RE: Abrupt drop and spontaneous recovery of kidney function in KTR 24 minutes ago

Any signs of atheroembolic disease as an explanation for the second acute graft dysfunction episode? ------------------------------ Emilio Ventu...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 hour ago

This is the publication from our group referred to by Dr. Rubin: https://www.ajkd.org/article/S0272-6386(88)80107-0/fulltext This is the only cas...

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RE: Hyperkalemia Post Kidney Transplant 2 hours ago

I had previously used the analogy of discover as being a process of peeling an inion, one later at a time. The assumption is that our conclusions p...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 2 hours ago

@Shoko Nawa- did renal function, returned to baseline after the last and most recent episode of AKI with fluids? ------------------------------ [...

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RE: Hyperkalemia Post Kidney Transplant 3 hours ago

Thank you Dr Balan for bringing up the Halperin retraction. I was just going to post it myself. I dont see why people don't use Fractional excretio...

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RE: Calciphylaxis 3 hours ago

How does STS work? No one knows, Both invivo and invitro, it does not remove calcium from tissues. Here is a theory that need to be tested. A numbe...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 3 hours ago

Personally, I have not found (except in a handful of cases) the doppler studies (parvus et tardus morphology, changes in peak velocity flows, etc.)...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 4 hours ago

When SCr increases and returns to baseline without any intervention other than volume repletion, the common cause is prerenal azotemia from volume ...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 4 hours ago

I think you could repeat the Doppler study and check for a stenotic pattern which may recur and may need stenting. TAC levels are important as ment...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 5 hours ago

Could you kindly post the allograft biopsy report and if you have a biopsy from the donor would during nephrectomy would be helpful as well any h...

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RE: Hyperkalemia Post Kidney Transplant 5 hours ago

@Ahmed Emara - One issue that has not been discussed in the case that you reported was, did you do an ECG on your patients? And were there any Chan...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 13 hours ago

Thanjs-this makes familial hypouricemia a very unlikely cause of bouts of AKI. ------------------------------ Richard Glassock MD, FASN Laguna W...

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RE: ADPKD ON JYNARQUE 13 hours ago

Interestingly we have good data that SGLT2is are an effective treatment for SIADH https://journals.lww.com/jasn/fulltext/2023/02000/treatment_effe...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 13 hours ago

Thank you for the additional information. The patient's baseline uric acid levels were typically in the 4.0-5.0 mg/dL range. However, when creati...

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RE: Hyperkalemia Post Kidney Transplant 13 hours ago

The effect of calcineurin inhibitors on DCT potassium regulation has been a hot topic. Calcineurin can dephosphorylate NCC directly and by affectin...

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RE: Calciphylaxis 14 hours ago

The question of whether to recommend switching the patient to in-center hemodialysis is an interesting one. I’ve noticed there has been a movement...

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RE: Hyperkalemia Post Kidney Transplant 19 hours ago

"Non-genomic effects of aldosterone occur rapidly, within minutes, and involve mechanisms independent of gene transcription, such as influencing io...

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RE: Hyperkalemia Post Kidney Transplant 21 hours ago

This is precisely why Nephrology and Astrophysics share a common appeal to the curious and research-oriented person. Many discoveries just waiting ...

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RE: Hyperkalemia Post Kidney Transplant 23 hours ago

In response to the intriguing question by Dr. Rodby about the nephron segment where the aldosterone resistance may be impacting the electrolyte or ...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

What is the serum uric acid during or before these episodes of AKI.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (94...

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RE: Calciphylaxis 1 day ago

What is most discouraging and frustrating to me is our inability to predict which patient is"at risk" and what are the best (and effective ) preven...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

What is the maintenance immunosuppression regimen? CNI trough levels? BP control/and medications? Body weight trends when SCr goes up? Urinalysis f...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Dr Rodby I agree/ Forty Years ago a Nephrologist at Temple U School of Medicine did some experiments of the effect of K supplementation to a tota...

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RE: Calciphylaxis 1 day ago

I predominantly agree with what has been posted and Dr Rodby summarizes treatment well, though I have found hyperbaric treatment has been helpful ...

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RE: Calciphylaxis 1 day ago

I am in the kitchen sink camp 1) get off all Ca based binders 2) stop Vit D or analogs 3) GIve VIt K 4) get off warfarin 5) STS - 25 gram...

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RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

I would repeat the resistive indices and even CTA. and if no recurrent stenosis, repeat renal biopsy? ------------------------------ Roge...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

At the risk of making a fool of myself after this very erudite physiology discussion. I am prepared to be vilified for this, but I am not just sayi...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

The elegant contributions of Dr. Manoocher Soleimani on this subject and many others in the past are a breath of fresh air and are/should be apprec...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

Very nice commentary by Dr Balan. Very informative and appreciated. Over the last several years I have seen increased use of the urine K/Cr ratio f...

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RE: Hyperkalemia Post Kidney Transplant 1 day ago

The use of the TTKG as a method to assess potassium secretion in the collecting duct was based on the detailed interpretation of the values in norm...

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Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Hello everyone! I need to seek your valuable insights on a challenging post-renal transplant case. A 32-year-old male, with a history of hypoplas...

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RE: Calciphylaxis 1 day ago

That is a very nice review and one take home point is how little we really know about this very complicated situation--"the pathogenesis remains po...

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RE: Calciphylaxis 1 day ago

Is he doing all his sessions at home? Is it 3,4, or 5 per week? What is PTH, Ca, and PO4 levels. Na thiosulfate is needed and may be 4 sessions p...

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RE: Calciphylaxis 1 day ago

See the nice recent review of the challenges in therapy for Calciphylaxis. Chewcharat and Nigwekar. Clin Kidney J. 2025; 18: sfaf098. -----------...

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RE: Calciphylaxis 1 day ago

Why not? - very likely safe so no downside (except cost) , but the upside is unknown. Calciphylaxis is a terrible disease, often fatal, so a "kitch...

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RE: Calciphylaxis 2 days ago

Any one would use vitamin k2? Best wishes --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Thank you!. Dr. Mellas concluded by stating: "So, for all of the shortcomings of TTKG, U og, and U pH, taken together I still find their usefulness...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

I read the research letter provided by Dr Solemani with interest. I would like to make two comments; 1- only 16 measurements of Uog and U NH4+ we...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Thank you all for this discussion. My understanding of TTGK s its usefullness as well as it 's limitations has definitely improved. ------------...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 2 days ago

thanks for your comments. I think there is one family with ADTKD-UMOD or ADTKD-MUC1 in ever nephrologist's practice. It is the third most common ge...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 2 days ago

Yes! Please given them my contact info: Ableyer@wakehealth.edu. Thanks! Or you can email me their contact info if they are agreeable and I will cal...

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RE: Autosomal dominant Tubulointerstitial Kidney Disease 2 days ago

Unfortunately, we do not enroll patients with this disorder as we do not have the bandwidth :(. There is a facebook page: https://www.facebook.c...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Let's utilize the latest published research, whether clinical or basic, to address the points of disagreement in this forum. In response to my poin...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

To answer our colleague from Cairo, Dr Emara, in which the renin and aldo levels are cumbersome, I would suggest that a low TTKG, U pH [More]

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Interesting discussions. The trans-tubular potassium gradient (TTKG) is used to gauge renal potassium secretion by the cortical collecting duct, ...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Thanks Dr. Mellas- great addition to the discussion. Since these patients seem to have responded to exogenous mineralocorticoid, it would seem that...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Thank you all for the great discussion Again, our patients BP readings were in the borderline low side Could we consider v good response to flu...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

TTKG is a simple test to confirm a defect in kidney K excretion and has no mechanistic insight per se. Further testing including the ability to ...

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RE: Calciphylaxis 2 days ago

I agree if you could post pictures, I also agree with Prof Glassock, that it should not be biopsied, nor should it be debrided as this greatly incr...

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RE: Hyperkalemia Post Kidney Transplant 2 days ago

Great discussion. I hope it helps in patient management.TTKG as an indication of aldosterone action in the CD seems to be no longer a viable concep...

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