RE: Hyperkalemia Post Kidney Transplant 11 minutes ago

This is precisely why Nephrology and Astrophysics share a common appeal to the curious and research-oriented person. Many discoveries just waiting ...

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RE: Hyperkalemia Post Kidney Transplant 1 hour ago

In response to the intriguing question by Dr. Rodby about the nephron segment where the aldosterone resistance may be impacting the electrolyte or ...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 3 hours ago

What is the serum uric acid during or before these episodes of AKI.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...

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RE: Calciphylaxis 3 hours ago

What is most discouraging and frustrating to me is our inability to predict which patient is"at risk" and what are the best (and effective ) preven...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 3 hours ago

What is the maintenance immunosuppression regimen? CNI trough levels? BP control/and medications? Body weight trends when SCr goes up? Urinalysis f...

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RE: Hyperkalemia Post Kidney Transplant 3 hours ago

Dr Rodby I agree/ Forty Years ago a Nephrologist at Temple U School of Medicine did some experiments of the effect of K supplementation to a tota...

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RE: Calciphylaxis 4 hours ago

I predominantly agree with what has been posted and Dr Rodby summarizes treatment well, though I have found hyperbaric treatment has been helpful ...

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RE: Calciphylaxis 4 hours ago

I am in the kitchen sink camp 1) get off all Ca based binders 2) stop Vit D or analogs 3) GIve VIt K 4) get off warfarin 5) STS - 25 gram...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 4 hours ago

I would repeat the resistive indices and even CTA. and if no recurrent stenosis, repeat renal biopsy? ------------------------------ Roge...

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RE: Hyperkalemia Post Kidney Transplant 4 hours ago

At the risk of making a fool of myself after this very erudite physiology discussion. I am prepared to be vilified for this, but I am not just sayi...

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RE: Hyperkalemia Post Kidney Transplant 5 hours ago

The elegant contributions of Dr. Manoocher Soleimani on this subject and many others in the past are a breath of fresh air and are/should be apprec...

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RE: Hyperkalemia Post Kidney Transplant 5 hours ago

Very nice commentary by Dr Balan. Very informative and appreciated. Over the last several years I have seen increased use of the urine K/Cr ratio f...

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RE: Hyperkalemia Post Kidney Transplant 6 hours ago

The use of the TTKG as a method to assess potassium secretion in the collecting duct was based on the detailed interpretation of the values in norm...

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Abrupt drop and spontaneous recovery of kidney function in KTR 6 hours ago

Hello everyone! I need to seek your valuable insights on a challenging post-renal transplant case. A 32-year-old male, with a history of hypoplas...

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RE: Calciphylaxis 7 hours ago

That is a very nice review and one take home point is how little we really know about this very complicated situation--"the pathogenesis remains po...

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RE: Calciphylaxis 14 hours ago

Is he doing all his sessions at home? Is it 3,4, or 5 per week? What is PTH, Ca, and PO4 levels. Na thiosulfate is needed and may be 4 sessions p...

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RE: Calciphylaxis 1 day ago

See the nice recent review of the challenges in therapy for Calciphylaxis. Chewcharat and Nigwekar. Clin Kidney J. 2025; 18: sfaf098. -----------...

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RE: Calciphylaxis 1 day ago

Why not? - very likely safe so no downside (except cost) , but the upside is unknown. Calciphylaxis is a terrible disease, often fatal, so a "kitch...

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RE: Calciphylaxis 1 day ago

Any one would use vitamin k2? Best wishes --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Thank you!. Dr. Mellas concluded by stating: "So, for all of the shortcomings of TTKG, U og, and U pH, taken together I still find their usefulness...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

I read the research letter provided by Dr Solemani with interest. I would like to make two comments; 1- only 16 measurements of Uog and U NH4+ we...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Thank you all for this discussion. My understanding of TTGK s its usefullness as well as it 's limitations has definitely improved. ------------...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 1 day ago

thanks for your comments. I think there is one family with ADTKD-UMOD or ADTKD-MUC1 in ever nephrologist's practice. It is the third most common ge...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 1 day ago

Yes! Please given them my contact info: Ableyer@wakehealth.edu. Thanks! Or you can email me their contact info if they are agreeable and I will cal...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 1 day ago

Unfortunately, we do not enroll patients with this disorder as we do not have the bandwidth :(. There is a facebook page: https://www.facebook.c...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Let's utilize the latest published research, whether clinical or basic, to address the points of disagreement in this forum. In response to my poin...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

To answer our colleague from Cairo, Dr Emara, in which the renin and aldo levels are cumbersome, I would suggest that a low TTKG, U pH [More]

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Interesting discussions. The trans-tubular potassium gradient (TTKG) is used to gauge renal potassium secretion by the cortical collecting duct, ...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Thanks Dr. Mellas- great addition to the discussion. Since these patients seem to have responded to exogenous mineralocorticoid, it would seem that...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Thank you all for the great discussion Again, our patients BP readings were in the borderline low side Could we consider v good response to flu...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

TTKG is a simple test to confirm a defect in kidney K excretion and has no mechanistic insight per se. Further testing including the ability to ...

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RE: Calciphylaxis 2 days ago

I agree if you could post pictures, I also agree with Prof Glassock, that it should not be biopsied, nor should it be debrided as this greatly incr...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Great discussion. I hope it helps in patient management.TTKG as an indication of aldosterone action in the CD seems to be no longer a viable concep...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

I agree that the measurement of plasma renin and aldosterone is superior to the TTKG measurement. The TTKG formula was developed based on the princ...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

In the evaluation of chronic hyperkalemia with relatively preserved GFR, I wonder if TTKG really adds much. Measurement of PRA-and serum aldosteron...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

That is why it is critical to measure the circulating aldosterone level in this, and other individuals post transplant with hyperkalemia. If the al...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

In my practice I do use TTKG for chronically elevated K based on the fact that K secretion is a distal nephron process so that the gradient for ser...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

The original post suggested that these patients have low blood pressure and are not hypertensive. Does this not make Gordon Syndrone Type IV RTA un...

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RE: Calciphylaxis 2 days ago

Are the skin lesions painful? Where are they located? Can you post a photography? I hope the dermatologist does not do "diagnostic " skin biopsy as...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Interesting question. It is critical to determine whether the serum aldosterone level is increased or suppressed. If increased, it falls under the ...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Many thanks Dr. Lerman. Great advice. I think we need PRA and serum aldosterone levels to separate TypeIV RTA from Pseudohypoaldosteronism Ty9e as ...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Would add that type IV RTA due to CNI is most likely cause , although Bactrim prophylaxis can also contribute . If Hypertension is present then dru...

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RE: Calciphylaxis 2 days ago

We use sodium thiosulfate all the times, watch for qt interval, also cinacalcet is reported to help as tolerated, surgical debridement, and increas...

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Calciphylaxis 2 days ago

70 y/o patient ESRD on home hemodialysis for more than 7 years, HTN, HLD, DM, Secondary hyperparathyroidism, Atrial fibrillation, s/p parathyroidec...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Thanks - although uncommon acquired Pseudohypoaldosteronism Type 1 or Type 2 (Gordon Syndrome) can be seen in renal transplant recipients receiving...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Serum K ranges from 5.8 - 6 Not on RASi eGFR preserved --------------------------------- Ahmed Emara MD, FASN Ain shams university, cairo Ca...

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RE: Severe AIN with Crescents 2 days ago

complements have been normal x 2 during the course of hospital stay. will circle back with the final path report once available -------------...

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RE: Severe AIN with Crescents 2 days ago

mpo / pr3 negative, updated / edited the case- along with urine eos 1% - no eosinophilia. after the prelim bx , repeated mp/ pr3- negative again. ...

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RE: ADPKD ON JYNARQUE 2 days ago

this may shed light on using sglt2 nature.com/articles/s41467-022-35537-2 lays theoretical basis for using these drugs in PCK intersting ph...

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RE: Severe AIN with Crescents 3 days ago

I agree with all of tge suggestions if Dr. Venkat, with the addition of the % eosinophils in tge interstitial infiltrate and the peripheral blood e...

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