Recalcitrant severe hyponatremia 5 minutes ago

I have a 48-year-old female who presented with severe hyponatraemia with headaches and no other symptoms. She was not confused. Sodium level had...

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RE: C1q Nephropathy - diagnosis? treatment suggestions 3 hours ago

Thank you so much for all insights. Will discuss and try to get more detaled info from our pathologist. Not sure how many glomeruli examined, ...

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RE: TMA Case 7 hours ago

Hello The aHUS panel is very different from aHUS//C3 genetic screening . In the panel they do levels of the components of Alternate pathway, such ...

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RE: Lupus nephritis 8 hours ago

We decided to start with mycophenolate. Will add voclosporine or benlysta as outpatient. Thank you all for your help. ---------------------...

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RE: TMA Case 14 hours ago

Thank you Drs Glassock, Beasarab and Dastoor. I was unaware the Mayo Clinic testing would take a mo. We will reach out to the Mayo Clinic to see if...

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RE: TMA Case 16 hours ago

I agree , you may not find a Monoclonal protein in the blood and Bone marrow may also be inconclusive . Also I see you have sent genetic testing t...

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RE: TMA Case 16 hours ago

See Meri S, et al J Exp Med 1992; 175: 939-950. Similar mechanisms are presumed to be operative in monoclonal LC induced TMA. -------------------...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 16 hours ago

O have a problem with such analyses which examine the length and quality of life years saved by a new therapy. At $59,000 pre QALY , most middle-cl...

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RE: TMA Case 17 hours ago

Thank you for the explanation. Makes sens;, Is there data to support i?. a Monoclonal spike is also found in MGUS where neuro symptoms and findi...

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RE: Hypertonic and Hypotonic Hyponatremia 17 hours ago

I am not sure , but literature states that Renal failure in Mannitol intoxication , is due to 2 mechanisms , an intense renal vasoconstriction and ...

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RE: TMA Case 18 hours ago

In this scenario the actual amount of monoclonal protein in the circulation is not very important, as the TMA is not due to the deposition of monoc...

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RE: Suspected Infection Related MPGN 18 hours ago

Fully agree!!! ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Hypertonic and Hypotonic Hyponatremia 19 hours ago

If you are attributing the AKI to be secondary to mannitol, why would a single dialysis treatment correct it? The osmotic nephrosis would be caused...

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RE: Suspected Infection Related MPGN 19 hours ago

Yes the prognosis is quite poor. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------...

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RE: TMA Case 19 hours ago

The questions I have are the following Is the amount of M-protein circulation large enough to account for the degree of pathologic changes . ...

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RE: Suspected Infection Related MPGN 21 hours ago

This case aligns with "Cluster 3" of cirrhosis-IgAN in the article published in KIR mentioned by Jonathan Zuckerman. (https://www.kireports.org/ar...

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RE: TMA Case 1 day ago

Tough decision. It is a judgement call. The patient needs to be informed of tge risk of fatal niningiciccal Dusease in the absence of immunization ...

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RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

So this patient was started on dialysis , with a Pna of 118 and Serum osmolarity 300 Osmolar gap of 46 attributed to Mannitol She was dialysed aga...

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RE: TMA Case 1 day ago

Thank you Dr Glassock. I did not make much of the slight MGUS with a relatively normal light chain ratio. I also though I might see an immunologic ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Any possibility of getting sample drug "free:. The key word sf "FREE," Of course you assume all of the responsibility for the patient. On 3 attempt...

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RE: TMA Case 1 day ago

With severe Renal limited TMA at this age with a monoclonal protein identified, would strongly suspect a MGRS presenting as a TMA. Eluluzumzb plus ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Compassionate use is an interesting concept . We don't allow it in Abudhabi, because once the drug is approved by the FDA , we are then obliged to ...

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RE: TMA Case 1 day ago

I should also mention, no hx of problematic htn. No features of clinical scleraderma. ------------------------------ Shaun Joshi MD North Idaho N...

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TMA Case 1 day ago

Dear colleagues, this is the first time I am posting on the ASN blog. Greetings from North Idaho! I recently picked up the nephrology service from ...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

I used to be involved with pharamcoecnomic studies with captopril and Irbesartan after those studies came out so I am a bit familiar with what is c...

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RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

" In light of her worsening renal failure , persistent Osmolar gap, I think it may be best to dialyse her , remove mannitol and allow kidneys to re...

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RE: Hypertonic and Hypotonic Hyponatremia 1 day ago

With this UNa would be hard to call it SIADH. this seems to be hypovolemic hypoNa Would require also repeat AM cortisol and Cosytropin stim tes...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

UpToDate suggests that patients receiving > 20mg daily who are HBs- and HBc+ are at risk for reactivation of HBV reactivation (including flooding s...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

O see the problem Novartis in it's (non) wisdom has priced Iptacopan for IgA at the same price as PNH indication. Who is sponsoring the ongoing Ipt...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

Agree, there are many ways to diurese him. But with severe hypoalbuminemia and thereby low oncotic pressure how can we redistribute more of his int...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

Recommendations vary for kidney tranplant recipients who are HBVsAg-/cAb+ve. Uptodate recommends anti-viral prophylaxis but not duration, EASL guid...

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RE: Lupus nephritis 1 day ago

Which one of the "Chinese Menu" if choices do you plan to use for initial therapy of this patient? ------------------------------ Richard Glassoc...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

Understood- common use, not supported by data- largely based on inferences from diabetic studies. Not included as recommended therapy by UpToDate, ...

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RE: Coronary angiogram in AKI 1 day ago

IMO, the most important practical points of the "Special Report" is that the risk of CI-AKI with IV contrast for eGFR> 30 is 0-2%, ie, nil, and, as...

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RE: Iptacopan In High Risk Patients With IgA .... not Again !! 1 day ago

Iptacopan , has been used for PNH , and being a very rare disease has been priced at an astronomical amount . Novartis in it's (non) wisdom has pri...

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RE: Lupus nephritis 1 day ago

Would you use Trimethoprim prophylaxis with antiCD 20 agents or only with steroids --------------------------------- Dr. Hormaz Dastoor. MD, FASN...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 1 day ago

In absence of ET1a , we use MRA's with RASi and SGLT2i, to reduce proteinuria . Is this EBM , probably not .. but as once said , Absence of Evidenc...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

I beleive that HDV reactivation can occur with post-transplant immunosuppression. Where dud you obtain informationbsupporting your conjecture that ...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

In cases like this the following always worked (in my hands): 3x 250 mg furosemide 50 mg chlortalidone or 40 mg xipamide (all as tablets; may...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 2 days ago

I believe with HepB core positive prophylaxis needed only when giving Rituximab Even not long term in Tx pt unless Liver Tx Please kindly correct ...

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RE: Coronary angiogram in AKI 2 days ago

Sure Prof.,my concern related to its practical predictive utility before giving contrast, Regards ------------------------------ Ahmed Yasin, M...

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RE: Coronary angiogram in AKI 2 days ago

The Mehran Score has utility in predicting risk of developing "CI-AKi" after Coronary angiography and PCI- in my opinion , it has no proven role in...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 2 days ago

I am curious why you would add an MRA. The patient is non-diabetic. Maybe a GLP1RA would be better to counteract the Obesity. I do not disagree wit...

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RE: Coronary angiogram in AKI 2 days ago

What do you think regarding applicability of Mehran 2 score in that context? ------------------------------ Ahmed Yasin, MD,FASN Al Ahmady,Hospit...

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RE: 67 y/o caucasian male BMI 34 with IgAN eGFR decline 60-40-37 in 2 years 2 days ago

1. Steroid based regimen and MMF if concomitant hematuria 2. I would add MRA , but doubt will be effective , if Sparsentan and SGLT2i were ineffect...

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RE: Suspected Infection Related MPGN 2 days ago

Many things influence the exertion of protein in urine. My interest in this area dates back 40 years. J. W. Swanson,A. Besarab,P. P. Pomerantz, an...

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RE: Suspected Infection Related MPGN 2 days ago

Since genetic mutations are coon in the normal population , I usually do not order them given their cost and their utility in diagnosis. However if...

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RE: Suspected Infection Related MPGN 2 days ago

pre AKi alb levels before both episodes ~ 2.2 , after albumin administration 2.7--3.6 in the hospital. Agree with your point about the denominator ...

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RE: Suspected Infection Related MPGN 2 days ago

For the female pt with recurrent uti- c3 level during infection episodes 50-60. inbetween- wnl C4 levels have been wnl through out Hep C ab...

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RE: Suspected Infection Related MPGN 2 days ago

Dr. Paramasivam: Your cirrhotic patient has had 2 episodes of AKI-on-CKD. After the first episode, SCr improved to 1.7 mg. During the current episo...

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