RE: Calciphylaxis 14 minutes 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 48 minutes 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 3 hours ago

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

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RE: Hyperkalemia Post Kidney Transplant 3 hours 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 5 hours 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 6 hours 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 9 hours 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 9 hours 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 9 hours 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 18 hours 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 20 hours 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 20 hours 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 22 hours 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 22 hours 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 23 hours 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 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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RE: Hyperkalemia Post Kidney Transplant 2 days ago

How are you defining "Hyperkalemia" ? Are these patients receiving RAS inhibitors.? What is the average eGFR in these patients? -----------...

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Hyperkalemia Post Kidney Transplant 2 days ago

Hi everyone I need to get your thoughts on a recurring issue we’ve been encountering post-transplant: persistent hyperkalemia. Despite dietary m...

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RE: Severe AIN with Crescents 2 days ago

Questions/comments: 1. ANCA results? 2. Is patient on hydralazine or allopurinol - may cause crescentic GN? 3. Type of interstitial infiltrate - if...

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Severe AIN with Crescents 2 days ago

63-year-old female with a past medical history of T2DM, bacteremia, perinephric abscess, leg wounds and urinary retention who presented with rash a...

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RE: ADPKD ON JYNARQUE 2 days ago

Dear Dr. Glassock, the evidence provided in the article that you mention in KI it cannot be considered convincing. The study is too small (only 2...

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RE: ADPKD ON JYNARQUE 2 days ago

Really interesting conversation about SGL2Is and ADPKD and mechanisms--thanks to all-- and the proof will be in the pudding, when the relevant stud...

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RE: ADPKD ON JYNARQUE 2 days ago

6.Kapoor S, Rodriguez D, Riwanto M et al. Effect of sodium-glucose cotransport inhibition on polycystic kidney disease progression in PCK rats. PLo...

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RE: ADPKD ON JYNARQUE 2 days ago

7.Morioka F, Nakatani S, Uedono H et al. Short-term dapagliflozin administration in autosomal dominant polycystic kidney disease-a retrospective si...

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RE: ADPKD ON JYNARQUE 2 days ago

I am not sure this has been established in human patients with ADPKD who are also on RASi. Can you cite any supporting literature for this statemen...

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RE: Hypocalcemia And Hypoparathyroidism 3 days ago

Thanks will do Very helpful --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc. Cincinnati OH (513) 841-0222 ----...

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RE: ADPKD ON JYNARQUE 3 days ago

Thanks But if pt not on Tolvaptan SGLTI will cause high vasopressin which will cause increase expansion of Cysts -------------------------------...

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RE: ADPKD ON JYNARQUE 3 days ago

My point was if decreased renal mass led to increased SNGFR and Glomerular HTN as part of the progressive nature of ADPKD, I would have predicted t...

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RE: ADPKD ON JYNARQUE 3 days ago

Thanks Dr. Rodby for arguing that SGLT2i have no physiological basis for being "renoprotective" in ADPKD. A counterargument is that as cysts expand...

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RE: ADPKD ON JYNARQUE 3 days ago

ADPKD is a genetically programmed tubular disease RAASi : ACEI and ARB work by lowering (ostensibly) predominantly by lowering glomerular capill...

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RE: ADPKD ON JYNARQUE 3 days ago

Until the knowledge gap is filled by well designed RCT this issue will remain as a conundrum for physicians and patients alike. See the excellent r...

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RE: Hypocalcemia And Hypoparathyroidism 3 days ago

Dr Edward Brown at the Brigham has described activating antibodies against the calcium sensing receptor in a variety of conditions causing hypopara...

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