RE: Acute proliferative GN with C3-dominant deposits 1 hour ago

Hyperphosphatemia, dry eyes, fatigue, diarrhea, retinal detachment , but not TMA or GN, are recognized side effects of the FGF receptor inhibitors....

View Discussion

RE: Lupus nephritis 2 hours ago

Dr. Rodby-  thanks for posting the reference.  As noted by the Authors , thus is an exploratory  post-Hoc analysis of a very short FU (only 6 month...

View Discussion

RE: Lupus nephritis 5 hours ago

Multitargeted therapy may have helped but I doubt that would be a difference maker @Richard Glassock regarding your mention of MMF resistance in ...

View Discussion

RE: Acute proliferative GN with C3-dominant deposits 5 hours ago

I believe vegf inhibition is one of the mechanisms of TKI which is typically htn and proteinuria and a TMA but there may be more, see table 3 http...

View Discussion

RE: Lupus nephritis 5 hours ago

Interesting case discussion and thank you. I believe combination lesions ( 3 or 4 and 5 ) do not do well to steroid MMF or to cyclophosphamide. Wou...

View Discussion

RE: Lupus nephritis 5 hours ago

Puzzled by normalization of complement and decreased anti-DS-DNA antibody titer. Makes me wonder if there is some other cause for recent deteriorat...

View Discussion

RE: Acute proliferative GN with C3-dominant deposits 6 hours ago

I looked up pemigatinib. Its mechanism of action is said to be tyrosine kinase (TK)-inhibition, specifically inhibition of TK activation via the FG...

View Discussion

RE: Acute proliferative GN with C3-dominant deposits 6 hours ago

Different types of glomerular lesions have been described in association with anti-angiogenesis drugs (such as VEGF and TKI inhibitors), not just T...

View Discussion

RE: Acute proliferative GN with C3-dominant deposits 10 hours ago

Can you tell us a bit more about the patients country of origin. In SE Asia, Cholangiocarcinoma is often related to chronic infection with liver fl...

View Discussion

Acute proliferative GN with C3-dominant deposits 10 hours ago

79 y/o man with metastatic cholangiocarcinoma presented with AKI (BUN 63, creat 3.3 - labs 4 weeks prior showed BUN 22 and creat 1.0) on routine f/...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 11 hours ago

thanks for this, few things are more complicated to sort out when you not only count on absolute levels but ratios ------------------------------...

View Discussion

RE: Lupus nephritis 11 hours ago

if you are opting not to accelerate therapy, then I would leave the MMF alone for now. If you put her on dialysis I would taper it off over 6 month...

View Discussion

RE: Lupus nephritis 12 hours ago

Thank you for the reply To clarify- she always had positive anti ds dna(initially at >100 IU/ml and now in 21 range High anti smith antibodies(repo...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 17 hours ago

I was taught, in the 1980's, and continue to believe that the Cl is a passive ion, either associated with a cation or replacing an anion. I have ne...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 18 hours ago

Agree, the hardest thing to change is an algorithm.  It is an impediment to independent thinking as new data come out. Its virtue is that it saves ...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 18 hours ago

No doubts here, but these things take on a life of their own, and especially with surgeons , critical care docs, ER docs, and once they seem to thi...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 19 hours ago

you have doubts? ------------------------------ Anatole Besarab MD ABesarab Consulting Bend OR (734) 417-4793 ------------------------------

View Discussion

RE: Lupus nephritis 19 hours ago

According to the ALMS trial about 30-40% of A-A subjects with Class III/IV +V LN are resistant to MMF therapy at 6-12 months. Compliance may also b...

View Discussion

RE: Hyperkalemia 21 hours ago

i agree to the point of stopping b blockers and wait and watch the response. no other action required. Hba1c - 6.2 with normal renal functions is n...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 23 hours ago

The ARR with different lab unit is shown in rugs figure  ------------------------------ Hayder Aledan MD, FASN Assistant Professor Basra Nephrol...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

Interestingly, the ARR is increased with oral contraceptives only when  PRC, and not PRA, is used to calculate the ratio. (See Ahmed AH, et al J Cl...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

Does the patient take contraceptives for her menstruation? Because these( esp Estrogen containing)  could rise Aldo and the ARR leading to false po...

View Discussion

RE: Lupus nephritis 1 day ago

As pointed out unlikely that Class 3 is resistant to Cellcept. My first approach would be to look at both biopsies myself. Class 3 can sometimes be...

View Discussion

RE: Lupus nephritis 1 day ago

I assume that her proteinuria has been > 2gm/d throughout her illness. Belimumab has no good record efficacy in such patients. With a SCr of 8mg/dL...

View Discussion

RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 1 day ago

My top 5 are Hypertriglyceridemia Hypertriglyceridemia Hypertriglyceridemia Hypertriglyceridemia Paraproteinemia See attached (shamelessly qu...

View Discussion

RE: Lupus nephritis 1 day ago

What were her serologic and urine data initially and now? c3C4 dS dna, urine sediment. And I would have to see the biopsy myself but the creatin...

View Discussion

Lupus nephritis 1 day ago

Greetings. I have a 31  yr old African American female with proteinuria and hematuria. Had hx of discoid lupus. Biopsied her and found her to have ...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 1 day ago

What bothered me most about this pseudo condition was the term hyperchloremia, which is not a thing. When the Cl is high it is high bc the Na is hi...

View Discussion

RE: Hyperkalemia 1 day ago

He has been losing weight however says somewhat intentionally. CT pending. BS 102  122  146  140  138 K    5.6   4.8   5.6   5.1   5.7 --------...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 1 day ago

The unsubstantiated Cl nephrotic theory spread like wildfire mainly among our surgical colleagues. However, only time will tell if evidence-based m...

View Discussion

RE: Finally, the question has been answered!!! Follow the link 1 day ago

Amen to that!! At least it tells us that the Chloride ion is non-toxic, if anyone really beloved that hypothesis. --------------------------------...

View Discussion

RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 1 day ago

Thank you Dr. Glassock. We will have her do home urine dip sticks weekly to monitor for microhematuria. ------------------------------ Balaji Srin...

View Discussion

RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 1 day ago

Are you going to send her a package of urinary dipsticks to check her urine 2+ or more hematuria at home once a week.  If hematuria develops,  I wo...

View Discussion

RE: Management of a patient with history of pANCA positive vasculitis in clinical remission, with increasing Myeloperoxidase Ab titers 1 day ago

Thank you all for your input. This patient is very reliable. She is not on any medications which will cause a positive MPO Ab. I will see her in cl...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

What is the normal range for ARR when the units for both PAC and direct PRC are given in pg/ml.? ------------------------------ Richard Glassock M...

View Discussion

RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 1 day ago

Commonest causes  of "psuedohypobicarbonatemia " are hypertriglyceridemia and  monoclonal gammopathy -  see earlier threads on this site. --------...

View Discussion

Finally, the question has been answered!!! Follow the link 1 day ago

http://t.n.nejm.org/r/?id=h2eea8cd0,5d4eb64,3300751&cid=NEJM%20Recently%20Published,%20January%2018,%202022%20DM637791_NEJM_Subscriber&bid=78712340...

View Discussion

Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 1 day ago

Hello everyone. I have a patient with persistent AGMA - AG 30-35 range ; Bicarb levels 5-7 range persistently x 3 readings on 3 different days  Che...

View Discussion

RE: How to dose paxlovid in dialysis patients 1 day ago

But is Molnupavir "effective " in reducing  the severity of COVID  in dialysis patients ?  Any RCT in this  population of patients? --------------...

View Discussion

RE: Tablo/Outset dialysate flow rates of 300 1 day ago

Yes, thank you for the information. Tablo did provide us with your poster information, but I prefer and appreciate hearing from the source. How has...

View Discussion

RE: Tablo/Outset dialysate flow rates of 300 1 day ago

Dr. Pohlman, As we were looking at adopting Tablo for use in a transitional care dialysis unit - we had the same concern/question as you relating ...

View Discussion

RE: How to dose paxlovid in dialysis patients 1 day ago

Paxlovid is not recommended for dialysis patients Molnupiravir is authorized for dialysis patients ------------------------------ Mitchell Kirsch ...

View Discussion

RE: AVF Pain During The Last Part Of HD session 1 day ago

Would help to have more information: 1. Was an attempt made to reposition the needle? Did that help? 2. How many kg were being removed, since that ...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

@Roger Rodby re: SGLT2i and hyperkalemia. Here's a quote from the conclusion of https://pubmed.ncbi.nlm.nih.gov/34732509/  Just happened to read th...

View Discussion

How to dose paxlovid in dialysis patients 1 day ago

Dear colleagues any recommendation? ------------------------------ Matthias Neusser MD Vaterstetten 0041442551111 ------------------------------

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

This was raised by Dr. Rodby, but how sure can we be that this is not just simply a manifestation of PCOS?. Also, spironolactone is very commonly u...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

Mohamed, Can you clarify the units. In the US, aldosterone is typically reported as ng/dL but you state pg/ml and PRA as ng/ml/hr, so aldo is per d...

View Discussion

RE: Hyperkalemia 1 day ago

Would add use of a very tight tourniquet for blood draw and long delay in measuring serum potassium after blood draw to tight fist clenching and ot...

View Discussion

RE: Raised Aldosterone with Normal Renin Levels 1 day ago

I think that sometimes the only indication of a primary aldosterone production problem is the high aldo/renin ratio (ARR). Have had a number of cas...

View Discussion

RE: Tablo/Outset dialysate flow rates of 300 1 day ago

This has been a wonderful discussion tracking the mediaeval history of dialysis to the future of extracorporeal therapy. Dr Gura's machine seems to...

View Discussion