Young male patient with IgA nepropathy 1 hour ago

Dear Collagues 26-year-old male with no known chronic disease. His serum creatinine was within the normal range in March 2025, then increased ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 8 hours ago

Serial PTH levels with corresponding serum calcium levels? Possible that PTH was higher and came down when hypercalcemia by a non -parathyroid caus...

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RE: Hypercalcemia in tertiary hyperparathyroidism 9 hours ago

If he becomes hypocalcemic, it would increase the PTH, but if the Calcium remains high normal and elevated likely not Very difficult case, not su...

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RE: Hypercalcemia in tertiary hyperparathyroidism 9 hours ago

bone excavation is in progress We need to stop the osteoclasts. This is hyper dynamic [not a-dynamic] renal osteo-dystrophy type. He might be b...

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RE: Hypercalcemia in tertiary hyperparathyroidism 9 hours ago

Dr. Sprague- Won't Denosumab therapy worsen the hyperparathyroidism? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Hypercalcemia in tertiary hyperparathyroidism 20 hours ago

High alkaline phosphatase, low phosphorus, high calcium, high PTH = Primary vs. tertiary hyperparathyroidism. Have you done a neck ultrasound looki...

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RE: Hypercalcemia in tertiary hyperparathyroidism 20 hours ago

The handful of patients I have treated with similar presentations all responded to higher dose of parsabiv, which can go to 15 mg per session. --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 20 hours ago

Then it is likely not adynamic bone and would proceed with either Pamidronate or Denosumab, whichever you feel more comfortable with. Would still m...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

Alkaline phosphatase is elevated at 320 IU/L (normal range 60-116) ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai --...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

At his age, I would not pursue a bone biopsy, though would check a Bone Alk Phos to see if it is relatively low. I also would not use teriparatide ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 21 hours ago

@Stuart Sprague ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773) ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 22 hours ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase levels? Skeletal X-ray findings including hands? ------------------------------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

This high level of serum iPTH makes adynamic bone disease rather unlikely but a bone biopsy would be required to exclude it completely ----------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

PTH level of 70 pmol/l (normal range 1.6- 6.9) with hypercalcemia , is tertiary hyperparathyroidism still questionable in this context? suspecting ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I am sorry for the typo , as ionized calcium is 7.5 mg/dl normal range (4.45 -5.29). adynamic bone disease with suppressed PTH is commonly encoun...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

In my experience Denosumab at 60 mg dose, has not led to a prolonged Hypercalcemia, but does cause severe hypocalcemia . Additional benefit , con...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Non-lateralizing back pain in a female with gross hematuria. . Not likely to be Nutcracker Syndrome. Pelvic pain or “heaviness” or Dyspareunua is m...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Hi, did she have a CTa or MRa? Would check the aortomesenteric angle to assess for nutcracker syndrome. Is she very thin? -----------------------...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

If hematuria dysmorphic (with acanthocytes) no need to evaluate fir Renal TB. If UACR normal and persistent dysmorphic hematuria present biopsy is ...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Not a bad idea but genetic testing has little no value in diagnosing IgAN, at the present time. No increase in UACR -no kidney biopsy, as a general...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I would avoid Bisphosphonates if adynamic bone disease is suspected., especially If the patient is on activex Vitamin D alalogure ( alphacalcidiol)...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Have --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

If this patient patient was to face adynamic bone disease bone biopsy what would pamidronate do? Thanks --------------------------------- Muhamma...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

There is no rush here. I usually do genetic testing before any kidney biopsy. Results in less than 2 weeks now. ------------------------------ ...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

If Dysmorphic rbc and no proteinuria would you biopsy prog glassock Should we check for urinary tb? Thanks --------------------------------- Mu...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Microscopic Haematuria persists She had ct scan --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

No clots , non colicky , non lateralising , no fh of renal disease, white British Urinary acr normal --------------------------------- Muhamma...

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RE: Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

Did she have a nob-cintrast CT. Is the pain colicky or lateralizing ? Any clots with gross hematuria . what is her ancestry and family history ? Wh...

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Macroscopic Haematuria With Microscopic Haematuria In 26 Female 1 day ago

26 female , active in sports , fit and well September 25 starred with macroscopic haematuria and back pain ( while Lowe back ) and microscopic Ha...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I dont know why, but PTH never seems to be totally suppressed in ESRD, you said the "He was found to have hypercalcemia with serum ionized calci...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Dr. Rodby thank you for your advise. Hypercalcemia of immobility could it be in this range 7.5 mmol/l.? if its not tertiary hyperpara. why PTH ...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

dialysate calcium 1.25. this the least we have. ------------------------------ Wael Jebur MD drwaellatif@hotmail.com Dubai ---------------------...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 1 day ago

My understanding is that a renal phosphate leak is commonly found in hypercalciuric renal stone formers, not due to excess FGF23. My questions ar...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I agree with Dr. Rodby Denosumab should not be used. What is the dialysate Calcium level. Should (or can) it be reduced. ------------------------...

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RE: Hypercalcemia in tertiary hyperparathyroidism 1 day ago

Denosumab has been shown to have prolonged hypocalcemia in ESRD I suspect this is immobilization hypercalcemia not tertiary hyperpara I would...

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Hypercalcemia in tertiary hyperparathyroidism 1 day ago

I would like to share this case with the community looking for your kind input. A 76-year-old long term care unit patient who is a case of chroni...

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RE: ?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 1 day ago

you can try dipyridamole for the renal phos leak... https://www.nejm.org/doi/full/10.1056/NEJM199407073310122 ------------------------------ To...

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RE: SLE with proteinuria 2 days ago

I agree fully with Dr. Rubin's skepticism concerning the hypothess of A T-Cell cytokine mediation of Lupus Podocytopathy. I know of no direct evide...

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RE: SLE with proteinuria 2 days ago

Thank you Dr. Wehbe for the references. They are all outstanding descriptions of the clinical entity of "Lupus Podocytopathy". I was referring to b...

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RE: SLE with proteinuria 2 days ago

https://pubmed.ncbi.nlm.nih.gov/15548564/ J Am Soc Nephrol. 2005 Jan;16(1):175–179. doi:10.1681/ASN.2004050350. https://pubmed.ncbi.nlm.nih.gov/26...

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RE: SLE with proteinuria 2 days ago

Could the proteinuria be due to Sulfasalazine ? , Case reports of non-nephrotic proteinuria , normal LM and IF and moderate FP effacement by EM hav...

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RE: SLE with proteinuria 2 days ago

My pleasure. Your guess is as good as mine. Let's ask Dr. Radhakrishnan for his thoughts. He was part of the very early description(see below) of t...

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RE: SLE with proteinuria 2 days ago

Thanks Dr. Rubin for this helpful reference, According to these criteria (and these of Olivia-Damaso )) this patient cannot be unequivocally catego...

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RE: SLE with proteinuria 2 days ago

I am attaching a great editorial by the Columbia group which provides a very simple diagnostic approach to this entity and is easy to understand an...

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RE: SLE with proteinuria 2 days ago

@Edgard Wehbe Can you please provide a reference(s) that support your point (i.e. lupus podcytopathy is a T-Cell disorder). Thank you ---------...

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RE: SLE with proteinuria 2 days ago

Dear Dr Glassock Thanks for the information Attaching the reference ------------------------------ Satish Balan MD DM DNB Senior Consult...

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RE: SLE with proteinuria 2 days ago

According to the Olivia- Damaso criteria (Olivia-Damaso, N et al, Adv Chronic Kidney Disease, 2019;;26:369-375) mesanfual immune deposits are not a...

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RE: SLE with proteinuria 2 days ago

I thought that the diagnosis of lupus podocytopathy required the presence of mesangial deposits. In this case there are no deposits whatsoever. The...

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RE: SLE with proteinuria 3 days ago

I agree , but the steroid and MTX therapy confound interpretation. I suppose this could be a partially treated anti-nephrin autoantibidy disease, b...

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RE: SLE with proteinuria 3 days ago

@Richard Glassock: Don't the always normal SAlb, subnephrotic proteinuria and (I presume) lack of edema make lupus podocytopathy unlikely, unless o...

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