are correct. Rapid increase in PNa with dialysis risks pontine dehydration and osmotic demylination, but if at the same time you hav...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 8 hours ago

In the end you have difficult HTN in a young (20s) person with an extraordinaryly high fenin level and low also level, the later possibly bc of med...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 8 hours ago

Thank you Dr. Glassock for clarification. Found more recent studies which showed similar Aldo and Renin levels in normal vs OSA patients. Sorry to ...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 9 hours ago

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 9 hours ago

In this study, and others, Plasma Renin levels were not increased in Obstructive Sleep Apnea. --------------------------------- Richard Glassock M...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 9 hours ago

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RE: Why do we check serum Na but not serum Osm when we worry about OSMOTIC demyelination syndrome in hypoNa cases? 9 hours ago

I would like to further complicate this topic, by presenting a few scenarios ( BUN  120= Urea 60 mmol/l) We know that it is tonicity (effective osm...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 9 hours ago

I don’t think that Obstructive sleep apnea causes increased plasma renin levels. Can you cite a reference for your suggestion. -------------------...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 10 hours ago

Could this patient have another cause for secondary renin elevation like untreated sleep apnea syndrome ? Have you tried Spironolactone to treat hi...

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RE: Why do we check serum Na but not serum Osm when we worry about OSMOTIC demyelination syndrome in hypoNa cases? 13 hours ago

Your case is analogous to dialyzing a Uremic patent with severe hyponatremia . There are 2 process' going on at the same time  1. Rapid correction...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 19 hours ago

Amazing that I just saw a 78 y/o gentleman referred to me for secondary hypertension w/u. DRA is 1746 pg/ml and Aldosterone of 9.8.  he was on En...

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RE: Resistant HTN 20 hours ago

This is the problem with adding new cases to an old thread. --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush Uni...

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RE: Resistant HTN 21 hours ago

Patient has never been on minoxidil  Medications prior to hospitalization- clonidine 300 mcg three times daily,  torsemide 20 mg twice daily,  hyd...

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RE: Resistant HTN 22 hours ago

On minoxidil- the pericardial effusion is very likely due to this agent. I would try to stop it, if possible. --------------------------------- Ri...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 22 hours ago

I see a lot of refeeding hypophosphatemia too, and these patient do not have to be that malnourished before they are fed.  probably not relevant h...

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RE: Dialysis for High Uric Acid?? 22 hours ago

Since urine output was ~ 3.0 L/day and SCr had already plateaued before rasburicase, wonder if this (very expensive) drug could have been avoided. ...

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RE: Dialysis for High Uric Acid?? 22 hours ago

$50,000 to treat a lab test. Something is wrong here. --------------------------------- Richard Glassock MD, FASN Emeritus Professor David Geffe...

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RE: FSGS/Obesity 22 hours ago

With this much Hypoalbuminemia and FPE I would treat like Primary FSGS. Probably with a CNI alone, no steroids. Interesting idea from Dr. Rodby abo...

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RE: Dialysis for High Uric Acid?? 22 hours ago

I still doubt the AKI was acute uric acid nephropathy but reflected Aki and catabolic state. cell breakdown from rhabdo,  and as pt was non-oliguri...

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RE: FSGS/Obesity 22 hours ago

Since tip-variant FSGS May be more steroid-sensitive than other FSGS variants and may in fact mimic MCD (this patient has ~ 90% podocyte effacement...

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RE: FSGS/Obesity 22 hours ago

Obesity related GN is not typically that nephrotic (low Albumin) and should not have that much FR effacement, so this looks like primary FSGS. You...

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RE: FSGS/Obesity 23 hours ago

Thanks Dr.Glassock, Serum Albumin was 25, total Serum cholesterol was 8.5 ------------------------------ Ali Habeeb, MD --------------------------...

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RE: FSGS/Obesity 1 day ago

We really need to know the serum albumin level.  The  biopsy certainly suggests a Primary form of FSGS.  If so, then  CNI might be best for initial...

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RE: Resistant HTN 1 day ago

Thank you for your comments @Ashraf El-Meanawy  @Satish Balan  Urine sediment was not suggestive of ATN.  Although Lipiduria was  noticed ( Maltes...

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FSGS/Obesity 1 day ago

47 years old woman, obese with BMI 46, Obstructive sleep apnea, but no diabetic.  Presented with nephrotic syndrome, proteinuria around 6-7g/day a...

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RE: Resistant HTN 1 day ago

This is AKI on CKD with HTN.  To sort things out, need to know if urine showing active sediments, ATN casts or blood which could be related to HTN....

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RE: Resistant HTN 1 day ago

Clearly this seems to be a volume dependent hypertension. I would vote for dialysis and ultrafiltration as the best way of getting his blood pressu...

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RE: Dialysis for High Uric Acid?? 1 day ago

Before rasburicase was introduced, allopurinol and dialysis were the mainstay of management of hyperuricemia in situations like leukaemia and its t...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 1 day ago

Tahnk you all for your interesting imputs! What I didn't mention in my previous post is that the hypophosphatemia was sustained for 5 days. When i...

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RE: Resistant HTN 1 day ago

Continuing this resistant HTN discussion further:  70 year old gentleman with PMH significant for OSA (on CPAP),  progressive CKD 3b , diastolic h...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 1 day ago

Thanks all.  I appreciate the insights.  I will update with more info for those interested after we figure out how to proceed. -------------------...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 1 day ago

I would repeat levels off the ACE-I and chlorthalidone. Values seem quite peculiar. ------------------------------ John Mellas MD Nephrology and H...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 1 day ago

Looks like poor po intake postop while receiving Ca, and active Vit D.  I would stop the medications and replace Pi as needed.  Maybe a nice st...

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RE: Dialysis for High Uric Acid?? 1 day ago

Here is a quick update. I will try to summarize/answer most of the questions in one post. No uric acid crystals in urine (UA). No uric acid/Cr do...

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RE: Resistant HTN 1 day ago

@Dr. Bakris.....so am i right in understanding. that in the cases you do use clonidine , you prefer to use it once a day ( preferably nocturnally)....

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RE: Atypical HUS and kidney transplant 1 day ago

The HUS in this condition is related to the presence of the antibody and clinical remission is seen if antibody levels are suppressed. Thus transpl...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 1 day ago

" Actually the literature suggest a 25- 50 fold increase in Plasma renin levels after Angiotensin II blockade" This is 173 fold. I might just repea...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 1 day ago

"P in urine is undetectable." Clearly I did not read the case very well. And of course tdn this is not an IV iron FGF23 issue. Respiratory alkal...

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RE: Resistant HTN 1 day ago

Impossible combination!  Assuming that his heart rate is controlled, When his EF is low and BP is so high, his PVR must be high which is not bein...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 1 day ago

Good point Dr. Friedman.. I suppose that we don’t know her respiratory acid-base status when the severe hypo-Phosphatemia was observed, but absence...

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RE: Hypophosphatemia, Hypercalemia and low PTH in Dialysis Patient after bone fracture and iron infusion 1 day ago

Can this acute, this severe & postop hypoP be from anything other than internal redistribution? Was she hyperventilating postop or infused dextrose...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 1 day ago

That renin level is astronomically high. Is is possible to repeat these on RAS blockade. If yes, might be good to document renin/aldo off this (if ...

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RE: Markedly elevated direct renin concentration in a patient with early onset hypertension 1 day ago

Actually the literature suggest a 25- 50 fold increase in Plasma renin levels after Angiotensin II blockade. So the values o served may simply be a...

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