RE: Immunosupressants withdrawl in SLE patients with ESRD 1 hour ago

Interesting cases. Hard to evaluate the significance without knowing the denominator. Is thus 10% or some other number( larger or smaller) of the p...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 2 hours ago

This conventional wisdom has been my understanding for years up until recently. I presently care for 2 females of African American ancestry with ES...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 3 hours ago

I usually stop Hydroxychloroquine as well. As far as I know there is no evidence to support or deny that this decision is the "correct" one. Anothe...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 hours ago

Unfortunately, the Tc99 DPTA nuclear scan (Gates method) is not very accurate and is not a replacement for a mGFR. see Xie, P, et al PLOS One, 20...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 4 hours ago

In these kind of cases I use a Technetium nuclear study that provides a GFR independently of muscle mass and age. However, I rather use a "mosaic" ...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 7 hours ago

Do you all stop the hydroxychloroquine or continue that in esrd patients? --------------------------------- Srilekha Sridhara MD Tucson AZ (314...

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RE: Lab potassium normal range 10 hours ago

Dr. Filler, Thank you for that incredibly thorough and thoughtful response. You have touched upon every issue that we are dealing with in our ins...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 12 hours ago

Also, recurrence of lupus nephritis in the transplant kidney is quite uncommon, especially in patients transplanted after being on dialysis, even i...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

Extra-renal manifestation of Lupus tends to decrease with increasing duration of HD or PD treatment for ESKD. Inly about 1 in 8-10 patients still h...

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RE: Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

This is a topic that has been of interest for years. I remember it as a controversy as an early attending in the 1990s. SLE is not limited to the k...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago

What is the current absolute free light chains levels? Did the initial biopsy show light chains tubulopathy? ------------------------------ Ash...

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Immunosupressants withdrawl in SLE patients with ESRD 1 day ago

Good evening I want to ask about any evidence or statement that recommend immunosupressants withdrawl in SLE patients with ESRD who are on dialy...

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RE: Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 1 day ago

I take care of a patient with SAM. He is special as he also has hemophilia A. He presented years ago with right sided renal infarction (typical pai...

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RE: Lab potassium normal range 1 day ago

I agree with Dr. Hirsch. A causal direct association between a K level > 5.0mmmol/L in CKD and poorer outcomes remains unproven. It might represent...

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RE: Lab potassium normal range 1 day ago

"Persistent values >5.0 mmol/L-even if common in CKD-are associated with worse outcomes, suggesting that a lenient "CKD-normal" upper threshold may...

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RE: Lab potassium normal range 1 day ago

Thank you for the interesting discussion. I would like to offer a few thoughts. 1. Plasma vs. Serum Potassium Plasma potassium (P-K) and serum po...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago

It depends. If you are asking about FDA approved indications, then no. FISH by itself does not have any bearing although hopefully soon, venetoclax...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 1 day ago

For sake of completeness check stool OB ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Center Beverly Hills CA (310) 657...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

Dr. Cancarini. I Don' t disagree with your hypothesis that CCr + C urea /2 might be a more "accurate " estimate of GFR than creatinine or Cystatin ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

My guess GFR is much less than you think, closer to that suggested by hign BUN, like not enough. May be ask lab what of meds may be interfering wit...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

4 eGFR and urinary clearances and I still have no idea what this patients kidney function really is. Itvis time for a measured GFR. -------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 days ago

Did you ever perform a bone marrow FISH to examine clonality of PC in marrow and as a possible indication for Daratumumab? ---------------------...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 2 days ago

A year ago, the use of daratumumab for active relapse had been brought up by Drs. Glassock and Leung, thank you. Given the effectiveness of Darat...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

Very true. Good idea. Thank you. _________________________________________ Ashraf El-Meanawy, MD, MS, PhD, FASN Professor of Medi...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

Dr. El-Meanawy, Another study that looked at the role of urea in uremic syndrome by supplementing dialysate with urea: https://pubmed.ncbi.n...

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RE: Lab potassium normal range 2 days ago

Here is an interesting reference. Wang J et al Comp Struct Biotechnology J. 2024; 24: 1-11. ------------------------------ Richard Glassock MD, F...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 2 days ago

At GFR values ​​<20 ml/min, the urea clearance (which underestimates) and creatinine clearance (which overestimates) can be averaged and the result...

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RE: Lab potassium normal range 2 days ago

Very interesting discussion. The definition of a normal range for blood K concentration must clearly specify the serum or plasma source of the spec...

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RE: Lab potassium normal range 2 days ago

Thanks Kamyar. We are attempting to advocate for the same expansion (or retention) of P-K NR. But I would think that all clinical labs would be und...

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RE: Lab potassium normal range 2 days ago

Thanks. Would you be able to provide those references? ------------------------------ Theodore Saad MD, FASN [Christiana Care Health System] Newa...

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RE: Lab potassium normal range 2 days ago

Thanks. Yes, the root of our "problem" here is the difference between S-K and P-K. Our lab has reported ONLY P-K results for several years. When th...

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RE: PIGN with only proteinuria? 2 days ago

I woul agree that the clinical and pathological picture is most compatible with an Atypical non-hypocomolementemic " PIGN." Of unknown etiology. It...

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RE: Lab potassium normal range 2 days ago

At one of the major university centers, we successfully advocated for the pathology department to expand the normal serum potassium reference range...

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RE: PIGN with only proteinuria? 2 days ago

To be more complete with the pathology findings, which will aid in the discussion. The pattern is Focal segmental endocapillary proliferative with ...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

'He has received total 40.8 g of protein in 24 hours the days of 24 hours urine collection' which is exactly what this gives us when I used 60 KG...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Dr Chander : Very weird results I think he is male ; do not have weight have assumed 110 lb = 50.2 Kg Creatinine excretion 7.8 dl at 365 mg/dl = 28...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Urine creatinine concentration very high and 24 hour excretion rate of creatinine greatly exceeds what would be expected in a malnourished ,sarcope...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Sure. He has received total 40.8 g of protein in 24 hours the days of 24 hours urine collection and 340.8g prior to that. Feed doesn't have crea...

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RE: PLA2R-positive membranous nephropathy, rituximab intolerance 3 days ago

to piggy back on PLA2r MN, I have a pediatric pt with his condition, received 3 ritux so far ( 6 wk interval roughly), but he is still not negative...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Dr Chander It may be possible instructive to play with numbers Could you upload desidentified data? Patient weight ( ideal Edema free) daily prote...

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RE: Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 3 days ago

Can you show the angiogram? Why this could not be fibromuscular dysplasia? Was the GI bleeding due to arteriolitis of celiac or gastric artery? SMA...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Thank you, everyone - that was a great discussion. We stopped the tube feeds, and the BUN remained stable; however, it worsened upon resuming feeds...

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RE: recurrent multidrug-resistant Pseudomonas urinary tract infections 3 days ago

Can you specify what urologic workup was done? In this scenario, I would typically start with a diagnostic cystoscopy, cross-sectional excretory im...

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RE: membranous nephropathy 3 days ago

I think that is the smart call ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates...

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RE: membranous nephropathy 3 days ago

Anti PLA2r titer came back 820. Pt is being treated with oral cytoxan and steroids by the treating physician. Thanks ----------------------------...

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RE: PLA2R-positive membranous nephropathy, rituximab intolerance 3 days ago

Thank you Dr. Rodby and Dr. Vasquez! ------------------------------ Raman Anam MD Assistant Professor of Medicine LSU Health Shreveport Shrevepor...

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RE: recurrent multidrug-resistant Pseudomonas urinary tract infections 3 days ago

Correction > > "Wouldn't use Bactrim for your patient due to CKD & not useful for Pseudomonas." ------------------------------ Sinasi Salman MD, ...

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RE: Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 3 days ago

Great question. No good answers. Uncommon condition that remains stable or regresses in 75% and progresses in 25%. Biomarkers predicting progressio...

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RE: 24 hours Urine Collection better or Serum Cystatin C, in a patien with high BUN. 3 days ago

Prof El-Meanawy : Never saw reference but told that early on to prove relative non toxicity of urea, very uremic patients were dialyzed against a b...

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Asymptomatic Segmental Arterial Mediolysis Right Renal Artery 3 days ago

Hi, Seeking any experience with potential Segmental Arterial Mediolysis (SAM) and indication/ need for stenting? 74F presented with recurrent j...

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