RE: The patient who keeps on giving 2 minutes ago

Interesting case. Was pronase IF performed on the FFPE tissue to exclude masked deposits in this case? Should be considered in any case of C3 domin...

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RE: The patient who keeps on giving 24 minutes ago

I keep seeing this statwment to often. It obviously appears in so many nations. "(fill in your favorite phrase) " Depending on his insurance , it w...

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RE: The patient who keeps on giving 26 minutes ago

Given rapid response of SCr, proteinuria and C3 hypocomplementemia to steroids, should we consider possibility of an antibody to C3 complement-regu...

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RE: Resistant hypertension 1 hour ago

This is an interesting concept raised by Dr. Germain. I thought it was well accepted that chronic hypertension is always the result of sustained in...

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RE: X linked Alport syndrome In Female 1 hour ago

Based on weak evidence the general consensus is that ACEi (Ramipril, Enalapril) are preferred for therapy of Alport Syndrome -------------------...

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RE: Reclast And Recurrent AKI 1 hour ago

Great point - treating reduced BMD in advanced CKD with long acting bisphosphonates is not a good idea!!! ------------------------------ Richard...

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RE: X linked Alport syndrome In Female 2 hours ago

Thanks Dr Glassock GFR 110 creat is 0.8 Will post Genetic report Why UpToDate mention ACEI only not ARBS believe does not matter ---------------...

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RE: The patient who keeps on giving 3 hours ago

We have requested genetic studies ... Depending on his insurance , it will either be done or not done . If we decide to use a complement blocker , ...

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RE: The patient who keeps on giving 3 hours ago

I would definitely wait until you have the results if the DNAJB9 stain. Did you also due genetic studies to evaluate the very low CFH levels ----...

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RE: The patient who keeps on giving 4 hours ago

Yes , I agree, even though we have requested Ravulizumab, this patient has C3G . He can qualify for C3 or Factor B blockers . His insurance will on...

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RE: The patient who keeps on giving 4 hours ago

This certainly looks like C3GN. The results of thecDNAJB9 sating will be crucial, as Fibrillary deposits should not occur in C3GN e. If the DNAJB9 ...

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RE: X linked Alport syndrome In Female 10 hours ago

She has Alport Syndrome of the heterozygous X-linked variety. Father very likely had hemizygous X-linked Alport Syndrome which cannot be transmitte...

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X linked Alport syndrome In Female 12 hours ago

X linked Alport syndrome 26-year-old female nurse with history of microscopic Hematuria at least since 2015 and recently found to have 255 mg of pr...

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RE: Membranous Nephroapthy - Obi vs Rituximab 15 hours ago

Interesting case. As noted above, PLA2R does seem to correlate with relapses. As the patient keeps to depopulate and induce remission with ritu...

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The patient who keeps on giving 21 hours ago

60 year old male from the Sudan. CC: Lower limb edema . Referred to us with S.Cr : 250 umol/l and uPCR of 1.2 g/g Initial hospital labs revealed ...

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RE: Resistant hypertension 23 hours ago

Thank you for this information, Michael. How available is impedance Cardiography? As you know, we can "estimate " total body water and then estimat...

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RE: Resistant hypertension 1 day ago

Though this is not well known, impedance Cardiography is very helpful In determining what class of medication will work the best Impedance cardio...

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RE: Reclast And Recurrent AKI 1 day ago

I also agree. The bigger issue here is treating pts with advanced CKD for osteoporosis. Just because they have a low BMD does not mean they have os...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 1 day ago

https://www.nejm.org/doi/full/10.1056/NEJM199005033221806 Have you checked , what the patient is doing during the blood draw . Some patients prefe...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 1 day ago

This patient's colon is intact. Does that make it unlikely that the high serum K is due to deficient bowel secretion of K.? ---------------------...

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RE: Role of Acthar in secondary FSGS 1 day ago

I presume that her serum albumin is normal. If so, then ACTHAR gel would not be useful (or approved by the FDA). It might even be harmful via aggra...

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RE: Resistant hypertension 1 day ago

Additionally how labile is his BP. If the average is 140/90, this may just be acceptable fot the next week or o. No hurry to get to 130 systolic; d...

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RE: Resistant hypertension 1 day ago

Hb went from 15 to 12 g/dL reflecting about 2 unit of whole blood loss, iie a loss of 20% of hi circulating blood volume. Replaced with? non colloi...

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Role of Acthar in secondary FSGS 1 day ago

I have a 19 yrs Caucasian young lady with obesity with BMI close to 40, normal renal functions and NS range proteinuria. Renal biopsy showed featur...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 1 day ago

Patients with bowel resection especially colon tend to have some degree of hyperkalemia is my understanding. This is because about 10-15% of daily ...

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RE: Resistant hypertension 1 day ago

thank you for suggestion and comment Today his bp is 140 90 , we got hydralazine added and started on 25mg tds dose We don't have minoxidil. And ...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 1 day ago

Mohamed but with normal kidneys without ?k secretion defect even if problem with bowel K should not rise Does not matter how much K one consume K...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 2 days ago

I checked an ABG — pH was 7.42, PaCO₂ 38 mmHg, HCO₃⁻ 24 mEq/L — so no respiratory acidosis or acid-base disorder. She’s not on any thermogenic agen...

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RE: Resistant hypertension 2 days ago

I agree with Dr Rodby and Dr Campese. The rule is HTN in CKD/ESRD is due to excess volume, whether you can detect it clinically or not, but there a...

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RE: Resistant hypertension 2 days ago

Touche ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ------------------------------

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RE: Reclast And Recurrent AKI 2 days ago

I agree. Dr. Mellas. Reclast should be used with great caution in patients with reduced eGFR and never when estimated creatinine clearance is less ...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 2 days ago

Please measure the pCO2 and pH. I have seen several patients with respiratory acidosis causing mild hyperkalemia. Qais Al-Awqati --------------...

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RE: Resistant hypertension 2 days ago

How about combining in them for the mother in law !! --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha ...

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RE: Resistant hypertension 2 days ago

Agree totally. Never combine Minoxidil with cyclosporin, particularly in females. ------------------------------ Anatole Besarab MD ABesarab Con...

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RE: Reclast And Recurrent AKI 2 days ago

I have a patient, 75 yo female, CKD with eGFR 35 ml/min received reclast by primary care physician for Rx of osteoporsis. Creatinine rose to 4.5 ...

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RE: Reclast And Recurrent AKI 2 days ago

Reclast and Zometa are identical agents with equal nephrotoxicity they are just used to treat different conditions , so the names and labels are di...

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RE: Reclast And Recurrent AKI 2 days ago

Thanks Dr Glassock Dont know the dose will check Good to know that different formulations of zoledronic acid So probably Reclast more Nephrotoxic ...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 2 days ago

Although uncommon , consumption of herbal remedies containing dried frog skin (containing a potent digitalis like alkaloid) should be considered an...

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RE: Case of Ig Nephropathy with triple postive autoimmune markers(GBM, dsDNA, and PR3) 2 days ago

Yes I saw that it's ruled out .. just put my 2 cents on a case of dual positive AAV and antiGBM , which are rare .. thank u. --------------------...

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RE: Case of Ig Nephropathy with triple postive autoimmune markers(GBM, dsDNA, and PR3) 2 days ago

The kidney biopsy ruled out anti-GBM disease and pauci-immune crescentic GN due to ANCA. ------------------------------ Richard Glassock MD, FASN...

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RE: C3 Inhibitor - Pegcetacoplan for C3G and RPGN 2 days ago

Yes , as long as they are from migrant workers from Abudhabi, they can be referred to me ... They can always contact us on 9712- 7117467 or WhatsAp...

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RE: Reclast And Recurrent AKI 2 days ago

Reclast and Zometa are different formulations of the same drug-Zoledronic acid (a bisphosphonate ) . Reclast is approved for therapy of osteoporosi...

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RE: Persistent Hyperkalemia with Normal Renal Function & Prior Bowel Resection 2 days ago

I am not sure , about the statement to leave her alone . There could be legal consequences , if something untoward were to happen to the patient , ...

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RE: Case of Ig Nephropathy with triple postive autoimmune markers(GBM, dsDNA, and PR3) 2 days ago

I would have to agree with Prof Glassock.. it's just noise . However would like to point out that we had a case of dual positive Anca and GBM dise...

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RE: C3 Inhibitor - Pegcetacoplan for C3G and RPGN 2 days ago

Thanks for the info. We have a lot of migrant workers from our state in the UAE. This might help them. Will pass on the information ------------...

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RE: C3 Inhibitor - Pegcetacoplan for C3G and RPGN 2 days ago

Dr. Balan. Pegcetacoplan is given to migrant workers , as long as they have a valid visa and residency status in the Emirate ( state ) of Abudhabi....

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Reclast And Recurrent AKI 2 days ago

Seeing a patient 88 year-old who came exactly one year ago on 5/2024 with acute kidney injury with Creatinime of 16 At that time, it wasn’t clear ...

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RE: C3 Inhibitor - Pegcetacoplan for C3G and RPGN 2 days ago

Pegcetacoplan is available for use , not officially approved for C3G , pending either European or FDA approval. We present each individual case to ...

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RE: Case of Ig Nephropathy with triple postive autoimmune markers(GBM, dsDNA, and PR3) 2 days ago

I think the serological findings are likely to be "false positives " or of little clinical relevance. In addition, he should be placed on a RASI or...

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RE: Case of Ig Nephropathy with triple postive autoimmune markers(GBM, dsDNA, and PR3) 2 days ago

In my opinion, this is IgA Vasculitis ( *formerly Henoch -Schonlein Purpura ) and should be managed accordingly, despite the serology of uncertain ...

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