RE: HD consent for hospitalized patients 1 hour ago

Thanks for the statement. Our hosp has the same policy, in-pt consent even for chronic pts. May be I can show them this statement. ----------------...

View Discussion

RE: Distal RTA without AKI from ICPI 4 hours ago

Thank you very much for your comments.  After discussing with the patient, planning to hold off on steroids, treat conservatively with potassium ci...

View Discussion

RE: Anuric AKI from anti-GBM 4 hours ago

Thank you for your comments.  The patient is a never smoker and ANCA is negative. Interestingly, This patient is a firefighter who does get exposed...

View Discussion

High levels of HCG in a male on home HDfor the last 15 years 9 hours ago

Dear All, I would like to ask if anyone has had experience with male dialysis patients with high levels of HCG since a while. Investigation for tes...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 12 hours ago

I agree a biopsy is needed  the response to calcitonin suggests increased bone turnover though the markers do not.  I would continue with calcitoni...

View Discussion

RE: IgAN - Additional treatment? And what? 14 hours ago

For what it is worth, I doubt she ever had lupus, the rash and arthritis may have been the IgAN all along (HSP). regardless the biopsy isn't very "...

View Discussion

RE: C3 glomerulonephritis with Type 2 Cryoglobulins 14 hours ago

While MMF has become a first line choice for C3 GN (attached), with the monoclonal IgM and cryoglobulin I would still prefer to see what Rituximab ...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 14 hours ago

this may indeed be a situation where a bone biopsy is needed. @Stuart Sprague ​ ------------------------------ Roger Rodby MD, FASN Professor of Me...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 16 hours ago

hi Jiunn Bone scan was ordered but she defaulted, so i am arranging for it again.. 12th Feb she was given SC Calcitonin inpatient, total of 3 doses...

View Discussion

RE: C3 glomerulonephritis with Type 2 Cryoglobulins 16 hours ago

I started patient on Steroids and have organised Rituximab- first dose next week. Meanwhile, I got few results of complement studies: Factor H leve...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 16 hours ago

@Roger Rodby Dr Rodby: she has not been on vitamin D, calcium binders 3etc for the past 3 years. cinacalcet was added just 3weeks ago this time whe...

View Discussion

RE: IgAN - Additional treatment? And what? 20 hours ago

Mycophenolate is another option worth considering.  The trial below is from 2017 (old) but may be helpful to you in this case. SGLT2i is another ch...

View Discussion

IgAN - Additional treatment? And what? 22 hours ago

Thank you in advance for help with this case. 48 y/o white woman with SLE - primary rash and arthritis as manifestations.  Previously on prednisone...

View Discussion

RE: Anuric AKI from anti-GBM 22 hours ago

3) pulmonary hemorrhage in anti-GBM disease may require a "second-hit" (e.g cigarette smoking, hydrocarbon exposure , cocaine inhalation , pneumoni...

View Discussion

RE: SGLT2i in elderly with BPH 23 hours ago

I see veterans everyday who are in their 60-70s and I use SGLT2i in many of them. BPH is not a contraindication. Dr. Priti (sorry i don't know her ...

View Discussion

SGLT2i in elderly with BPH 23 hours ago

A 73 yo male with history of HTN and DM2 that is well controlled with Sitagliptin and Metformin has A1c of 5.8 has spot urine protein/creatinine of...

View Discussion

RE: Anuric AKI from anti-GBM 1 day ago

1) untreated anti-GBM disease with extensive crescents and dialysis dependency uniformly leads to permanent Kidney failure.  PLEX and steroids alon...

View Discussion

RE: Too late to biopsy or just treat Hep C? 1 day ago

Thank you @Tejas Desai and Dr. @Richard Glassock , Hep C viral load 87000 Never had treatment Not sure about the his veteran status, but I will see...

View Discussion

RE: Too late to biopsy or just treat Hep C? 1 day ago

If his kidneys are of normal size by US he needs an urgent kidney biopsy.  The findings are compatible with HCV induced GN which may respond to ant...

View Discussion

RE: Secondary + Primary Membranous GN 1 day ago

Like Dr. Rodby, I would wait to see how his SCLC responds to chemotherapy before adding any new IS agents for the MN.  I do not know what to say ab...

View Discussion

RE: Secondary + Primary Membranous GN 1 day ago

Thank you Drs. Rodby, Glassock, Gharib, Desai, Serum albumin is 2.5 to 3.0. We don't have Exostosin staining. 2009 biopsy showed subepithelial, int...

View Discussion

RE: Secondary + Primary Membranous GN 1 day ago

I am not adding to the discussion but opening a can of worms and would like to hear others opinion. The goal of therapy is the reduction of the pat...

View Discussion

RE: Distal RTA without AKI from ICPI 1 day ago

I agree with the sentiment of no biopsy (or steroid) for this patient.  Regarding the impact of platinum related compounds, published literature in...

View Discussion

RE: Too late to biopsy or just treat Hep C? 1 day ago

What is his hepatitis C viral load?  Has he ever been treated with antiviral curative therapy? Even at CKD 5 I believe the patients in C-SURFER wer...

View Discussion

Too late to biopsy or just treat Hep C? 1 day ago

Saw a patient about 3 weeks ago for the first time, with Serum Cr of 5.8, eGFR of 11. Smoker. Hypertensive, not on any meds. Recently re-establish ...

View Discussion

RE: Anuric AKI from anti-GBM 1 day ago

This is sounding like a really sad case. I hope things make a rapid turnaround but given that 27 out of 27 glomeruli are heavily damaged and a crea...

View Discussion

RE: Anuric AKI from anti-GBM 1 day ago

I would say less than 1% chance of renal recovery. Do you have an ANCA too? Chemo to salvage kidneys? No This is typically a single hit one time se...

View Discussion

RE: Secondary + Primary Membranous GN 1 day ago

Do you have an IgG sub-classification? Reference: https://datastudio.google.com/s/jxI8RTJ7nsY Exostosin 1/2 staining would be great, but I think mo...

View Discussion

RE: Secondary + Primary Membranous GN 1 day ago

curious to know was there mesangial deposits revealed by electron microscopy or immunoflourescence in first or second biopsy? was the patient sympt...

View Discussion

Anuric AKI from anti-GBM 1 day ago

32-year-old WM with creatinine 1.0 mg/dl on 2/4/21 which increased to 6.1 mg/dl on 2/19/21 with anuric AKI requiring dialysis. No pulmonary hemorrh...

View Discussion

RE: HD consent for hospitalized patients 1 day ago

I work in hospitals owned by Sentara a large hospital system in Virginia. Consent is required for patients who have never dialyzed. For chronic pat...

View Discussion

RE: Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 1 day ago

This has happened to me a few times.  I've asked my PC colleagues to discontinue the SGLT2i and we've switched the patient to a GLP-1a.  Recent dat...

View Discussion

RE: The cause of cresentic GN 1 day ago

trans esophageal echo to exclude infective endocarditis if-ve rituximab is my choice ------------------------------ Alaa Nabih Abdalla nephrology f...

View Discussion

RE: Distal RTA without AKI from ICPI 1 day ago

@Satish Balan , you are correct in that majority of magnesium (65-70%) is reabsorbed in the thick ascending loop of Henle, but there is little evid...

View Discussion

RE: Distal RTA without AKI from ICPI 1 day ago

@Nelson Leung Clinically, carboplatin nephrotoxicity is accompanied by hypomagnesemia suggesting proximal tubule as the site of injury.   I would h...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 1 day ago

I like the idea of the drifting calcium. I have seen two patients in whom the calcium was completely independent of any pth action where the pth wa...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 1 day ago

Did you end up doing the bone scan? You gave  2 doses of calcitonin  and the ALP came down[More]

View Discussion

RE: Distal RTA without AKI from ICPI 1 day ago

Hi Chintan To answer your questions: 1. I agree with no biopsy and no steroids. Given relatively mild manifestations of presumed renal toxicity fro...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 1 day ago

Perhaps this hypercalcemia has nothing to do with her long past hypercalcemia? She now has a low pth. Could this now be adynamic bone disease and y...

View Discussion

RE: Hypercalcemia in a hemodialysis patient 1 day ago

Thanks Dr Balan, her calcium was ok throughout her CKD trajectory and only started becoming a problem after 1.5-2 years of dialysis. she started HD...

View Discussion

RE: Distal RTA without AKI from ICPI 2 days ago

Thank you for your valuable response Dr. Rodby. Did you mean to say carboplatin could be responsible for distal RTA in this case? As this patient r...

View Discussion

RE: Distal RTA without AKI from ICPI 2 days ago

While cis-platinum toxicity is mostly concentrated in the S3 segment, Carboplatin nephrotoxicity is less well studied.  Clinically, carboplatin nep...

View Discussion

RE: Asymptomatic Bacteriuria in older patient with SGLT2-inhibitors 2 days ago

Dr Balan is right that there is no enough data or consensus.  My Concern is that pt had h/o UTIs in the past.  Diabetic frequency has bladder dysfu...

View Discussion

RE: Distal RTA without AKI from ICPI 2 days ago

Thank you for your valuable response Dr. Rodby. Did you mean to say carboplatin could be responsible for distal RTA in this case? As this patient r...

View Discussion

RE: Distal RTA without AKI from ICPI 2 days ago

The lack of AKI doesn't rule out AIN completely, but I dont think it matters. Your approach is fine, I would probably give a short course of steroi...

View Discussion

RE: AKI -Anuria 2 days ago

Urinalysis? Medications? may need biopsy ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center C...

View Discussion

Distal RTA without AKI from ICPI 2 days ago

46 yo WF with Metastatic lung adenocarcinoma and invasive sq cell cancer of right tonsil since 3/2020. s/p 6 cycles of carboplatin/taxol/pembrolizu...

View Discussion

RE: AKI -Anuria 2 days ago

Hello all,  Good learning point from this case.  Question: I have a patient 51 yr old F whose creatinine is slowly worsening. She has 1.2 cm non ob...

View Discussion

RE: The cause of cresentic GN 2 days ago

Sometimes it is impossible to wedge an individual patient into the rigid confines of a classification system. This case is a good example. Low C3 a...

View Discussion

RE: Challenging case 2 days ago

For false positive APL I quote up-to-date uncertainty about their clinical significance [ 7 ]. Timing of testing  -  Initial testing is usually...

View Discussion