RE: is it primary hyperaldosteronism? 12 minutes ago

Is there anything harder to cleanly assuredly diagnose than PA? This thread clearly exemplifies this opinion… and now we are told that PA is not ra...

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RE: is it primary hyperaldosteronism? 48 minutes ago

Yes, these findings are highly suggestive of primary aldosteronism. The markedly suppressed plasma renin activity ( 200). Although aldosterone pr...

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RE: Fibrillary GN 1 hour ago

I agree with Dr. Friedman. Very tare and atypical case of FGN. Needs IgG subclass staining. Therapy is completely unknown due to rarity of the cond...

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RE: Fibrillary GN 1 hour ago

Seems to be rare, true monotypic DNAJB9-positive FGN; strictly speaking, need IgG subclass staining. Despite that, > 90% lack a detectable clone. D...

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Fibrillary GN 3 hours ago

A forwarded message.inputs appercepted Dear Dr Dastoor, I really appreciate your thought on this case as fibrillary GN is very rare, 37 female, ...

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RE: Use rituximab or not 17 hours ago

My primitive logic says "don't wait, carve it out." Emergent surgery needed now. ------------------------------ Sinasi Salman MD, FASN Owner Nort...

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RE: Unclear cause of kidney function reduction in a single kidney 18 hours ago

" I see this patient is on the 4 pillars of care, RAASI, SGLT2i , aldo antagonist and GLP1a. " Prof Rodby I agree with his A/P In our neck of t...

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RE: is it primary hyperaldosteronism? 20 hours ago

Despite i have no evidence but i think the supressive effect of B blockers on renin is more potent than the removal of inhibitory effect of angiote...

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RE: Unclear cause of kidney function reduction in a single kidney 22 hours ago

My AI (Claude) gives a very equivocal answer to this Question. More data is needed. Very tricky issue because of acute effects of SGLT2i on GFR and...

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RE: Unclear cause of kidney function reduction in a single kidney 23 hours ago

Good question. I really do not know. uPEP might pick up urine LC missed by UPCR . ------------------------------ Richard Glassock MD, FASN Emerit...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

With a normal UPCR, would a UPEP have the mcg-scale sensitivity needed to yield a reliable tubular pattern & the mathematical precision to separate...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Interesting and convincing argument. I wonder if a urinary electrophoresis would not give the same information concerning a light chain related tub...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Degradation in acidic urine is one of the reasons why I parenthesized β₂M. Without having to withdraw SGLT2i, I went back & forth with AI & ultim...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Since SGLT2 inhibitors tend to decrease proximal tubule reabsorption of filtered Beta 2 microglobulin, any increase is such excretion will be diffi...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Interesting suggestion. An increased urine B2 microglobulin excretion might be a biomarker of proximal tubule injury in this case. Be sure to alkal...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

I will reach out to our laboratory personnel. May I know whether it adds clinical information in addition to serum beta-2 microglobulin? --------...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

Can lab identify which of mixed enteric is urease +ve? If so, can you then try prolonged isolate-directed antibioRx? I’d restart NaHCO₃, doubt you ...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Can you check a urine α₁M/Cr (or urine β₂M)? --------------------------------- Oded Friedman ---------------------------------

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RE: is it primary hyperaldosteronism? 1 day ago

I agree with Dr. Campese. Does this patient have any spontaneous hypokalemia or metabolic alkalosis.? ------------------------------ Richard Gla...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

Thank you Dr Hirsch for the comments. I am implementing the approach you described. Thanks Dr Lerman. I have been in correspondence with the haem...

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RE: Unclear cause of kidney function reduction in a single kidney 1 day ago

would consider switching off Pantoprazole as well as other suggestions. the Kappa/lambda ratio 7.75 is high for creat 190umol/l-given unexplained l...

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RE: is it primary hyperaldosteronism? 1 day ago

Thank you. Confidentiality Notice: This electronic message, including any and all attachments hereto, is intended solely to be used by the individ...

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RE: is it primary hyperaldosteronism? 1 day ago

I agree that there are compelling reasons to suspect primary Aldo in this patient. However, given the absence of critical information, such as seru...

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RE: is it primary hyperaldosteronism? 1 day ago

Hi, Dr. Campese, Question about your advice not to start spironolactone. Are you concerned that it would spuriously elevated PRA? Dr. Jebur d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

I see no issue with using citrate to treat the hypocitraturia and prevent oxalate stone . Have you considered using UROMUNE vaccine , to prevent r...

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RE: is it primary hyperaldosteronism? 1 day ago

@Vito Campese the use of an ARB should have no effect on Aldosterone levels , as it is autonomous , but may increase Renin levels. I prefer not to...

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RE: is it primary hyperaldosteronism? 1 day ago

I would also discourage starting soironolactone: This would make the lab data uninterpretable. ------------------------------ Vito M Campese Pr...

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RE: is it primary hyperaldosteronism? 1 day ago

Dr. Glassock, as usual, You are raising a very relevant and intriguing point. Atenolol blocks β1-adrenergic stimulation of juxtaglomerular cells a...

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RE: is it primary hyperaldosteronism? 1 day ago

Dr. Campese. Will telmisartan increase PRA in the presence of Beta blocker therapy, as in this case.? ------------------------------ Richard Glas...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 1 day ago

Yes I agree that is quite possible because struvite stones are secondary to infection and the milieu of the renal calyces and pelvis. On thinking t...

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RE: is it primary hyperaldosteronism? 1 day ago

In interpreting PRA and Aldo levels in this patient one should not disregard that he is taking telmisartan; this should result in increased PRA lev...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

Struvite stones are generated mostly by the environment of the urinary tract , primarily ammonia production from urease secreting organisms, indepe...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

On a different note, how reliable are 24 hour urine values in a patient with Stage 4 CKD? Also I believe the stone forming risk decreased as renal ...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

I meant the normal CFB , elevated C5b-9,low C3 and low C4 suggest activation of Classic pathway .. but am not sure I clearly understand why the AP5...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

Is this pattern, with normal CFB ,high C5b-9 and low C3/C4, exactly what you would expect in severe LN, without aHUS.? Just wondering. Does it indi...

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RE: Lupus nephritis - Renal Limited TMA - Complement mediated CAPS 2 days ago

good morning/evening Just as a follow up. This gentleman is doing well , his renal function is improving on Obinutuzumab and MMF His initial d...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

The cause of the NAGMA is likely the effect of bicarbonate secretion by the ileal pouch, not dRTA This is seen in an about 10-20% of patients with ...

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RE: Stage 4 CKD and index struvite stone - metabolic acidosis and alkaline urine 2 days ago

A urine pH that high is supraphysiologic. It's most likely from bacteriuria or from bacteria growing in the urine after it leaves the body (in the ...

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RE: is it primary hyperaldosteronism? 2 days ago

The obesity in this case represents a major confounding issue in interpretstion of the AAR. In some but not all cases of Obesity related hyperaldos...

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RE: Primary Aldosteronism on Medical Management 2 days ago

Many, myself included, are excited about the utility of ASI for primary aldosteronism but for now it's still exploratory and "off label" in the US....

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RE: is it primary hyperaldosteronism? 2 days ago

in the absence of spontaneous hypokalmia an aldo level > 30 , would be suggestive of Primary hyperaldo. in this case you may have to do confirmat...

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RE: is it primary hyperaldosteronism? 2 days ago

The aldo and PRA are markedly consistent with primary hyperaldo. What is her serum K? The urine K is surprisingly low but not something I'd typic...

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is it primary hyperaldosteronism? 2 days ago

Just wanted to share with the community the following details of a recently diagnosed hypertensive female patient of African origin with poorly con...

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RE: Primary Aldosteronism on Medical Management 3 days ago

It has been a really fruitful discussion. Currently if we decide to continue MRA, I should repeat renin levels and if that comes up, Aldactone is d...

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RE: Unclear cause of kidney function reduction in a single kidney 3 days ago

IMO, there are two almost competing aspects to this case. First, agree with all, we should be careful about giving medicines without clear cut in...

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RE: IgA nephropathy--repeat biopsy at this point? 3 days ago

Thank you so much Dr. Glassock--I appreciate your expertise. ------------------------------ Leah Metz MD Onalaska WI (608) 775-1673 ------------...

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RE: Primary Aldosteronism on Medical Management 3 days ago

"My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control." - v...

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RE: Primary Aldosteronism on Medical Management 3 days ago

Thank you for your answer, However, is it still indicated to change aldactone and finerenon with baxdrostat in those patients on the MRA?? giving...

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RE: Primary Aldosteronism on Medical Management 3 days ago

My answer is no, but the goal of titration of MRA is to "de- suppress" the PRA or PRC , not just to avoid hypokalemia and improve BP control. ---...

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RE: Proteinuria 3 days ago

This is a very challenging case. The clinical data provides a compelling story supporting Zoledronic acid nephrotoxicity provoking a partial podocy...

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