RE: Jynarque for PKD2 with two high risk APOL1 alleles? 11 minutes ago

If the two APOL1 mutations are on the same chromosome (in cis) then the other chromosome has a normal APOL1 gene and there is no increased kidney r...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 55 minutes ago

Appreciate the input and I also find it curious thecthe second bx just 6 months later shows the perihilar sclerosis which is suggestive of 2ry FSGS...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 56 minutes ago

@Graham Abra Can you please explain and provide references on the clinical value of determining a luminal (cis) vs. cytoplasmic (trans) orientati...

View Discussion

RE: Onconeph case 1 hour ago

Urine can be sometimes bland in interstitial nephritis If interstitial nephritis due to ICI will need steroid Dr Glassock don’t you think Bx is ne...

View Discussion

Data Leakage from AI in Kidney Care?-- Enterprise Data Protection in AI: What It Really Means? 3 hours ago

🔒 Enterprise Data Protection in AI: What It Really Means As AI becomes woven into clinical, research, and operational workflows, Enterprise Data P...

View Discussion

RE: Onconeph case 4 hours ago

Dr. Glassock don't you think Nivolumab, more than Cabozantinib, might be the culprit in this case given the absence of proteinuria and the presence...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 4 hours ago

Dr. slater in my opinion the second biopsy with perihilar focal segmental sclerosis provide additional support that this is secondary (most likely ...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 5 hours ago

Thanks for the additional information. I am not convinced that this is Primary FSGS. Diabetic Nephropathy + Obesity related Glomerulopathy is most ...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 7 hours ago

Apellis is recruiting patients for Phase 3 trial on Primary FSGS with Pegcetacoplan. Perhaps that would be an option. ---------------------------...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 10 hours ago

Can we have the bone imaging findings and the bone turnover studies? The explanation for normal PO4 levels without binders might be the use of more...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 10 hours ago

Yes the bx was from his native kidney and it was mislabelled further digging I found he has h/o pre diabetes at time of 1st bx HbA1C 6.2...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 13 hours ago

Very interesting case! I agree with your thought that the two APOL1 gene mutations are likely in cis given the lack of proteinuria though certain...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 13 hours ago

Very interesting case, and thank you for the references Drs Besarab and Raduca. Our Endocrine Surgeons do a reasonable number of subtotal parathy...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 13 hours ago

Thanks- this is labeled as an allograft biopsy. Is this an error? There are significant changes for Diabetic Nephropathy.. Is the patient Diabetic ...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 14 hours ago

Salb range 2.5 to 4 dependent on UPCR now Salb 4.0 w UPCR 3 gm ------------------------------ Jonathan Slater MD Renal & Transpla...

View Discussion

RE: Steroid Resistant FSGS treatment with Obi ? 15 hours ago

Did the EM of the original biopsy show diffuse FP effacement? What was the serum albumin when he presented with proteinuria? Has genetic testing fo...

View Discussion

Steroid Resistant FSGS treatment with Obi ? 15 hours ago

Appreciate others thoughts regarding 64 y/o M I inherited with primary FSGS Apol1neg kidney bx 2020 with all IS regiments w/o any benefit, in...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 16 hours ago

Although I sent the references, my own experience has not been one of ever having to do an inter-operative dialysis during a subtotal or total para...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 16 hours ago

Another factor that has been implicated in perioperative hyperkalemia in patients with impaired renal function is prolonged preoperative withholdin...

View Discussion

RE: Onconeph case 18 hours ago

Single kidney, no hematuria or proteinuria and a falling eGFR that is unexplained. The Cabozantinb has to be the main suspect, based on information...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 21 hours ago

I have never encountered this phenomenon either. Intra-operative hyperkalemia has been reported when succinylcholine is used as an anesthetic (part...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 23 hours ago

I must admit that in my limited experience with management of patients with ESKD on dialysis following subtotal parathyroidectomy (not total PTX) I...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

My gestalt is that hyperkalemia is a function of how well the patient is prepped for the surgery See references Sent from Outlook Files Attached...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

I would love to see such examples in patients with severe secondary hyperparathyroidism with ESRD. They must be as rare as 'hens teeth". Never obse...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

We have a cohort of patients here , without insurance , or in the country illegally . They are provided with free of cost dialysis, with certain li...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

------------------------------ Radu Raducu MD MD Sanford Hospital BIsmarck ND (203) 606-7322 ------------------------------

View Discussion

RE: Proteinuria/Hematuria without kidney biopsy 1 day ago

I wonder if the outcome would have been different if we had not waited for often desired diagnostic greed that we at times strive for or hustle for...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 1 day ago

IDH is a real problem particularly in elderly patients A blood pressure estimator that runs in real time during hemodialysis using pressure w...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

Dr. Dastoor: I agree with you that examples of very high PTH values with surprisingly near normal SPO4 and SCa values can be found in the literatur...

View Discussion

Onconeph case 1 day ago

45F with single kidney post right nephrectomy for RCC in 2024. Has been on cabozantinib and nivulomab for lung mets since June 2024. Referred for...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 1 day ago

Wide fluctuations in BP and heart rate that you describe suggest autonomic dysfunction, especially in the setting of prior spinal cord injury. Is t...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Like others, am astounded by the near "normality" of Ca and P with seemingly little binders being used Are the PTH measurements of intact hormone...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Sestimibi has been planned as an outpatient . This patient has a low serum calcium , despite tertiary hyperPTH, hence we will use Vit D , prior to ...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Like Dr. Venkat I am astounded by the finding of a normal PO4 level in a patientwith such severe secondary hyperparathyroidism on dialysis without ...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Dr. Duang- thanks for your response. Experience with Daratumumab for therapy of recurrence of PGNMID in a kindey allograft is limited to anecdotes ...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Thank you all for the thoughtful input and generous sharing of expertise on this challenging case. @Dr. Jonathan Zuckerman – Your detailed interp...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 1 day ago

You could use Na modelling. That is use a higher dialysate Na of 145 for the first 1-2 hours , during which time the higher osmolality ( from inf...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

Having now concluded that 24 hour Creatinine clearance may be inaccurate in estimating true GFR, especially with impaired renal function ( since tu...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

My understanding is that hypokalemia is common in partial obstruction, as tubular function is impaired and losses of K are common. ------------...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

We have a recent patient admitted for resection of a massive mandibular brown tumor . His PTH is 500 ( 5000 in US terminology) with normal Ca and P...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

Serum calcium of 9.5 (assuming normal SAlb) and SPO4 of 4.7 mg/dL are surprisingly good in the setting of the astronomically high PTH levels posted...

View Discussion

risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 day ago

dear friends, 42 year old female with 10 years dialysis vintage, ESRD secondary to presumed hypertension, 7 years on IHD and last 3 years on hom...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

Actual urinary creatinine clearance is the sum of GFR and TS of creatinine. The measured value of urinary creatinine clearance always exceeds measu...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

@Fouad Chebib My understanding is that Tolvaptan has only been approved for MIC C through E. He is a B without data on serial renal function (to ...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

Grazie Giovanni for the clarification and the references. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -----------...

View Discussion

RE: 24 hr urine creatinine clearance 1 day ago

Creatine supplementation does not affect renal creatinine secretion, but rather its overall renal excretion. The creatine from dietary supplements ...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

POTASSIUM HOMEOSTASIS IN OBSTRUCTIVE UROPATHY AND INTERSTITIAL NEPHRITIS RICHARD L. TANNEN Department of Medicine, University California, L...

View Discussion

Spinal Cord Injury, ANS Dysfunction on HD 1 day ago

Good afternoon, I have a question regarding a 72-year-old patient with lumbar spinal cord injury >20 years ago and BP management on IHD. UF du...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Great question and one that we will encounter more frequently as screening genotyping for APOL1 increases. The co-existence of APOL1 high risk alle...

View Discussion

Jynarque for PKD2 with two high risk APOL1 alleles? 2 days ago

Hi, I have a question hoping to survey the crowd for opinions. Pleasant 44 yo M Fhx of kidney disease. Dx with HTN in his 20s. Otherwise healthy. B...

View Discussion