RE: AKI after living related kidney transplant 36 minutes ago

Yes salt intake is associated with urinary calcium excretion but the patient in question has no evidence of nephrolothiasis or calcium deposition o...

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RE: Dialyzing A Patient Declared Brain Dead 54 minutes ago

I have done this many times during my fellowship ------------------------------ Cagil Deniz Arslan MD Cape Girardeau MO (312) 478-9102 ----------...

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RE: Albuminuria vs Proteinuria 1 hour ago

In young patients ACR is sufficient. In older population, with higher risk for gammopathy, it is better to get UPC and ACR. you can have > 5 grams ...

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RE: Biopsy for Alport vs Genetic testing 4 hours ago

Interesting. I probably would biopsy the older patient with more advanced CKD. However a sensorineural hearing loss may be due to aging and an inp...

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RE: 65 yr female with polyuria 4 hours ago

Which explains the low urine urea ------------------------------ Satish Balan MD DM DNB Nephrologist Kerala Institute of Medical Sciences Trivand...

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RE: 65 yr female with polyuria 4 hours ago

No..not on protein restricted diet but due to fear of urination more..she hardly taking anything in dinner as with food she needed to take water al...

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RE: AKI after living related kidney transplant 4 hours ago

There is a linear association between salt intake and calcium excretion even for modest levels of salt intake, that is probably the basis of recomm...

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RE: 65 yr female with polyuria 4 hours ago

It may be better to remove the lab report and post a de-identified report as patient and lab data are clearly visible. She is a 45kg lady. Assumin...

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RE: anaphylaxis to feraheme 6 hours ago

Why does the patient require IV Iron therapy? Why not oral iron formulations? --------------------------------- Richard Glassock MD, FASN Emeritu...

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anaphylaxis to feraheme 7 hours ago

I have a 33 YOM with lupus nephritis, anemia with iron deficiency. He had anaphylaxis to feraheme infusion. He has not received any other IV iron i...

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RE: 65 yr female with polyuria 8 hours ago

Using Dr Rodney's calculation and excluding the U osm of 411 this is a urine with high Na reflecting high intake and positive free water excretion ...

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RE: 65 yr female with polyuria 8 hours ago

You may be correct. The normal values cited are those for urea excretion , not urea nitrogen. Why is the urea content of urine so low? Is the patie...

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RE: Albuminuria vs Proteinuria 8 hours ago

maybe discrepancy is the protein creatinine ratio is picking up non albumin protein as well , given recent cancer diagnosis- like light chains?? -...

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RE: Biopsy for Alport vs Genetic testing 8 hours ago

Excellent point Dr. Venkat. I should emphasize that in such situations, the choice between genetic testing and kidney biopsy is not "either or" but...

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RE: Dialyzing A Patient Declared Brain Dead 8 hours ago

I have been asked to do this before, it was only for 48 hours or so. I believe early ATN on a young donor patient but I'm not sure. Also I believe ...

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RE: Dialyzing A Patient Declared Brain Dead 8 hours ago

Things to know 1. Common practice for OPO to request measures to stabilize Brain dead donors ( as mechanical chest compression is sometimes start...

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RE: Biopsy for Alport vs Genetic testing 9 hours ago

Since other renal disorders (IgA nephropathy, other glomerulopathies, AIN, ATN, etc.) may be superimposed on Alport Syndrome, genetic testing alone...

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RE: 65 yr female with polyuria 11 hours ago

Not really but it would be best done on a 24 hour urine collection to really determine daily osmotic excretion Preferably as out pt under normal ...

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RE: Dialyzing A Patient Declared Brain Dead 11 hours ago

I would do anything to increase the odds of a brain dead patient being able to donate a liver or heart lungs etc. The problem is if you need crrt y...

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RE: Dialyzing A Patient Declared Brain Dead 14 hours ago

This is new "policy" to me. CRRT for a "dead" donor, must be an uncommon event. How would it be Re-imbursed , what are the specific indications and...

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RE: 65 yr female with polyuria 14 hours ago

As per the lab..it is urea....so today..i m repeating all the value.....one question...is there a specific time when we should do a urine osmolalit...

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Dialyzing A Patient Declared Brain Dead 15 hours ago

I am being asked by UNOS to start CRRT on a patient who was just declared brain dead and family consented to organ donation. The director just call...

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RE: Biopsy for Alport vs Genetic testing 20 hours ago

What is the Family History in both cases? . If compatible with a heterozygous mutation of a X-linked genetic disorder, I would do genetic testing f...

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Biopsy for Alport vs Genetic testing 20 hours ago

I have two females suspected Alport syndrome with proteinuria, hematuria & sensorineural hearing loss, and I am wondering which one to do, renal bi...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 21 hours ago

Thank you! I will discuss this with the patient's GI physician. ------------------------------ Halil K. Erol, M.D. Tulane University New Orleans, ...

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RE: Biopsy In Anti Gbm Disease 21 hours ago

I am not “anti-biopsy” in pure anti-GBM disease. I just think that one should be cognizant of its limitations as a guide to therapy or declaration ...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 21 hours ago

There is an association between Nutcracker Syndrome and annular pancreases causing chronic pancreatitis . ERCP/MRCP May be indicated.. see Sagirogl...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 22 hours ago

Her BMI is 16, malabsorption is present. ------------------------------ Halil K. Erol, M.D. Tulane University New Orleans, LA (504) 275-7488 -----...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 22 hours ago

Fasting triglyceride: 56 mg/dL No eosinophilia (1.2%) US Renal Doppler: partial compression of the Left renal vein with pre-stenotic dilation ---...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 23 hours ago

Any features of malabsorption from chronic pancreatitis? What are the triglyceride levels (fasting)? Any eosinophilia? I agree with Dr. Rodby about...

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RE: 65 yr female with polyuria 23 hours ago

Please check with the lab about the urine Urea- is this Urea or Urea Nitrogen?. If it is the latter, there no missing osmoles, and the patient has ...

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RE: Biopsy In Anti Gbm Disease 1 day ago

Let us know what the biopsy shows and how it changed the management of the patient. --------------------------------- Richard Glassock MD, FASN E...

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RE: Simultaneous focal, segmental necrosis in glomeruli (? recurrent ANCA-related GN) and BKVAN in second kidney transplant and 1 day ago

I am sorry if I did not make it clear: Both BKVAN and segmental necrotizing GN were found in the same kidney biopsy. Positive BKV-PCR result became...

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Albuminuria vs Proteinuria 1 day ago

What is your to go test? I usually get Urine Alb/Cr, but at least once a Urine Pr/Cr as well. Occasionally, order both urine Alb/Cr and Pr/Cr at...

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RE: 65 yr female with polyuria 1 day ago

U Na = 284.3 meq/d U K = 45.68 meq/day 284.3 + 45.68 = 329.98 329.98 X 2 = 660 mosm/day in Na and K/d urine urea 6.93 g/day, MW urea is 60 the...

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65 yr female with polyuria 1 day ago

I have a patient of 65 yr old female c/0..excess urine output from 15 yr...patient is non diabetic..All serum lab parameter is normal.But whenever ...

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RE: Simultaneous focal, segmental necrosis in glomeruli (? recurrent ANCA-related GN) and BKVAN in second kidney transplant and 1 day ago

there is a lot here. but to answer one question, granulocyte stimulation has been well established as a cause of vasculitis relapse. see attached, ...

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Simultaneous focal, segmental necrosis in glomeruli (? recurrent ANCA-related GN) and BKVAN in second kidney transplant and 1 day ago

I wish to obtain the impressions/recommendations of the Forum participants regarding the following patient. Questions: 1. Could (Evushield® or filg...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 1 day ago

As a nephrologist, If I even get just a whiff of pancreatitis, and any question of a diagnosis, I think IgG4 IgG4 IgG4 related disease. Since you c...

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RE: Dual ANCA + anti-GBM + 1 day ago

I think this means that the presence of dual-ANCA/anti-GBM is bad except when it isnt. Frankly my limited experience is that nothing is worse than...

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RE: Renal nutcracker syndrome and pelvic congestion in the setting of chronic pancreatitis, glucose intolerance, and weight loss. What to do next? 1 day ago

Acarbose may be a contributory factor as the drug is advised along with meals. May not be a good choice on a patient with chronic pancreatitis. You...

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RE: Biopsy In Anti Gbm Disease 1 day ago

I think the indication for renal biopsy here is to wean or continue IS therapy and totally agree with Dr. Glassock insightful input. Not for Dx bu...

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RE: Biopsy In Anti Gbm Disease 1 day ago

So far as I know there is no "cut off" for kidney biopsy in anti-GBM disease based on serum creatinine values, but as I mentioned previously a kidn...

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RE: Biopsy In Anti Gbm Disease 1 day ago

Thank you for the reply Please update us on the kidney biopsy ------------------------------ Samir Mallat Professor of Clinical Medicine Americ...

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RE: AKI after living related kidney transplant 1 day ago

This case has some semblance with one I posted Persistent Graft Dysfunction. My patient improved remarkably after switching to MTOR and Cr has come...

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RE: Biopsy In Anti Gbm Disease 1 day ago

Hi thanks for interesting discussion Patient albumin normal . Gbm antibody is 69 (0-7 u/ml) Uk lab measure . Creatinine 1.3622/04 and then 3.4 now...

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RE: Dual ANCA + anti-GBM + 1 day ago

As a o sequence of this excellent discussion, I have come to appreciate the heterogeneity of anti-GBM + ANCA disease to a much greater extent. Thes...

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RE: vit d supplement 1 day ago

No need to monitor 1,25 D ------------------------------ Stuart Sprague DO, FASN Chief, Division of Nephrology and Hypertension NorthShore Univers...

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RE: vit d supplement 1 day ago

Thanks Dr. Sprague for this excellent advice. Would you monitor 1,25 dihydroxy Vitamin D and PTH, in addition to 25- hydroxy Vitamin D levels durin...

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RE: Dual ANCA + anti-GBM + 1 day ago

Not an unreasonable decision, but expectations for meaningful clinical improvement are low. I would probably limit the trial to 7 consecutive days ...

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