RE: Unexplained Renal Failure or Not 20 minutes ago

not an issue DR. GLASSOCK you are amazing -thanks for all you and Dr. Rodby do by creating this forum !!! ------------------------------ [Mark] [...

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RE: Unexplained Renal Failure or Not 27 minutes ago

We agree 100%. Sorry I missed your point in a prior post. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Scho...

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RE: Unexplained Renal Failure or Not 33 minutes ago

"He does not have CKD- as he does not meet any of the criteria used for making this "diagnosis". -almost exactly what I said Number 5 above. Dr. ...

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RE: Unexplained Renal Failure or Not 3 hours ago

He does not have CKD- as he does not meet any of the criteria used for making this "diagnosis". ------------------------------ Richard Glassock M...

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RE: Unexplained Renal Failure or Not 3 hours ago

In the general population the eGFR Cystatin C is no more accurate the eGFR creatinine in estimating the level of measured GFR. The combination of t...

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RE: Unexplained Renal Failure or Not 4 hours ago

I think one major issue is exercising at 50 degree C. You don't need a muscle disorder to produce AKI at that level. It may be better for him to ex...

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RE: Unexplained Renal Failure or Not 5 hours ago

I dont think he has chronic kidney disease. His cystatin C is normal with normal eGFR of 125 ml/min. Despite the fact that he is on ARBs with diure...

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RE: Unexplained Renal Failure or Not 6 hours ago

Or do genetic screening for the mutant PYGM allele. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of ...

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RE: Unexplained Renal Failure or Not 6 hours ago

You might want to consider a muscle biopsy for glycogen deposits (McArdle disease) in light of exercise induced rhabdomyolysis. -----------------...

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RE: Unexplained Renal Failure or Not 8 hours ago

I agree with Dr Rodby on all four points. I suspect--based on Cystatin C vs Cr-based eGFR discrepancy--that his musculature is more than "average b...

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RE: Unexplained Renal Failure or Not 9 hours ago

1) i suspect he does not have ckd 2) i would not do a renal biopsy 3) i would work him up for metabolic muscle disease such as McArdles, and si...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 13 hours ago

Thank you for your reply. I think its only chronic kidney disease with no active disease warranting risking the patient with immunosuppression. J...

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RE: Unexplained Renal Failure or Not 15 hours ago

He has a high risk metabolic profile with high BMI, high uric acid , Impaired glucose tolerance , high lipids .. seen and started on oral orforglip...

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RE: Unexplained Renal Failure or Not 16 hours ago

I'm interested to know about his other metabolic risk factors, such as his BMI, waist circumference, lipid profile, triglyceride levels, HbA1c, and...

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RE: Unexplained Renal Failure or Not 1 day ago

Would not label as CKD as criteria is not made post discharge ARB can elevate serum creatinine and lower eGFRcr but not eGFRcys more importan...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Hi, Dr. Jebur, thanks for the discussion. Below are the answers for your questions: The patient is 1.829m tall. In 11/20217, renal US showed:...

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RE: Unexplained Renal Failure or Not 1 day ago

I have scheduled him for a measured GFR estimation. 24 hour urine collection has not been requested and not done as yet . Peak creatinine during ...

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RE: Unexplained Renal Failure or Not 1 day ago

What is the 24 hour creatinine excretion compared to estimates based on Age, sex, weight, height?. Ethnicity. I would do a measured GFR. I have lil...

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RE: Unexplained Renal Failure or Not 1 day ago

Peak SCr levels during 2 episodes of rhabdomyolysis? May consider an accurate 24hr urine collection for measured creatinine clearance or radioisoto...

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RE: salt losing nephropathy 1 day ago

In a steady state with euvolemia and negligible insensible losses of Na and H2O; 2000 ml .45% NS = 154 meq Na in, 1000 ml H2O in, 154 meq Na out, 1...

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RE: salt losing nephropathy 1 day ago

In a situation of euvolemia and a steady state with negligible insensible losses of Na and H20. 2000 ml .45% NS = 154 meq Na in, 1000 ml free wat...

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RE: salt losing nephropathy 1 day ago

@John Mellas i didn't understand point number 2. Is it possible you could elaborate with some numbers ...thank you ------------------------------...

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RE: salt losing nephropathy 1 day ago

2 points; 1 If the kidney function is improving a salt wasting state is not likely and reflects infused and retained solute. 2 The urine Na exc...

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Unexplained Renal Failure or Not 1 day ago

This is a case of a 42 year old male , who is the legal counsel of our hospital. He comes from London , but is of mixed Afro Caribean origin from...

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RE: Denovo Idiopathic MPGN of Renal Allograft 1 day ago

Dr. Sarwat- thanks for posting the native and allograft biopsy reports. As I was concerned given using Tac monotherapy alone- particularly in a pat...

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RE: salt losing nephropathy 1 day ago

Your patient is experiencing polyuria from an osmotic diuresis (NaCl induced). I suspect that thus is more related to the infusion therapy than to ...

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RE: salt losing nephropathy 1 day ago

In a normal subject infusion of 0.45% Saline would be expected to induced a water diuresis (suppress ADH) so urine sodium concentration would decli...

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RE: salt losing nephropathy 1 day ago

The specimen is not native renal urine; it has transited an intestinal reservoir,, which actively reabsorbs and secretes electrolytes and water. Bo...

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RE: salt losing nephropathy 1 day ago

In steady state, urinary sodium reflects intake. Normal saline has double sodium content and urinary sodium expected to be higher ---------------...

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RE: salt losing nephropathy 1 day ago

Out of curiosity , a question for anyone What would you expect urine Na to show if u infuse a patient 0.45% Nacl vs 0.9% Nacl. Will it be around ...

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RE: salt losing nephropathy 1 day ago

He was resuscitated with NS initially then shifted to RL --------------------------------- Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ----...

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RE: salt losing nephropathy 1 day ago

(He is anuric for few hours) , can we consider him truley anuric? Did you repeat renal US and the hydro resolved. What is the type of fluids an...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

I wondered, he is minimally proteinuric , which apparently denotes lack of active disease in the presence of advanced renal failure!!, what s the r...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 1 day ago

Whats kidney size by US study? Girst biopsy was on 2017. I feel repeat kidney biopsy is imperative for further planning of the management. If, IFTA...

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RE: salt losing nephropathy 2 days ago

Sorry, misread the Urine k of 7 mmol/l as serum K ... Apologies --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional He...

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RE: salt losing nephropathy 2 days ago

Thank you for your replys. The patient is hypokalemic and hypernatremic with diuresis and natriuresia. His creatinine amounts to 3.2 mg/dl and ure...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

Patient initially Received LKDT from her sister that lasted 2 years but failed due to CNI toxicity . she is now s/p DDKT since 2016 , Creat continu...

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RE: Denovo Idiopathic MPGN of Renal Allograft 2 days ago

2004 Native Biopsy The tissue examined at the ultrastructural level includes one (1) glomerulus. The capillaries appear largely obsolescent, wit...

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RE: salt losing nephropathy 2 days ago

Looks like post obstructive diuresis . How high was the urea or BUN levels . Any clue why despite the diuresis the K is high??? Is it due to obst...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

thanks. Will talk to pathologist. Jingjing ------------------------------ JingJing Zhang MD, PhD [Associate professor of Medicine] Sidney Kimme...

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RE: salt losing nephropathy 2 days ago

Most likely postobstructive diuresis , urine studies c/w osmolar diuresis . Slowly reduce fluid replacement and correct hypernatremia with hypotoni...

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salt losing nephropathy 2 days ago

45 year old patient with a history of total cystectomy due to ca. bladder with creation of surgical pouch as an artificial kidney from bowel loop, ...

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RE: GLP -1 RA question 2 days ago

I agree- the problem is not the GLP1RA per se but the rapidity of HBA1c fall that us the hazard for worsening pre-existing Diabetic Retinopathy. ...

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RE: GLP -1 RA question 2 days ago

"can we start GLP1-RA in view of treated diabetic retinopathy? Yes what if diabetic retinopathy was not yet treated would colleagues start GLP-1 ...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

I have encountered quite a few cases of "C3G" diagnosed by very good renal pathologists that turned out to be PGNMID with masked monoclonal deposit...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Hi, Dr. El-Meanawy, thanks for another thought. The previous pathologist retired, I will discuss with current pathologist to see if he can hel...

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RE: GLP -1 RA question 2 days ago

8-9 % ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transplant Medical...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Thank you so much for sharing the experience. I feel more confident now about using these agents if needed. best, jingjing ----------------...

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RE: GLP -1 RA question 2 days ago

The risk of worsening retinopathy is not related to GLP-1 -, It's the rapidity of the correction of the hemoglobin A1c which is usually temporary ....

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RE: GLP -1 RA question 2 days ago

Hb1ac 80-90 --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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