RE: Friday : Unexplained metabolic acidosis 45 minutes ago

Dr. Rubin, Thank you for attaching this NEJM 1982 landmark paper on the presence of high anion gap acidosis as well as the development of non-gap...

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RE: white male with collapsing FSGS 59 minutes ago

Thank you everyone for your expertise! Great suggestions and tips! Very grateful to have great minds come together. ----------------------------...

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RE: white male with collapsing FSGS 1 hour ago

Also to be noted: "There is mild epithelial foot process effacement." This also argues against typical collapsing glomerulopathy, a podocytopathi...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 3 hours ago

Dr Rodby, you are correct. Release of creatinine from muscle woyld increase the plasma levels without a change in true FFR as measured by inulin or...

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RE: Friday : Unexplained metabolic acidosis 3 hours ago

Yeap. See attached. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------ Files Attached Docu...

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RE: Friday : Unexplained metabolic acidosis 3 hours ago

ketoacidosis (diabetic or starvation) will develop a NAGMA as you excrete the ketoanions in the urine in fact the loss of the salt of those anion...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 3 hours ago

I always thought the under appreciated thing about Rhabdo is that creatinine production increases and that will raise your serum creatinine without...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 4 hours ago

Thank you Dr. Teixeira. Very helpful. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 4 hours ago

Good question. This graph has been reproduced a bunch in reviews (even UpToDate), but I think the primary data are super old, and many of the revie...

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RE: Friday : Unexplained metabolic acidosis 4 hours ago

I would and could be wrong but I think what this patient has , has been well described in this case report https://academic.oup.com/qjmed/artic...

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RE: Metabolic alkalosis interpretation 4 hours ago

Thanks Dr. Teixeira for your very helpful post . It is my impression that Alcoholic, Starvation and DKA are all characterized by relative hypo-insu...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 5 hours ago

Thank you for the graph. I always taught that it might take up to week for CPK to normalize assuming no new insults to the muscles --------------...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 5 hours ago

Great educational figure. Do you happen to know the reference for this work? Thank you ------------------------------ Mario Rubin, M.D. Houston T...

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RE: Metabolic alkalosis interpretation 5 hours ago

Great case. I may use this for fellow case conference. Agree with not giving insulin. At least classically, starvation / alcoholic ketoacidosis s...

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RE: white male with collapsing FSGS 5 hours ago

Thanks Dr. Zuckerman for your very welcome post and citation as well as thanks to Dr. Makhyoun for posting the case in the first place. We have all...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 5 hours ago

Agree with all of the above, but have 1 more point. Not only is it important to realize that myoglobin rather than CPK is the kidney toxin, they ha...

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RE: Friday : Unexplained metabolic acidosis 5 hours ago

The more you look, the more you find!! The serum bicarb was 20 with a gap of 20 on admission. The serum bicarb goes down to 3 mmole in 2 days (a dr...

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RE: white male with collapsing FSGS 5 hours ago

Collapsing glomerulopathy has been associated with ischemia (as you noted) (TMA, atheroembolic disease, and severe arteriosclerosis) in older adult...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

Was D-Lactate levels measured in this patient with GI problems? ------------------------------ Manoocher Soleimani MD Professor University of New...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

I would invite more answers before I release what I think is the answer ... But 8 think the answer is well evident in the table presented . -----...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 6 hours ago

I agree with Dr. Glassock. It is the myoglobin and not the released cellular enzymes from damaged muscle cell that produce renal damage. His Cr if ...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

The unfortunate patient was admitted with aspiration pneumonia . She was unable to consume calories and the family had a DNR in place , which inclu...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

@Manoocher Soleimani In the setting of significant ketonuria (a non-reabsorbable anion) shouldn't we expect to see some degree of hypokalemia. Wh...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

The rising chloride, along with the persistent low HCO3-, may be due to a change from high-anion-gap to non-gap acidosis precipitated by a large vo...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

Starvation ketosis most likely, give some d5w and thiamine and I bet it goes away fairly rapidly . Ketones+++ is that blood or urine? Doubt it matt...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

I noticed that the serum lactate is normal, which is probably against a pyruvate dehydrogenase deficiency alone. In that case, an starvation ketosi...

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RE: Friday : Unexplained metabolic acidosis 6 hours ago

Excellent and fascinating case. This is a case of severe metabolic acidosis as a primary disorder, since no respiratory alkalosis can lower the ser...

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Friday : Unexplained metabolic acidosis 11 hours ago

Question : We were asked to investigate cause of unexplained low Bicarbonate in this patient . The questions were what was the cause of the me...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 11 hours ago

With heme negative urine and a declining Scr I see no reason to continue a forced saline diuresis. Just an opinion. ----------------------------...

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RE: MPGN Input Appereciated 12 hours ago

Further evaluation of the paraffin blocks might reveal a likely diagnosis. . I fully agree that IgAN is most likely, especially if the serum IgA/C3...

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RE: MPGN Input Appereciated 12 hours ago

Yes I agree , given her Asian origin could be IgA --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidn...

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RE: MPGN Input Appereciated 17 hours ago

This MesPGN not MPGN pattern of injury- pretty non-specific lesion. You may have to do another biopsy. ------------------------------ Richard Gl...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 17 hours ago

I would have peace of mind as the CK is trending downwards. However if the CK pushes up again , I would be worried about persistent compartment syn...

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RE: MPGN Input Appereciated 17 hours ago

Unfortunately that's the final report . The lab in India could do neither IF or EM.. All we have is an MPGN pattern of injury and labs . -------...

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RE: Accurate diagnosis is half the treatment ! 19 hours ago

Thanks Dr Glassock for your valuable advice and intelligent questions. He does not have Diabetes Mellitus ( HbAIC 5.5 two months ago) - He is a for...

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RE: Accurate diagnosis is half the treatment ! 20 hours ago

Although I accepted Dr Venkat's explanation as being reasonable, I was still uncomfortable with a polyclonal explanation. Despite the severity of t...

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RE: Cystine stone and penicillamine 20 hours ago

Thanks prof goldfarb --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Accurate diagnosis is half the treatment ! 20 hours ago

Intercapillary nodular Glomerulosclerosis was identified in the kidney biopsy. is the patient a diabetic or a heavy smoker.? In the absence of EM, ...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 21 hours ago

Urine is now heme-negative. On admission, phosphorus wasn't checked; calcium was 8.8 with albumin 4.1. Currently, phosphorus is 1.5 and calcium 7.9...

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RE: white male with collapsing FSGS 21 hours ago

Collapsing FSGS, unrelated to viral infection, drug use has been seen from time to time in Association with obstructive sleep apnea. Glomerulomegal...

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RE: MPGN Input Appereciated 22 hours ago

I can't find the IF or EM report. This is Mesangial proliferative GN not Membranoproliferative FN , pattern of injury in both cases - not a disease...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 22 hours ago

It is not the CPK that is "nephrotoxic " but is the myoglobin, which is cleared by the kidney, if GFR is sustained.. A nice 5 L diuresis and a fall...

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white male with collapsing FSGS 23 hours ago

65-year-old CAUCASIAN man with history of CAD status post 6V CABG 2012, ischemic cardiomyopathy EF 25-30%, hypertension, OSA on CPAP, obesity, we...

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Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 23 hours ago

Hi everyone, I'd appreciate your input on the duration and tapering of IV fluid therapy in the setting of rhabdomyolysis-associated AKI. Case sum...

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MPGN Input Appereciated 1 day ago

I saw a 33 year old lady from Burma today in the clinic . She works as a waitress at the Rixos Saadiyat Island in Abudhabi- nice place . She had ...

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RE: Accurate diagnosis is half the treatment ! 1 day ago

Thanks everyone for valuable input. Few updates. Please find the attached kidney biopsy report ( de-identified) I have reached out to rena...

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RE: Metabolic alkalosis interpretation 1 day ago

Probably not. Just dextrose and saline. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 314537...

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RE: Accurate diagnosis is half the treatment ! 1 day ago

Many thanks to Drs. Venkat and Besarab for you many valuable contributions to the Open Forum. Teaching and learning are but two faces of the same p...

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RE: Accurate diagnosis is half the treatment ! 1 day ago

Quite reasonable explanation Glad you are so active. Teaching and learning are great joys. Tony ------------------------------ Anatole Be...

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RE: Accurate diagnosis is half the treatment ! 1 day ago

Hi Tony: Since there was no light chain restriction on IMF and serum immunofixation showed only polyclonal increase in immunoglobulins, I thought t...

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