RE: Central diabetes insipidus with a nephrogenic component? 1 hour ago

The only clear " evidence" supporting a central DI is the MRI finding (a decline in the "bright spot" in the posterior pituitary ), but according t...

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RE: AAV 1 hour ago

See the Gulati et al protocol (Kidney Int, 2021 ) provided by Dr. Rodby provided, I think that PLEX is optional, but that is only a personal opinio...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 hours ago

Thank you Dr. Rubin for sharing this! Hussain Abde Ali Karimi Clinical Assistant Professor of Medicine Renal Electrolyte | Department of Medici...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 hours ago

I have learned lots of more information about DNAJB9 and fibrillary GN by streaming a GlomCon lecture on the subject (link enclosed) given by Dr. M...

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RE: Global glomerulosclerosis vs. FSGS 3 hours ago

Some additional information on these 2 cases: Neither patient is an agricultural worker or from the Balkan area. Case #1 (SCr 3.5 mg/dL; normal UP...

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RE: AAV 3 hours ago

Would cyclophosphamide 750 mg iv and rituximab 1g on d1 and same on d14 be a sensible regime( + iv/oral steroids ) +/-avacopan If using iv rituxi...

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Nephrology Certification Exam 3 hours ago

Hello everyone, What is the most effecient method to prepare for the nephrology certification exam? I appreciate your advice. Thanks.

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RE: Low value care in nephrology 4 hours ago

I would hope we are not doing low value care on a "regular basis ." who determines “value?” The person doing the work or the person asking for...

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RE: Central diabetes insipidus with a nephrogenic component? 5 hours ago

"The Fenske study suggests that hypertonic saline can help differentiate between polydipsia and central DI better than water deprivation alone when...

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RE: Central diabetes insipidus with a nephrogenic component? 12 hours ago

Urine osmolarity below 100, is quite unusual for NDI and is more compatible with CDI. Persistent polyuria and submaximal urine osmolarity on desmop...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

The Fenske study suggests that hypertonic saline can help differentiate between polydipsia and central DI better than water deprivation alone when ...

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Low value care in nephrology 1 day ago

I am working on a talk about low value care in nephrology; that is, things we do as routine in nephrology that have no proven value or that have be...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

I would consider allowing his usual salt and protein intake to get insight into what has been going on at home The important thing now is to hold...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

READY. I'M GOING TO BE ADMITTED TO TAKE THE WATER DEPRIVATION TEST AND REDO THE 24-HOUR COLLECTION. THIS WAY I CAN ALSO LIMIT SODIUM AND PROTEIN IN...

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RE: AAV 1 day ago

I don't disagree with the "full court press" as suggested by Dr. Rodby, but we need to recognize that PLEX is associated with an increased risk of ...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

Boy!!! This case had been very instructive for me. Read the post carefully. Be suspicious when data don't fit. Starting all over as suggested by Dr...

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RE: Clot/ Debris In Right Jugular Vein 1 day ago

Although it could be a clot , it is difficult to tell based on this image alone. A clip would be helpful. The possibility is that the near-field ga...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

ALL WERE COLLECTED FROM 24H URINE ------------------------------ Thaisa Valverde MD, MSc ARACAJU 557999911168 ------------------------------

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RE: AAV 1 day ago

Thank you ------------------------------ Toni Sabbouh MD, FASN Philadelphia PA (703) 717-1666 ------------------------------

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RE: AAV 1 day ago

Did he have sinus issues for long time before his presentation? ------------------------------ Ashraf El-Meanawy , MD, MS, PHD, FASN Professor of...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

I assume all urine tests were done on spot urine samples and preferably to de done on 24 hour urine sample to have accurate assessment of osmolar l...

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RE: AAV 1 day ago

I would use the attached (retrospective uncontrolled) regimen with rituximab and oral CYC. I have no problem with the plex, even if unproven, see a...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

Agree 100% with @Sheldon Hirsch. These cases get murky and you have to start from scratch Off DDAVP for a day at least a day overnight wate...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

IMO, a lot of the data presented here seems hard to interpret and/or inaccurate--for example, you can not have a sOsm of 247 with a Na of 144 as re...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

Of course Dr. Mellas is correct . The serum Sodium and Posm are incompatible with each other. I chose the Posm, but thus was likely a biased choice...

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RE: AAV 1 day ago

Thanks for your replies ------------------------------ Toni Sabbouh MD, FASN Philadelphia PA (703) 717-1666 ------------------------------

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

"The first examination of the patient without using the ddavp was urine osmolarity of 58 (urine volume of 19.6 liters), sodium 144, calcium 10.5, a...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

The initial low Uism is compatible with both CDI or polydipsia . The initial low Posm is not compatible with CDI snd strongly suggests polydipsia ....

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RE: AAV 1 day ago

The comparative efficacy and safety of CYC vs RTX regimens were not tested in the landmark RAVE trial which excluded patients with this level of Sc...

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RE: AAV 1 day ago

RTX is the preferred agent in ant-PR3 AAV. Perhaps a combination of RTX and low dose, short term (8 weeks) of oral CYC might be useful. ---------...

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RE: AAV 1 day ago

Only 1 dose of Ritux. No DAH, no Anti GBM. Yes bx pauci immune gn. Wouldn't cytoxan be a preferred agent with this degree of AKI? (I am also aware ...

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RE: AAV 1 day ago

How many doses of RTX did he receive?. . I would probably restart RTX and add Avacopan with rapid steroid taper after finishing the IVMP Pukses. No...

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AAV 1 day ago

A previously healthy 50 yo patient, presented end of December w AKI, creatinine 1.7 w GN features. Found to AAV c-ANCA + and elevated PR3 titers. W...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

Certainly Sodium restriction along with preventing polydipsia (a very difficult task. I am much less sure about the need for Amiloride and/or thiaz...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

In this case, would the treatment be amiloride hydrochlorothiazide and sodium and water restriction? ------------------------------ Thaisa Valver...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 1 day ago

This thread still has some LIFE to it! thank you for ongoing discussion and input. Patient was not on any VEGF inhibitor therapy. He did receive RI...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

According to published studies MRI imaging of the Pituitary (T1 imaging) is neither sensitive or specific for Central DI . I would disregard the MR...

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RE: Case For Thought 1 day ago

Thanks really helpful --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

A 'false positive " test, I presume. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------...

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RE: Low Potassium 1 day ago

Thanks so much Just to clarify last part 40/14 ( 40 mmol in 1 litre added to 14 litres ) total volume =15 litres Assuming concentration = amou...

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RE: Case For Thought 1 day ago

The lower age limit for live kidney donor is age 18 years. There is no upper age limit, so long as the donor is healthy and willing to donate free ...

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RE: Central diabetes insipidus with a nephrogenic component? 1 day ago

In this case, how can we explain the finding on MRI? ------------------------------ Thaisa Valverde MD, MSc ARACAJU 557999911168 ----------------...

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RE: Correcting bicarb or PH? 2 days ago

Can't agree anymore. Even without stroke, giving bicarb or bicitra to patient with respiratory alkalosis has detrimental effects and it is the PH, ...

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RE: Case For Thought 2 days ago

Thanks so much Any cut off age in young donors and age cut off in USA for older donors assuming normal kf , blah Urine sediment and relatively Goo...

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RE: Correcting bicarb or PH? 2 days ago

With normal kidney function the response to central nervous system driven hyperventilation is urinary excretion of HCO3. In ESRD this renal compens...

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RE: Central diabetes insipidus with a nephrogenic component? 2 days ago

The initial findings in this case are quite incompatible with a diagnosis of central DI but are compatible with a combined excessive water and solu...

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Correcting bicarb or PH? 2 days ago

I saw this 72-year-old female patient with ESRD on dialysis , respiratory failure post tracheostomy on mechanical ventilation developed acute ische...

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RE: Case For Thought 2 days ago

I fully agree with Dr. Venkat - donor selection is all about the balance of benefits and harms- to both the donor and the recipient. The Dr. Giving...

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RE: Case For Thought 2 days ago

A 60 year old live donor is fine, so long as the birth weight of the donor was not below 2.5 Kg. ------------------------------ Richard Glassock ...

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RE: (another) Refractory Minimal Change Disease (Dialysis dependent and I promised patient I would submit) 2 days ago

Todays Rush University Kidney Biopsy Conference described a case of MCD who developed dialysis dependent AKI superimposed on a severe steroid-resis...

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