RE: 24 hr urine creatinine clearance 4 hours ago

Actual urinary creatinine clearance is the sum of GFR and TS of creatinine. The measured value of urinary creatinine clearance always exceeds measu...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 4 hours ago

@Fouad Chebib My understanding is that Tolvaptan has only been approved for MIC C through E. He is a B without data on serial renal function (to ...

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RE: 24 hr urine creatinine clearance 6 hours ago

Grazie Giovanni for the clarification and the references. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -----------...

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RE: 24 hr urine creatinine clearance 7 hours ago

Creatine supplementation does not affect renal creatinine secretion, but rather its overall renal excretion. The creatine from dietary supplements ...

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RE: hypertension and Hypokalemia not responding to eplerenone 7 hours ago

POTASSIUM HOMEOSTASIS IN OBSTRUCTIVE UROPATHY AND INTERSTITIAL NEPHRITIS RICHARD L. TANNEN Department of Medicine, University California, L...

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Spinal Cord Injury, ANS Dysfunction on HD 8 hours ago

Good afternoon, I have a question regarding a 72-year-old patient with lumbar spinal cord injury >20 years ago and BP management on IHD. UF du...

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RE: Jynarque for PKD2 with two high risk APOL1 alleles? 10 hours ago

Great question and one that we will encounter more frequently as screening genotyping for APOL1 increases. The co-existence of APOL1 high risk alle...

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Jynarque for PKD2 with two high risk APOL1 alleles? 12 hours ago

Hi, I have a question hoping to survey the crowd for opinions. Pleasant 44 yo M Fhx of kidney disease. Dx with HTN in his 20s. Otherwise healthy. B...

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RE: hypertension and Hypokalemia not responding to eplerenone 13 hours ago

Fully agree, Dr. Glassock. The focus has been on the mechanism for hypokalemia , all the while no treatment for the obstructive uropathy which over...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Without any features of Cushing syndrome or imaging evidence of lung cancer an Ectopic Paraneoplastic ACTH syndrome seems unlikely. What is the rea...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Per the abstract from reference cite "The least interfering drugs are calcium antagonists, alpha blockers, hydralazine, and possibly moxonidine. If...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

"renin undetectable and aldosterone 1.5 indicating primary hyperaldosteronism unless proven otherwise" this is hyporenin hypoaldo state. Apparent M...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Hi K supplementation requirements is not much (10 mEq), would expect more to suspect ENaC activating process. Still will look into cortisol level (...

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RE: A case of tubulointerstitial nephritis 1 day ago

Update on his lab Ca 8.7, alp 86, anti SS-A & B negative, anti-ccp <16 Uric acid 10.6 I have not thought to send for cortisol level since he has ...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Although transplant pathology is not typical, DSA testing is definitely indicated given glomerular capillary wall duplication (occurs in chronic AM...

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RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consultant- SSMC,PureHealth LLC. A...

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RE: pANCA positivity 1 day ago

CRP <1 , hepatitis serologies are negative , ESR not done ------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Se...

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RE: Iptacopan Dosing issues 1 day ago

I agree , but i dont think the rise in C3 levles is specific to IgA patients , or patients with diseases of classic or alternative pathways . Eve...

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RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Dr. Glassock: Agree with you that multiple auto-antibodies should suggest a drug-induced disorder. However, isn't anti-GBM antibody uncommon in tha...

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RE: pANCA positivity 1 day ago

Hepatitis B & C serologies, ESR, CRP? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------------------------------

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RE: pANCA positivity 1 day ago

cardiac echo is normal cryoglobulins - awaited RF is negative we are hoping to get a biopsy There are many reports of low complements in ...

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RE: 67 year old male with Class IV-V lupus nephritis 1 day ago

So sorry for the delay, Dr. Venturelli - we have sent out the flow cytometry this week and pending. I don't have an APOL1 at this time, but do have...

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RE: pANCA positivity 1 day ago

The hypocomplementemia is a bit concerning as this is uncommon in ANCA- associated Vasculitis. The Lupus. Serology makes SLE with nephritis unlikel...

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RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Case #1- a mild crescentic GN with a spontaneous resolution is possible, but not if the aGBM antibody remained elevated on serial testing. Cas...

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pANCA positivity 1 day ago

My colleague has a 20 year old young male who was referred to him from the Police department , where a routine checkup revealed microscopic hematur...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Question how long after proteinuria occurred post transplant was biopsy showing his histology consistent with FSGS And how long after onset of prot...

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RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Is it still possible that your patients have true anti GBM with crescents , but not severe enough to present as RPGN -------------------------...

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RE: 24 hr urine creatinine clearance 1 day ago

I agree with Dr. Rubin - where is the evidence that creatine supplement promote Proximal Tubule secretion of creatinine. I need to be educated on t...

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RE: A case of tubulointerstitial nephritis 1 day ago

I agree with Dr. Rodby- Sarcoidoisis, Sjogrens, Auto-immune lymphoproliferative syndrome , Leptospirosis IgG4 related disease and TINU (without ...

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RE: A case of tubulointerstitial nephritis 1 day ago

I think this patient has prednisone deficiency. :) With the plasma cell rich TIN I thought the IgG4 staining would be positive. The systemic di...

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RE: 24 hr urine creatinine clearance 1 day ago

@Giovanni Cancarini Buon pomeriggio Dr. Cancarini. I was aware of medications that block tubular secretion of creatinine (e.g. cimetidine, Bact...

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RE: 24 hr urine creatinine clearance 1 day ago

Buon pomeriggio Dr. Cancarini. I was aware of medications that block tubular secretion of creatinine (e.g. cimetidine, Bactrim) but, I will be ho...

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RE: 24 hr urine creatinine clearance 1 day ago

Creatinine clearance (ml/min) can be compared to eGFR (ml/min/1.73 sqm of body surface area) only after normalization for a reference body surface ...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

I agree with Dr. Zuckerman and Balan. In the original post the native kidney biopsy diagnosis was FSGS (NOS). The "official " report is very differ...

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A case of tubulointerstitial nephritis 1 day ago

Dear Colleagues sorry for the long post, tried to mention as much important details as possible would appreciate your help with this case A 5...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

I should also note, as we don't have EM in the case, I should have left the ddx a bit broader for a possible monotypic GN. DDX includes PGNMID but ...

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RE: Challenging case of (pseudo?)-hyperkalemia 1 day ago

Thanks for the explanation. So, she has been on treatment since childhood for her congenital heart disease. ------------------------------ Anato...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

I agree. This patient needs to have urologic intervention. What is the issue that is preventing decompression of the obstruction with a simple Fole...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Just read the pathology interpretation of Dr Zimmerman. In that case, the issue changes ------------------------------ Satish Balan MD DM DNB Se...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

The biopsy report suggests Transplant glomerulopathy. This is chronic antibody mediated rejection though C4d is reported negative but the descripti...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

It would be good to clarify the conclusions that the main diagnosis here is "FSGS". Both pre biopsy reports note an MPGN pattern injury with IgG, C...

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RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Obstructive uropathy usually causes tendency towards hyperkalemia rather than hypokalemia. ------------------------------ K.K. Venkat MD Troy MI ...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

No additional recommendations beyond what was recommended by Dr. Glassock. ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 -...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Thanks Dr. Soobadar. I've posted the full English translation of the biopsy report below. Also, just to clarify, in Vietnam we send the biopsy ...

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RE: Challenging case of (pseudo?)-hyperkalemia 1 day ago

Believe no clumping of platelets due to EDTA Which can cause pseudo Hyperkalemia But of course that will be only with serum samples Such a rapid ...

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RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Thanks Dr. Glassock. Unfortunately, we don't have EM here in Vietnam, so the diagnosis relies on Light Microscopy and IF. We also can't get Obinutu...

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RE: hypertension and Hypokalemia not responding to eplerenone 2 days ago

Tomorrow > > > Convince him - he needs indwelling Foley catheter ASAP; keep it until he gets his prostate out. He is going towards nose dive! Would...

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RE: Challenging case of (pseudo?)-hyperkalemia 2 days ago

No, this hasn't been done yet but would be interesting to try. The patient previously had exome sequencing performed, so we asked genetics to re-an...

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RE: Challenging case of (pseudo?)-hyperkalemia 2 days ago

Tadalafil and other PDE5 inhibitors are used frequently, in pediatric cardiology at least, for treatment of pulmonary hypertension associated with ...

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RE: Challenging case of (pseudo?)-hyperkalemia 2 days ago

Why is the patient on Tadalafil 5 mg QD. It us used for erectile dysfunction, in A woman? What symptom or disorder is being treated? Assuming th...

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