RE: Elevated BUN evaluation 5 hours ago

If available, I would obtain a measured GFR in this patient. If not available, I would do a 24 hour urinary creatinine clearance. ---------------...

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RE: DHP/Diuretics as 2nd line antihypertensive in DKD 5 hours ago

RASi ate always first choice for therapy of hypertension In DKD. I prefer to combine them with diuretics (chlorthalidone) if needed and try to av...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 6 hours ago

I think that OBI + MMF + hydroxychloroquine is the best option for this patient. Belimumab probably will not do much with this degree of proteinuri...

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DHP/Diuretics as 2nd line antihypertensive in DKD 6 hours ago

2022 KDIGO guidelines recommend dihydropyridine calcium channel blockers (DHP-CCBs) or diuretics as second-line antihypertensive agents in diabetic...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 8 hours ago

Thank you for your responses: Dr Abra: I actually like this option, between Rituxilup and the Nobility trial Dr Campese: The patient was p...

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RE: Diffuse proliferative GN 9 hours ago

Agree for infective endocarditis related proliferative GN and new 2023 criteria including PCR for microbiological diagnosis, CT scan and even FDG P...

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RE: Elevated BUN evaluation 14 hours ago

My assumption was both volume depletion with high protein. wondering why the sarcopenia adds to the situation. wouldn't this contribute to less end...

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RE: Elevated BUN evaluation 14 hours ago

"But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if this couple with high serum cystatin-c, doesn't this indica...

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RE: Elevated BUN evaluation 16 hours ago

Agree with the quintuple whammy to explain this scenario. But I see that there is tripling in serum creatinine from baseline (0.4 to 1.1) and if th...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 16 hours ago

The information provided that this is a case of class III/V LN and not pure class V and so my choice would be MMF plus Belimumab if non-nephrotic a...

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RE: Elevated BUN evaluation 17 hours ago

I have also been a big proponent of FE UN as an index of kidney status in acute situations (both for renal perfusion and catabolic rate). In this c...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 18 hours ago

The patient was admitted with anasarca and AKI. I presume UACR was high and sAlb very low. In this contest, I would like to know more about the r...

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RE: Elevated BUN evaluation 18 hours ago

I assume this patient is not on steroids or a tetracycline which can increase BUN level. Doxycycline is the only tetracycline with lesser effect of...

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RE: PLA2R positive membranous nephropathy 21 hours ago

Is the high levels of serum PLA2R Ab or the severe nephrotic syndrome or the necessity for faster onset of action, the rational for combining RTX p...

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RE: PLA2R positive membranous nephropathy 1 day ago

I agree with Dr. Rodby and would pick a regimen that does not involve steroids. High dose RTX (to compensate for urine losses of RTX) and kis dose ...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

Obinutuzumab and MMF might be a nice option given the patient is declining steroids - sort of an updated Rituxilup steroid free regimen. --------...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

I have seen this in DKD and retell in IgA. These patients do poorly on RASi and I agree that CNI are relatively contraindicated. With pure Type V L...

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RE: Elevated BUN evaluation 1 day ago

I agree- a"quintuple whammy"-very rarely observed in the wild. It belongs in the museum of rare disorders. Kind of an extreme version of Hickams di...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

Many thanks Dr Rodby, she was just admitted with AKi (creat up to 2mg/dL, now improving) with active sediments, ascites and anasarca, prompting the...

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RE: Elevated BUN evaluation 1 day ago

Agree with Dr Glassock, too much protein -> urea and very little muscle mass -> low creatinine. the only thing that bothers me (uinsg this numbe...

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RE: PLA2R positive membranous nephropathy 1 day ago

Thank you so much Dr. Rodby. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 --------------...

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RE: PLA2R positive membranous nephropathy 1 day ago

Personally I dont think you need malignancy wu in this patient but mammogram and pap are fine. I would be fine with your plan, the CNI for a ...

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RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

I dont know if there are data on this but I would not use it exactly for your reasons. What does she have now that makes you consider using Voclo...

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Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 day ago

Dear all, I have a 36y AA lady dx with biopsy proven LN class 3 and 5 (Ext-2 +ve). creat has been 0.8-1mg/dL. seems like she was treated a few y...

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PLA2R positive membranous nephropathy 1 day ago

46 year-old white female with type2 DM and obesity (BMI 31) who presented with progressive lower extremity swelling and weight gain and was found t...

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RE: Elevated BUN evaluation 1 day ago

Most likely a sarcopenic patient (with low creatinine generation), impaired kidney function (50% of normal for her age) on a high protein intake (>...

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Elevated BUN evaluation 1 day ago

I have a 61yo weight 60kg with some edema who was in an accident a month ago and eventually required tracheostomy and PEG. I was contacted for BUN ...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Really appreciate your quantitative-qualitative reasoning. I have usually used the Fx E of K in trying to solve K issues in a given patient. ----...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Based on Halperin's editorial and commentary on U urea and its affect on U K excretion I ran some simulations using many of his assumptions. It sho...

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RE: Diffuse proliferative GN 1 day ago

I apologize for the delay. He was admitted to another hospital (for volume overload) during which I had asked them to get the TEE while he was inpa...

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RE: Diffuse proliferative GN 1 day ago

He is seeing cardiology today and his daughter (a physician) is going to ask about the TEE and explain my concern about endocarditis and the new fi...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you Venkat. During my 18 years ta HFHS, I remember few cases presented of transplant kidneys during the conferences for our Fellows. So I wil...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

"Relatively widespread tubular vacuolar degeneration was noted." Isometric tubular vacuolization can be caused by CNI nephrotoxicity. ---------...

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RE: Calciphylaxis 1 day ago

I've wondered about the extremely (far too) simple standard story of STS finding Ca deposits in walls and tissues, leeching them out, and being dia...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Dr Glassock. Bx showed Relatively widespread tubular vacuolar degeneration was noted. Could this reflect inadequate O2 delivery to tubules bi...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Yes, a plot of Serum CR vs time with episodes of hospitalization would be very helpful . We might see a tendency for an upward drift in baseline cr...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

@Shoko Nawa I am curious. Is quadruple therapy (MMF, Pred, TAC, Sirolimus) your usual immunosuppresive regimen following what appears to be a un...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

I am confused. He is admitted multiple times. Treated as though he is "dehydrated" [ I assuming this is deemed as volume depletion, and he receives...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Would agree a repeat contrast study post angioplasty is appropriate to exclude restenosis with stenting of lesion if found to be henodynamically si...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you for summarizing the discussion. During fluid resuscitation, there were no significant fluctuations in blood pressure, which remained co...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

@Emilio Venturelli There were no signs of that. ------------------------------ Shoko Nawa MD Senior resident Hyogo prefectural Nishinomiya Ho...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you. At the renal biopsy performed five weeks post-transplant, interstitial inflammatory cell infiltration was predominantly perivascular a...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you. When an improvement in renal function was achieved, it returned to baseline. ------------------------------ Shoko Nawa MD Senior resid...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you for the additional information. The immunosuppressive regimen was initiated with tacrolimus, MMF (mycophenolate mofetil), and prednisol...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you for the additional information. The immunosuppressive regimen was initiated with tacrolimus, MMF (mycophenolate mofetil), and prednisol...

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RE: Calciphylaxis 2 days ago

I think this a key point about calciphylaxis, we need to more deeply understand the pathophysiology in order to treat it successfully. Nice write ...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 2 days ago

Patient with Hypoplastic kidneys due to congenital coarctation of the aorta, underwent a living-donor renal transplant from his mother at age 32. O...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 2 days ago

Agree , are we blaming the allograft dysfunction on the main stenotic RA ? How is the flow in the rest of the kidney? Can you share the biopsy repo...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 2 days ago

Any signs of atheroembolic disease as an explanation for the second acute graft dysfunction episode? ------------------------------ Emilio Ventu...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 2 days ago

This is the publication from our group referred to by Dr. Rubin: https://www.ajkd.org/article/S0272-6386(88)80107-0/fulltext This is the only cas...

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