RE: bisphosphonates for high turnover bone disease 9 hours ago

This is a very bizarre and unusual case and as discussed by Prof Glassock, would not expect a decrease in PTH, but an increase. Clearly bone specif...

View Discussion

RE: FSGS 13 hours ago

I wouldn't change a thing therapeutically, enjoy however this happened. I think time will tell, if he has only 300 mg albuminuria I think prog...

View Discussion

RE: FSGS 14 hours ago

You are probably correct that an APOL1 genotype would not affect treatment decision, but a positive HIV virion test done after onset of NS would gr...

View Discussion

RE: FSGS 14 hours ago

--Unfortunately (unclear why since I always order both), u protein was not done on the last visit, just the u alb On the previous visit, U protei...

View Discussion

RE: FSGS 14 hours ago

What is the total protein urinary excretion per day or a UPCR.? I "never" use urinary albumin excretion for decision making in "FSGS". Did you do a...

View Discussion

RE: FSGS 15 hours ago

Is this not a spontaneous (+ RAS/SGLT2i-induced) partial remission of primary FSGS? From an older KDIGO guideline (except don’t know whether this...

View Discussion

FSGS 16 hours ago

67 yo black man with long hx HIV (long undetectable on the same meds) and recent hx of DM (no retinopathy, easily controlled) develops acute nephro...

View Discussion

RE: lupus patient with IgA nephropathy 17 hours ago

On further reflection, primarily because of the a rumor onset of v severe nephrotic syndrome and the rapidity of the response to steroids , I think...

View Discussion

RE: lupus patient with IgA nephropathy 20 hours ago

@Wael Jebur: Was serum C3 level also low? This is important to know because multiple diagnostic possibilities have been raised. -----------------...

View Discussion

RE: lupus patient with IgA nephropathy 20 hours ago

Great job in diagnosing and treating this patient! Agree this is IgAN and should be treated as such the evidence of complement pathway activati...

View Discussion

RE: lupus patient with IgA nephropathy 23 hours ago

In my opinion, the strong mesangial IgA, the EM findings and the low serum C4 make C3GN snd IRGN less likely possibilities, but neither can they be...

View Discussion

RE: lupus patient with IgA nephropathy 1 day ago

Dr. Glassock, would you consider C3 GN and infection related GN in the DD? probably the strength of staining for IgA vs C3 and lambda vs. kappa can...

View Discussion

RE: IVIG with Rituximab treatment 1 day ago

Thank you all for sharing your opinions. This is very helpful as we have always had doubts about whether to use IVIG or not. Thank you once again. ...

View Discussion

RE: lupus patient with IgA nephropathy 1 day ago

I agree - a low C4 serum level and no C1q glomerular or subendothelial ED deposits is not very indicative of "classical pathway" activation. Lectin...

View Discussion

RE: Electrolyte Issue 1 day ago

This was called "disequilibrium vomiting induced metabolic alkalosis" by the great Donald Seldin. It is beautifully described and analysedby him in...

View Discussion

RE: Electrolyte Issue 1 day ago

In that particular scenario with aldosterone elevated and a bicarbonaturia present, the U K will be elevated, the tendency to absorb Na and Cl from...

View Discussion

RE: Electrolyte Issue 2 days ago

Thanks so much it’s clear now Someone with active vomiting - Ph alkalosis , urinary na high ( more bicarbonate being generated , urinary k high ...

View Discussion

RE: lupus patient with IgA nephropathy 2 days ago

@Wael Jebur: My understanding is as follows. In SLE, classical complement pathway is activated. This pathway involves initial C1 activation by anti...

View Discussion

RE: bisphosphonates for high turnover bone disease 2 days ago

Thank you all; I called SDC requested those labs and scan. We will see if we can get those done next week. No intention to steal focus from Dr ...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 2 days ago

Thank you . His CTA showed RT kidney with two cysts 1.3 ad 0.8 cm and left kidney has two cysts 0.6 and 0.8 cm there are no hepatic or pancreat...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 2 days ago

If a family member (particularly older like a parent) has the same VUS but no PKD phenotype, it becomes less likely that this VUS is significant. ...

View Discussion

RE: bisphosphonates for high turnover bone disease 2 days ago

high alkaline phosphate is against significant role or effect of Alendronate. May we have bone alkaline phosphatase or osteocalcin for further eval...

View Discussion

RE: lupus patient with IgA nephropathy 2 days ago

Dr. Venkat, Thank you for your reply. Low C4 indicates involvement of classical pathway secondary to immune complex binding in SLE, thus low C4...

View Discussion

RE: lupus patient with IgA nephropathy 2 days ago

The rapidity of improvement is quite striking. The anemia was attributed initially to SLE and AKI. However the swift recovery is not commonly enc...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 2 days ago

Thank you Dr. Chebib, If we test and do imaging on both parents and one of them has the same VUS, but with normal kidney function and minimal nu...

View Discussion

RE: bisphosphonates for high turnover bone disease 2 days ago

Dr. Venkat- good suggestion- a very likely cause for reduced PTH despite hypocalcemia. Serial DEXAscans might prove useful in assessing the bone re...

View Discussion

RE: lupus patient with IgA nephropathy 2 days ago

What was the cause of initial severe anemia (hemoglobin 8.0 g/dL)? Any evidence of hemolysis? Coomb's positive? WBC and platelet counts? Rapidity o...

View Discussion

RE: bisphosphonates for high turnover bone disease 2 days ago

@Richard Glassock, @ Sinasi Salman: Wonder if the fall in PTH in Dr.Salman's patient is from decrease in SPO4 resulting from decreased bone turnove...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 2 days ago

I agree with the previous comments. This is indeed a challenging case, particularly given the absence of a known family history of kidney disease. ...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 2 days ago

I agree to hold off on allowing kidney donation. 2 cysts on each kidney with a PKD2 VUS (predicted in silico to be a missense). I would recommend...

View Discussion

RE: Potential donor with 2 cysts on each kidney and PKD2 VUS 3 days ago

I would reject the donor. But if you want to take a closer look, that is reasonable. First of all, does the patient have liver cysts? Liver cysts o...

View Discussion

RE: bisphosphonates for high turnover bone disease 3 days ago

I do not understand why thec iPTH decreased. Bisphosphonates usually increase iPTH levies, largely because of hypocalcemia, which can be severe in ...

View Discussion

RE: bisphosphonates for high turnover bone disease 3 days ago

Thanks Dr. Glassock; AA male early 70s - h/o poverty related noncompliance with medicines + early sign offs and missing treatments for work.. H...

View Discussion

RE: bisphosphonates for high turnover bone disease 3 days ago

The fall in serum calcium is expected with addition of Bisphosphonates. am a bit surprised that the iPTH did not get worse. Is the patient on Cinac...

View Discussion

RE: bisphosphonates for high turnover bone disease 3 days ago

iPTH management - n=1 study After I saw PTH jumped to 3488 from 2K I started him on Alendronate 35 mg /wk. Please see the trend towards left. ...

View Discussion

RE: lupus patient with IgA nephropathy 3 days ago

This is a rare but well described finding. I think this is IgA Nephropathy in a patient with SLE. I do not think that the biopsy morphology is cons...

View Discussion

lupus patient with IgA nephropathy 3 days ago

I have this patient and I am looking for your thoughtful ideas 41 year old female patient presented with acute renal failure with creatinine of ...

View Discussion

RE: Refratory nephrotic syndrome? 3 days ago

Do not be surprised if anti-nephrin antibody trsts us negative. This may more likely be an anti-KIRREL antibody mediated MCD. No harm in adding IV ...

View Discussion

RE: Refratory nephrotic syndrome? 3 days ago

Dear all, We decided to go with rituximab 14th April. Because he is very nephrotic, I decided to use prophylactic amoxicillin. I was wondering i...

View Discussion

bisphosphonates for high turnover bone disease 3 days ago

I have a 45 yo patient with ESRD on HD x 28 years, h/o Hyperparathyroidism s/p 2 surgeries (don't have details of this) yet with still PTH of 6000,...

View Discussion

RE: IVIG with Rituximab treatment 3 days ago

I am not convinced that routinely evaluating serum IgG levels in patients with ANCA Vasculitis before Commencing RTX therapy is a cost- effective s...

View Discussion

RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 3 days ago

De-indexed eGFR creatinine normal. . I expect that the CCr will be over 100ml/min. Much ado over nothing. ------------------------------ Richard...

View Discussion

RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 3 days ago

Thank you all Patient 35 y Absolute GFR ≈ 99 mL/min I requested 24-hour creatinine clearance with middle time creat -----------------------...

View Discussion

RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 3 days ago

I share Dr. Rodby's take on creatine supplements. I think that only Creatine ethyl ester has any consistent effect on serum creatinine levels. If a...

View Discussion

RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 3 days ago

I have looked into this a lot, I will attach what I have, but it was my impression from attached that only creatine ethyl ester (not typicall...

View Discussion

RE: Electrolyte Issue 3 days ago

These differing units will be the death of me. If you have access to UpToDate you can use this link for a calculator and you can choose your inpu...

View Discussion

RE: IVIG with Rituximab treatment 3 days ago

I have not done it but this came up at GlomCon Hawaii last summer and I was surprised how many doctors routinely follow IgG levels after Rituximab ...

View Discussion

RE: IVIG with Rituximab treatment 3 days ago

Need to do risk benefit and cost analysis: Most patient after initiating anti-CD20 or anti-CD38 have low Ig. There is nothing in the standard of ca...

View Discussion

RE: Electrolyte Issue 3 days ago

A random urine can be used to indirectly measure urine NH4+ using the anion gap or oamolar gap in the evaluation of a hyperchloremic acidosis. -...

View Discussion

RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 3 days ago

A word of caution with creatine. I have seen it effect serum creatinine when taken in large quantities. Serum creatinine should be measured off cr...

View Discussion