RE: PLA2R negative Membranous Nephropathy- Management Q 1 hour ago

You need ig subclass If it is one subclass then treat as primary If more than two subclass r:o lymphoproliferayive disorder --------------------...

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RE: PLA2R negative Membranous Nephropathy- Management Q 1 hour ago

Update: This patient with PLA2R negative Membranous Nephropathy underwent a BM biopsy, it came back as negative for Waldenstroms or myloma. Co...

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RE: Alkaline urine in primary hyperaldosteronism 1 hour ago

Similar to the urine pH in rodents in lab investigations the most accurate method is via pH microelectrode. Indicator pH papers are not very accura...

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RE: Alkaline urine in primary hyperaldosteronism 2 hours ago

How do we accurately measure urine pH? Can we rely on urine dipstick only? ------------------------------ V. Melnikov MD, FASN NW Kaiser Permane...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 3 hours ago

"Dr. Rodby: If ANCA-positive pauci-immune GN can occur in a patient with SLE, it is also possible that ANCA-negative pauci-immune GN can also occur...

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RE: IgAN vs postinfectious 12 hours ago

South Asian. Worse prognosis Maybe it might work/. You will know in a few months time.. keep us in the loop. ------------------------------ Richa...

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RE: Alkaline urine in primary hyperaldosteronism 13 hours ago

I agree that direct measurement of NH4+ would be desirable though I do wonder if that day were to come whether the nephrology community would be re...

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RE: IgAN vs postinfectious 13 hours ago

She is of Indian origin.

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RE: IgAN vs postinfectious 15 hours ago

Adding Myfortic at this stage is not unreasonable, UtcI would not expect much benefit as she is non-Asia.b. I nonof no new trials of my ophenolate ...

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RE: IgAN vs postinfectious 16 hours ago

She is 50 kg and I started her on 25 mg prednisone daily, and then added losartan and SGLT2i. Her UPCR initially improved from max of 6g/g to 1.4 g...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 16 hours ago

Most pauci-immune GNs have been found to be ANCA positive, but 10–30% of the cases could be ANCA negative (1). ANCAs are detected by indirect immun...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 19 hours ago

really good question, we used to think that immune complex lupus GN (subendothelial deposits)would have hypocomplementia but pauci immune lupus GN ...

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RE: combined rejection 20 hours ago

Thanks for all ur kind feedbacks, ACR 335, repeated DSA not done. ------------------------------ Ahmed Mahedy MD Banha Faculty of Medicine Banha ...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 21 hours ago

Thanks Dr Venkat. This happened last week and waiting to get updated results of urine and complements. ------------------------------ Saurabh Go...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 21 hours ago

Thanks for your response Dr Rodby. I want to avoid cyclophosphamide in this young female with creatinine already improved to 1.3. Do you see hypoco...

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RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 23 hours ago

Now we have a diagnosis and prognosis for the liver disease present in the prospective kidney donor. What's next? ------------------------------ ...

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RE: Dialysis dependent lupus nephritis 1 day ago

Dr. Png: Thanks for providing a long-term update on this patient's course. Residual SCr of 3.95 mg. Is he a small or large individual? Renal functi...

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RE: Dialysis dependent lupus nephritis 1 day ago

Further follow up on this case: after completion of IV cyclophosphamide, he was started on mycophenolate mofetil 500 mg BID, and maintained on pre...

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RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 1 day ago

Follow up on this case: Hepatologist proceeded with liver biopsy, showing NASH CRN histological scoring system 2 (steatosis score 1 (15-30%), lobu...

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RE: Combined ANA, ANCA and PLA2R serology 1 day ago

SCr of 1.6 mg is worrisome, unless it is already decreasing. Also, if SCr is stable from day-to-day, it means all the creatinine generated daily is...

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RE: Combined ANA, ANCA and PLA2R serology 1 day ago

The serology (ANA and ANCA) is complicated because if Hydralazine use- but the Anti-PLA2R + probably means that MN is present that will Need therap...

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RE: Ozempic+statin= rhabdo 1 day ago

In that case, a long shot but you may want to check for anti-HMGCR autoantibody. --------------------------------- Oded Friedman -----------------...

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RE: Combined ANA, ANCA and PLA2R serology 1 day ago

that ANCA titer is non specific, need an MPO and PR3 Elisa P/C ratio may not be reliable in the setting of AKI with what sounds like ATN from the ...

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RE: Combined ANA, ANCA and PLA2R serology 1 day ago

On hydralazine 10 mg per cardiologist and p-ANCA titer was around 1:640 ------------------------------ Laith Al dahabreh MD Leesburg GA (216) 856...

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

We will be happy to do that. It is going to be either in July or August. I will forward the zoom link. Warm regards, --------------------------...

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

Doctor Bhave is raising a very interesting point in regards to the role of hypokalemia in enhancing NH4+ excretion, and possibly in generating meta...

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RE: Ozempic+statin= rhabdo 1 day ago

Yes she had diffuse myslgias which are minimally getting bett ------------------------------ Jeffrey Lautman MD Cleveland Kidney & Hypertension C...

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RE: Yellow Fever Vaccine For Lupus Nephritis Patient In Complete Remission 1 day ago

Yellow fever virus vaccine is a live but attenuated vaccine that is contraindicated in immunosuppressed patients.. I assume that he has been in a C...

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RE: Ozempic+statin= rhabdo 1 day ago

Did she present with muscle weakness in addition to myalgia and if so, has it persisted despite stopping rosuvastatin? ---------------------------...

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Yellow Fever Vaccine For Lupus Nephritis Patient In Complete Remission 1 day ago

A 35-year-old man with lupus nephritis, now in complete remission on MMF 1000 mg bid l, HCQ 200 mg bid and prednisolone 5 mg od. He want to travel...

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

If possible, your division should make the lecture available to this audience via zoom. Thank you. Mario

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

Agree little data on ammonium excretion in primary hyperaldosteronism. The only paper that addresses this clearly is the 1965 Japanese paper with 2...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 1 day ago

SCr improved from ~ 5 mg to 1.3 mg/dL. AKI might have spuriously increased the UPr/Cr ratio. What are the current UPr/Cr, complement and anti-DS DN...

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RE: ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 1 day ago

Pauci immune pathology is not unusual with SLE, in fact although SLE is often considered the consummate immune complex disease, I think we see the ...

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ANCA negative pauci immune GN. ANA, anti dsDNA positive. Low complements. 1 day ago

I have a young female who was admitted vomiting, diarrhea, hypotension, with NSAIDs use, had AKI (clinically pre renal/ischemic ATN) with no prior ...

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RE: Ozempic+statin= rhabdo 1 day ago

I always wonder if these patients need a workup for metabolic diseases. "Drug responses can also be affected by predisposing genetic factors. For ...

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RE: Ozempic+statin= rhabdo 1 day ago

Dr Glasssock thanks for your reply patient lost approximately 20 lbs on ozempic jeffrey ------------------------------ Jeffrey Lautman MD Cleve...

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RE: Ozempic+statin= rhabdo 1 day ago

I fully agree. Rosuvastatin is the most likely culprit here, not semaglutide ------------------------------ Richard Glassock MD, FASN Laguna Wood...

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RE: Lupus nephritis with APS and MMF. Relapse during tapering MMF 1 day ago

I had a similar case where a 35/F was in remission for 3 years and then slow taper was done. Her proteinuria and dsDNA started going up but complem...

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RE: Alkaline urine in primary hyperaldosteronism 1 day ago

There are no good studies that I know of that indicates enhanced NH4+ excretion in primary hyperaldosteronism independent of hypokalemia. So the po...

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RE: Ozempic+statin= rhabdo 2 days ago

We have seen many cases of Rhabdomyolysis and AKI with high-dose Rosuvastatin. It is the most likely culprit. Withhold Rosuvastatin and wait. Patie...

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RE: Ozempic+statin= rhabdo 2 days ago

Even a relatively minor change in body weight might make a difference when one is taking a high dose of a potentially nephrotoxic agent like rosuva...

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RE: Screening for CKD 2 days ago

Thanks for the excellent discussion. I think we agree on most items; however, I think we should do universal albuminuria screening at least once so...

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RE: Ozempic+statin= rhabdo 2 days ago

With sitagliptin yes, but not w. semaglutide (Ozempic)...also, it seems it took only 3 wks from the start of Ozempic for the muscle pains to begin....

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RE: Screening for CKD 2 days ago

Thanks Drs Rodby, Venkat, Hirsch and Weiner for your excellent response to my post. I was chiefly addressing population wide screening of asymptoma...

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RE: Alkaline urine in primary hyperaldosteronism 2 days ago

The urine anion gap measurement should not be applied to any urine pH above 7, since that implies the presence of excess HCO3-, If that is the ca...

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RE: Alkaline urine in primary hyperaldosteronism 2 days ago

Dr. MellasI apologize for the typing mistakes . AMD is tough when you become monocular and never learned how to touch type. --------------------...

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RE: Alkaline urine in primary hyperaldosteronism 2 days ago

The urine anion gap measurement should not be applied to any urine pH above 7, since that implies the presence of excess HCO3-, which will make the...

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RE: Alkaline urine in primary hyperaldosteronism 2 days ago

Ammonium is the most important component of urinary acid excretion, normally accounting for about two-thirds of net acid excretion. Yet many Hospit...

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RE: combined rejection 2 days ago

Have you repeated DSA after treatment? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kid...

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