RE: Kidney stones for prospective kidney donor 1 hour ago

Dr Lerman, His 25-OH vitamin D was measured in November 2024, which was 53 nmol/L. I apologise for not attaching the citrate level. The citrate l...

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RE: Kidney stones for prospective kidney donor 1 hour ago

Thank you Dr Glassock for the recommendation regarding 1,25 OH Vitamin D and Sestamibi scan - I will arrange them. ------------------------------...

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RE: Kidney stones for prospective kidney donor 7 hours ago

Even if the risk of nephrolithiasis does not translate to the recipient, donors may be excluded if the risk of recurrent stones in the remaining so...

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RE: Kidney stones for prospective kidney donor 7 hours ago

I think a single historical stone may allow a person to donate a kidney, or so I read... After all, most stones are not the kidney's doing and th...

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RE: Kidney stones for prospective kidney donor 8 hours ago

NPHPT is very likely in this patient which can be associated with hypocalcuria. Assuming vit D insufficiency was excluded. Was a urine citrate meas...

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RE: can loop diuretics causes hyponatremia 9 hours ago

To answer Dr Omar more directly, I reviewed the original micro puncture data from Maurice Burg and others from KI in 1981 (see attached) Remem...

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RE: can loop diuretics causes hyponatremia 10 hours ago

Thank you for the diagram. . Keeping up with the increasing granularity from modern techniques is not easy. We are way past the simple micro-punctu...

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RE: metabolic acidosis 10 hours ago

Lab error due to faulty drawing technique is a very real possibility these days, especially in a small person or pediatric patient. This has been ...

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RE: can loop diuretics causes hyponatremia 11 hours ago

Thiazide induced hyponatremia (TIH) not always ADH dependent as there are some cases with suppressed plasma ADH (as shown in attached picture) and ...

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RE: metabolic acidosis 11 hours ago

If Pseudohypobicarbonatemia has been ruled out, and without blood gas analysis, possible explanation as mentioned is respiratory alkalosis which ex...

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RE: Solute clearance in fast transporters CAPD patients 11 hours ago

Not really "backleak" because, as Dr. Rodby says, the most you can have is complete equilibration. But I think what you are getting at is that with...

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RE: Kidney stones for prospective kidney donor 12 hours ago

The presence of reduced bone density, a tendency to hypercalcemia, a history of pancrearitis, elevated serum PTH levels and nephrolithiasis makes P...

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Kidney stones for prospective kidney donor 20 hours ago

I would greatly appreciate your opinion of my patient. A Caucasian male, 57-year-old, presented for altruistic kidney donation. He had a history o...

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RE: metabolic acidosis 1 day ago

Urine pH is elevated at 7.5. Was this an early-morning urine sample? If the patient has a high intake of vegetables and fruits, resulting in increa...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

The normal ESR and CRP make inflammatory bowel disease very unlikely. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Is this patient on any medication --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 ------------------------------...

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RE: can loop diuretics causes hyponatremia 1 day ago

My guess would be that the cortical and juxtamedullary nephrons dilute the tubular fluid to a different degree and that the admixture of these woul...

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RE: can loop diuretics causes hyponatremia 1 day ago

@John Mellas, during studying renal physiology in medical school we are told that tubular fluid osmolality that reaches the DCT is about 100 mOsmol...

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RE: metabolic acidosis 1 day ago

Obtain a venous blood gas then make corrections for the pCO2 and HCO3 ------------------------------ John Mellas MD Nephrology and Hypertension S...

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RE: can loop diuretics causes hyponatremia 1 day ago

In a simplified physiology (which I use) one needs to absorb Na, without water in the DCT to generate a dilute urine prior to passage into the CCD ...

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RE: metabolic acidosis 1 day ago

Is the plasma lipemic? At this age a monoclonal gammopathy woukd be a very unusual cause of "metabolic acidosis " with an elevated AG. ----------...

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RE: can loop diuretics causes hyponatremia 1 day ago

Dr. Mellas how do thiazides inhibit urine dilution? ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Phil...

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RE: metabolic acidosis 1 day ago

Dr. Glassock So should i check the lipid profile only in that case? no Urinary Ammonium ? no work up for Sjoegren? she is young and had no signif...

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RE: metabolic acidosis 1 day ago

I will try to do the gas and BMP at the same day, it is very hard to arrange this blood gas as an outpatient. Regular outpatient lab is not doing i...

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RE: metabolic acidosis 1 day ago

not all BMPs have a gap and sometimes the bicarb is normal in the 22 range but she has this problem now since multiple years with bicarbs in the 15...

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RE: metabolic acidosis 1 day ago

I did not check a lipid profile yet, will add it on ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philade...

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RE: metabolic acidosis 1 day ago

no edema ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia PA ------------------------------

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RE: metabolic acidosis 1 day ago

Pr/Cr ratio 292 mg/g no history of Sjoegren ------------------------------ Mustafa Saidi MD Nephrology Department Albert Einstein Philadelphia ...

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RE: metabolic acidosis 1 day ago

One needs to see a blood gas and chemistries drawn at the same time to define the disorder. ------------------------------ John Mellas MD Nephro...

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RE: metabolic acidosis 1 day ago

Sorry- my stupid. The AG is 17. Obviously elevated. If confirmed on repeated measurement. The evaluation is for an AGMA not a NAGMA.. please disreg...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Agree pt needs a gastroenterologist and a rheumatologist to work together to figure this out. A 25 y/o with auto immune markers is suspect, maybe...

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RE: metabolic acidosis 1 day ago

pseudohypobicarbonatemia - not common but not that rare, most commonly from hypertriglyceridemia and paraproteinemias, and always a good point when...

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RE: Solute clearance in fast transporters CAPD patients 1 day ago

Rapid transporters means that the Dialysate to Plasma ratio of a given substance will approach 1 faster than a slower transporter. There is no back...

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RE: can loop diuretics causes hyponatremia 1 day ago

Addendum Loop diuretics are used for treatment of 2 conditions (SIADH plus oral salt tablet for treatment of hyponatremia and CHF for treatment of ...

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RE: can loop diuretics causes hyponatremia 1 day ago

From medicine textbook, we have learned that we should wait for RAASi prescription until correction of hypovolemia and hyponatremia so I think the ...

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RE: Sjogren nephritis 1 day ago

Renal Involvement in Primary Sjögren's Syndrome: A Clinicopathologic Study. Saugar Maripuri, Joseph P Grande, Thomas G Osborn, et .PMCID: PMC273668...

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RE: can loop diuretics causes hyponatremia 1 day ago

Dear Dr. Soleimani, thank-you for the info provided. Given the inverse relationship between SVR and CO in CHF, I find very useful to closely mo...

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Solute clearance in fast transporters CAPD patients 1 day ago

Appreciate inputs for the following question and providing reference if available CAPD rapid transporter patients develops ultrafiltration failur...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

I do not think her findings are related to SLE and certainly not AD alport. She needs evaluation by a gastroenterologist. Things like celiac and cr...

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RE: Sjogren nephritis 1 day ago

Dear Dr. Venkat Thank you for your reply. During her second visit to my clinic two months ago, her PCR was 0.35 mg/mmol. Her C3 level was 0.7...

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RE: Sjogren nephritis 1 day ago

Dear Dr. Anatole Besarab, Regarding persistent leucocyturia , she has no signs of urinary tract infection, and cultures came back negative many ti...

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RE: Sjogren nephritis 1 day ago

Dear Dr. Jadav, Thank you for your reply. During her visit to my clinic two months ago, her urine PCR was 0.35 mg/mmol. Her C3 level was 0.7 g...

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RE: metabolic acidosis 1 day ago

Addendum- Is the serum lipemic? If so, and the calculated HCO3 level from arterial blood gas is normal , thus is ""Pseudo-hypobicarbonatemia ". D...

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RE: metabolic acidosis 1 day ago

What is the appearance of the urine sediment.? Is hypergammaglobulinemya present (if chronic respiratory alkalosis excluded ). Any SS-A .SS-B serol...

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RE: Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

A diagnostic conundrum. ANA and anti-dsDNA antibody negative. SLE is extraordinarily rare. A diagnosis of SLE cannot be made on true basis of the t...

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Lupus Enteritis? Alport-Associated Enteritis? 1 day ago

Lupus Enteritis? Alport-Associated Enteritis? 25-year-old female with known autosomal dominant Alport syndrome (COL4A3 mutation) Persistent mi...

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RE: metabolic acidosis 1 day ago

3+ LE, tubular proteinuria? Sjögren's Syndrome? ------------------------------ Sinasi Salman MD, FASN Owner Northlake Nephrology, PLLC Mooresvi...

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RE: metabolic acidosis 2 days ago

My suggestions, as well. If the patient is not on any bicarbonate-wasting medication, I would like to exclude respiratory alkalosis, as the major c...

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RE: can loop diuretics causes hyponatremia 2 days ago

Thank you, Dr. Campese, for your post and your question about my suggestion : " …… that ACEi through hemodynamic effects may alter the ability to e...

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RE: metabolic acidosis 2 days ago

Urinary Ammonium and an Arterial Blood gas. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------...

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