Case of FSGS 47 minutes ago

Hello, I would appreciate other's review of this case. 70 yo Caucasian male referred to me for evaluation of proteinuria 3- 4 years ago years a...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 22 hours ago

While I agree with all suggestions, anything is worth a try, But I still believe this is not going to be medically manageable with the agents we...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Once surreptitious drug abuse (cocaine, amphetamines ) has been excluded, there is much to support Dr. El-Meanawy' s suggestion to wean off all ora...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Too Many Drugs, some will contribute to BP and allow for volume. I doubt that Prison has low sodium diet. Yes, volume can cause such high BP, we ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

George Bakris, may he RIP ------------------------------ Daniel Kniaz MD, FASN Associates in Nephrology, SC Glencoe IL (847) 308-8144 -----------...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

Despite all these highly intelectual discussions: Just an idea. Did you rule out drug abuse, especially cocaine, a potent vasoconstrictor? ----...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

Beep beep "Do not turn your brain off; an update is in progress. One of your 36 core chips in your mid-brain will be replaced. Look up straig...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

As far as I remembee that high dose clonidine can cause paradoxical hypertension by stimulating peripheral alpha receptors , specially in combinati...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 2 days ago

A patient taking 40 mg of minoxidil does not need nifedipine. This dose of minoxidil is too high; 20 mg is more than enough. Does the patient m...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

If memory serves me correctly , I have only used bilateral nephrectomy for "resistant hypertension" twice in my 60 year career in Nephrology . Both...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Having practiced in a HTN referral center for over 15 years at UConn This case is highly unusual. The doses and numbers of drugs is exceptionally h...

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RE: " Super" Severe Resistant HTN in CKD 4 patient 3 days ago

Update on our rHTN (Super Severe HTN) after more digging it appears he never had a complete Complement panel for both functional and genetic ...

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RE: Aldosteroma Diagnosis 3 days ago

Thanks Dr. Leisring- all very reasonable observations and opinions. Time will tell. A non-invasive way of diagnosing unilateral aldisteronoma (macr...

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RE: Aldosteroma Diagnosis 3 days ago

I see this as encouraging progress, but still far away. Apparently, the primary molecule in this study requires an on-site cyclotron so it seems li...

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RE: CMS rules for hospice in advanced CKD not on dialysis Friday, March 21 @ 10:10 AM

I think Dr. Schell hit the nail on the head. The issue is treatment and drug coverage once a patient is in hospice. What if your patient develops a...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Friday, March 21 @ 8:59 AM

This patient has advanced CKD stage 4 and behavioral issues impacting BP control. He is on redundant medications and inadequate diuretic regimen, m...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Thursday, March 20 @ 8:55 PM

An amateurish brain storming An infection or something else turns the ignition key "complements etc" and starts TMA/HUS - micro thrombi shower to...

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Aldosteroma Diagnosis Thursday, March 20 @ 12:33 PM

Is this the end of Adrenal Vein sampling for the diagnosis of an unilateral aldosterone secreting tumor? (see Goodchild E, et al Molecular Imagin...

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RE: MPGN/Lupus/DKD - biopsy. Wednesday, March 19 @ 10:18 PM

Dr. Sasongko: Dapagliflozin + Perindopril + Ozempic + mycophenolate: unclear how much of improvement in proteinuria is from immunosuppression vs a ...

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RE: Gross hematuria in a pregnant patient Wednesday, March 19 @ 7:56 PM

Thank you everyone for the great discussion. The hematuria resolved on day 5. Since the patient underwent an exchange transfusion on day 2, it's un...

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RE: MPGN/Lupus/DKD - biopsy. Wednesday, March 19 @ 5:10 PM

Anti-Ro auto-antibodies can be associated with abnormalities in AV conduction. I am impressed with the extent of IC deposition and the "response " ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Wednesday, March 19 @ 10:40 AM

A case or refractory hypertension and MAHA requires a systematic approach both diagnostically and therapeutically. DIAGNOSIS 1. In this type of...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Wednesday, March 19 @ 9:16 AM

Dear Dr Robdy thank you for sharing your opinion and Dr Chang 's take on this very interesting and not well known etiology of resistant hyperten...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Wednesday, March 19 @ 7:30 AM

I had brought up baxdrostat a aldosterone synthase inhibitor Dr Friedman similarly brought up zilebesiran an angiotensinogen blocker both...

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RE: Diabetic nephropathy with positive congo red Wednesday, March 19 @ 6:15 AM

There is a reasonably high probability that this patient has H. Pylori infection related Cryoglobulinemic Glomerulonephritis. See Almemhi A et al A...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 7:16 PM

When/if available, zilebesiran might be a great option for the RAS-mediated element of his HTN given its VERY prolonged duration of effect without ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 5:00 PM

Agree with the many excellent comments but to mention the issue of volume, the expansion of the ECFV in most patients with hypertension is subclini...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 4:41 PM

Thanks Roger We may be at least partially talking about two different things. My comments/references were about resistant HTN in general. This ca...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 3:38 PM

Sheldon, Again just because BP responds to volume removal does not mean it is just volume I think this is a different bird than 95% of our pati...

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RE: Hyponatremia Tuesday, March 18 @ 3:31 PM

Urea will work, as long as you achieve steady state you will excrete the urea you make and take, and you BUN will increased, will level off, grante...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 3:19 PM

addendum (ugh): In reviewing the Talor article, turns out I exaggerated. Nurses were involved but treatment decisions in both groups were made by a...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 3:00 PM

I agree with Roger that volume is not always the culprit in resistant HTN, but it very commonly is. The evidence for that is strong and it is compl...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 1:09 PM

Digging deeper RNs inform me they checking his mouth after swalliwing pills but he routinely goes to bathroom after taking pills be has bee...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 11:37 AM

I agree with Dr. Hirsch that it would be very difficult to imagine such as huge increase in blood pressure primarily due to "volume overload". The ...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 11:18 AM

Not to beat a dead horse, (overly quote an very odd case report) but our patient that eventually required nephrectomy was always controlled on IV C...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 11:07 AM

@Jonathan Slater: is the patient refusing IV access or is it difficult to obtain IV access? If BP is easily controlled with IV medications in much ...

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RE: Hyponatremia Tuesday, March 18 @ 11:06 AM

I do not think it will work very well due to the low GFR and urea will surely build up in the blood but urea per se is not toxic so IMO, the treatm...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 10:38 AM

I suspect the TMA was during the severe TMA episode, and even if biopsy showed TMA Im not sure what you do with that. However you are correct in th...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 9:22 AM

Did you check complement gen mutations for aHuS there are good data of aHUS associated with resistant HtN and TMA . Your patient already has evid...

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RE: MPGN/Lupus/DKD - biopsy. Tuesday, March 18 @ 8:00 AM

Thank you all. BMI - roughly 28. No other clinical symptoms, mild LFT derangement that is associated with her worsening of metabolic syndrome w...

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RE: MPGN/Lupus/DKD - biopsy. Tuesday, March 18 @ 7:23 AM

"I would definitely continue the MMF. I might also consider adding Belimumab(off label) if the Anti- Ro antibody persists." @Richard Glassock: Gi...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 7:11 AM

I our case report I attached earlier, renal denervation (surgical) markedly lowered the BP but it only lasted a short time, thus the decision to re...

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RE: Diabetic nephropathy with positive congo red Tuesday, March 18 @ 5:12 AM

DsDNA : 0 ------------------------------ Mustafa Ahmad MD, FASN Consultant Nephrologist King Fahad Medical City Riyadh 966568310309 ------------...

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RE: Diabetic nephropathy with positive congo red Tuesday, March 18 @ 5:11 AM

Thanks for the feedback. Apologies for the wrong title- it happened because I wanted to post another patient as well with diabetic nephropathy an...

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RE: " Super" Severe Resistant HTN in CKD 4 patient Tuesday, March 18 @ 4:15 AM

I think renal denervation is an option to consider here. ------------------------------ M.N. Alhosaini ------------------------------

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RE: Hyponatremia Tuesday, March 18 @ 4:04 AM

What is the patients BMI and BSA? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

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RE: Hyponatremia Tuesday, March 18 @ 2:41 AM

Is administration of urea for hyponatremic patient advised in chronic kidney disease patients? ------------------------------ Wael Jebur MD, FAS...

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RE: MPGN/Lupus/DKD - biopsy. Tuesday, March 18 @ 12:47 AM

Taken together, the findings in this case support the notion of a forme fruste of Sjogren Syndrome and not SLE , IgAN, or Mixed Connective Tissue D...

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MPGN/Lupus/DKD - biopsy. Monday, March 17 @ 9:32 PM

Hi all, Trying to discern the treatment approach for this 54yo lady of Aboriginal background w metabolic syndrome (variable DM control, HTN, obes...

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RE: Diabetic nephropathy with positive congo red Monday, March 17 @ 6:20 PM

No results for Congo red stain found in report. No features of Diabetic Nephropathy. Need more information on nature of 'organized subendothelial e...

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