RE: Recalcitrant severe hyponatremia 37 minutes ago

Hypouricemia is not commonly observed in "tea and toast " syndrome in the elderly and it would not be a expected feature of diuretic abuse. Any com...

View Discussion

RE: Recalcitrant severe hyponatremia 50 minutes ago

Sheldon, I see your point and generally agree. The issue I see is whether the low Na excretion represents a steady state with euvolemia suggesting ...

View Discussion

RE: Recalcitrant severe hyponatremia 1 hour ago

Hi John: I'll be the third (or more) to agree and I'll suggest that you two guys agree with each other as well, just using different vernacular. Wh...

View Discussion

RE: The patient who keeps on giving 1 hour ago

Would anyone consider giving periodic infusions of fresh frozen plasma to restore the CfH level to normal.? ------------------------------ Richar...

View Discussion

RE: Simple case - need help 1 hour ago

------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

View Discussion

RE: Simple case - need help 2 hours ago

With a normal serum albumin, non-nephrotic proteinuria, normal renal function and probable "pure" Class V LN I would seriously consider opting for ...

View Discussion

RE: Recalcitrant severe hyponatremia 2 hours ago

I agree with Dr Rodby except for one issue, that being the U Na [More]

View Discussion

RE: Recalcitrant severe hyponatremia 4 hours ago

The The admission chemistry pre treatment (mmol/L) - Sodium 118, chloride 87, urate 0.079, urine creatinine in 2.4 , urine sodium less than 20 ,...

View Discussion

RE: Simple case - need help 4 hours ago

We are having a core sent to arkana Labs - i will have them stain for pla2r, nell1, ext1/2. Serum albumin is 4.1, no edema. --------------------...

View Discussion

RE: Simple case - need help 4 hours ago

We are having a core sent from Pakistan to arkana Labs - i will have them stain for pla2r, nell1, ext1/2. Serum albumin is 4.1, no edema. ------...

View Discussion

RE: Simple case - need help 4 hours ago

- are we looking at primary or secondary membranous GN? - her proteinuria is subnephrotic and pla2r is negative -> would she require any immunosu...

View Discussion

RE: The patient who keeps on giving 4 hours ago

I might add MMF , continue to taper steroids and observe. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-888...

View Discussion

RE: Simple case - need help 4 hours ago

Certainly with this history and serology, ClassV Lupus Nephritis would be the Prime Suspect. The negative C1q and C3 is a bit disconcerting . Was t...

View Discussion

Simple case - need help 4 hours ago

Good morning, I need help with a case. Questions are at the bottom of the page. 63 F from pakistan with PMH of HTN for >20 yrs - well control...

View Discussion

RE: The patient who keeps on giving 4 hours ago

the DNAJB9 was negative ------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consult...

View Discussion

RE: Recalcitrant severe hyponatremia 4 hours ago

Some older women have ( especially as suggested by the Uosm of 180 and PNa 120 ) Inability to dilute urine ( to around 100 mOsm/l) even in the f...

View Discussion

RE: The patient who keeps on giving 6 hours ago

I fully agree that right now with progressive improvement of overall kidney function and decreasing ROCR, a biopsy might not help in decidng whethe...

View Discussion

RE: The patient who keeps on giving 6 hours ago

This may be a response to steroids or a "spontaneous " partial remission. Any results from DNAJB9 stains yet. ? I am not very enthusiastic ablution...

View Discussion

RE: Recalcitrant severe hyponatremia 6 hours ago

I like Dr. Mellas's response to this conundrum. His comment that a "water intake issue " is of concern is very important, in my opinion. -------...

View Discussion

RE: TMA Case 6 hours ago

I agree 100% with Dr. Balan's assessment of this complex case. Genetic testing test is going to be very low yield. Eculizumab might work, but has a...

View Discussion

RE: TMA Case 7 hours ago

I would also add that the yield of a genetic test in this lady is going to be miniscule because it seems rather improbable that a genetic disease m...

View Discussion

RE: Recalcitrant severe hyponatremia 7 hours ago

"sodium less than 20 , urine urate 0.77 and urea 83. Urine osmolarity was 181 mmol/kilogram. The ability to excrete free water requires satisfyin...

View Discussion

RE: The patient who keeps on giving 8 hours ago

As a follow up to this patient with TMA and C3G.. over last 4 weeks his renal function is normal . His proteinuria has decreased from 6 grams to 2....

View Discussion

RE: TMA Case 8 hours ago

I respectfully disagree on the second part of your statement. "Fellowship programs need to focus a part of the curriculum on genetic training ra...

View Discussion

Help with suspected dialyzer circuit allergic reaction 9 hours ago

Hello colleagues, Does anyone know if B Braun streamline airless bloodline set for dialog + systems is sterilized using ethylene oxide? We hav...

View Discussion

Recalcitrant severe hyponatremia 11 hours ago

I have a 48-year-old female who presented with severe hyponatraemia with headaches and no other symptoms. She was not confused. Sodium level had...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 15 hours ago

Thank you so much for all insights. Will discuss and try to get more detaled info from our pathologist. Not sure how many glomeruli examined, ...

View Discussion

RE: TMA Case 18 hours ago

Hello The aHUS panel is very different from aHUS//C3 genetic screening . In the panel they do levels of the components of Alternate pathway, such ...

View Discussion

RE: Lupus nephritis 20 hours ago

We decided to start with mycophenolate. Will add voclosporine or benlysta as outpatient. Thank you all for your help. ---------------------...

View Discussion

RE: TMA Case 1 day ago

Thank you Drs Glassock, Beasarab and Dastoor. I was unaware the Mayo Clinic testing would take a mo. We will reach out to the Mayo Clinic to see if...

View Discussion

RE: TMA Case 1 day ago

I agree , you may not find a Monoclonal protein in the blood and Bone marrow may also be inconclusive . Also I see you have sent genetic testing t...

View Discussion

RE: TMA Case 1 day ago

See Meri S, et al J Exp Med 1992; 175: 939-950. Similar mechanisms are presumed to be operative in monoclonal LC induced TMA. -------------------...

View Discussion

RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

O have a problem with such analyses which examine the length and quality of life years saved by a new therapy. At $59,000 pre QALY , most middle-cl...

View Discussion

RE: TMA Case 1 day ago

Thank you for the explanation. Makes sens;, Is there data to support i?. a Monoclonal spike is also found in MGUS where neuro symptoms and findi...

View Discussion

RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

I am not sure , but literature states that Renal failure in Mannitol intoxication , is due to 2 mechanisms , an intense renal vasoconstriction and ...

View Discussion

RE: TMA Case 1 day ago

In this scenario the actual amount of monoclonal protein in the circulation is not very important, as the TMA is not due to the deposition of monoc...

View Discussion

RE: Suspected Infection Related MPGN 1 day ago

Fully agree!!! ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

View Discussion

RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

If you are attributing the AKI to be secondary to mannitol, why would a single dialysis treatment correct it? The osmotic nephrosis would be caused...

View Discussion

RE: Suspected Infection Related MPGN 1 day ago

Yes the prognosis is quite poor. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------...

View Discussion

RE: TMA Case 1 day ago

The questions I have are the following Is the amount of M-protein circulation large enough to account for the degree of pathologic changes . ...

View Discussion

RE: Suspected Infection Related MPGN 1 day ago

This case aligns with "Cluster 3" of cirrhosis-IgAN in the article published in KIR mentioned by Jonathan Zuckerman. (https://www.kireports.org/ar...

View Discussion

RE: TMA Case 1 day ago

Tough decision. It is a judgement call. The patient needs to be informed of tge risk of fatal niningiciccal Dusease in the absence of immunization ...

View Discussion

RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

So this patient was started on dialysis , with a Pna of 118 and Serum osmolarity 300 Osmolar gap of 46 attributed to Mannitol She was dialysed aga...

View Discussion

RE: TMA Case 1 day ago

Thank you Dr Glassock. I did not make much of the slight MGUS with a relatively normal light chain ratio. I also though I might see an immunologic ...

View Discussion

RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Any possibility of getting sample drug "free:. The key word sf "FREE," Of course you assume all of the responsibility for the patient. On 3 attempt...

View Discussion

RE: TMA Case 1 day ago

With severe Renal limited TMA at this age with a monoclonal protein identified, would strongly suspect a MGRS presenting as a TMA. Eluluzumzb plus ...

View Discussion

RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Compassionate use is an interesting concept . We don't allow it in Abudhabi, because once the drug is approved by the FDA , we are then obliged to ...

View Discussion

RE: TMA Case 2 days ago

I should also mention, no hx of problematic htn. No features of clinical scleraderma. ------------------------------ Shaun Joshi MD North Idaho N...

View Discussion

TMA Case 2 days ago

Dear colleagues, this is the first time I am posting on the ASN blog. Greetings from North Idaho! I recently picked up the nephrology service from ...

View Discussion

RE: Iptacopan In High Risk Patients With IgA .... not Again !! 2 days ago

I used to be involved with pharamcoecnomic studies with captopril and Irbesartan after those studies came out so I am a bit familiar with what is c...

View Discussion