RE: Microscopic Haematuria 47 minutes ago

I don't think kidney biopsy is required for genetic testing in any case I this case family history is positive , generic test is appropriate nex...

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RE: Low value care in nephrology 10 hours ago

I like the corrected Ca example how about treating K 5.5-6.0 in stable CKD? or sending a patient to the ED the same for an EKG. Baseline PET t...

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RE: Immune complex GN in patient with untreated RA 11 hours ago

that is one high RF and makes me think of cryoglobulinemia or endocarditis but I think these have been eliminated by the biopsy and other tests. ...

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RE: Low value care in nephrology 12 hours ago

Hi Muna, You may find these two papers helpful. Amir 1) Misapplications of Commonly Used Kidney Equations: Renal Physiology in Prac...

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RE: Immune complex GN in patient with untreated RA 16 hours ago

Rheumatoid factor is 1299 (0-29). Seems a skosh a high. will discuss rituximab with patient as next visit. also, there is concern regarding medic...

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RE: Nephrology Certification Exam 17 hours ago

Thank you for this fruitful discussion. @Hithem Fargaly Asked how to most efficiently study and many suggestions have been given. The literature su...

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RE: Global glomerulosclerosis vs. FSGS 17 hours ago

I share the view that this histological picture of focal global glomerulosclerosis + IFTA is primarily seen in disorders that effect tubulointersti...

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Soliciting recommendations for disability guidelines (US) 18 hours ago

I was asked to speak to a conference of administrative law judges who adjudicate all SSA disability cases in the US. They are asking me to talk abo...

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RE: Nephrology Certification Exam 18 hours ago

Of course, I should have added a disclosure that I have no ongoing affiliation with the American Board of Internal Medicine (ABIM) and my comments ...

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RE: Microscopic Haematuria 18 hours ago

In my opinion, this is an ideal case for genetic test first and avoiding an unnecessary kidney biopsy. This patient very likely has an Alport Spect...

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Microscopic Haematuria 19 hours ago

Dear all , 28 male years hx of microscopic haematuria , no proteinuria preserved kf. Mum has col4a35 and is on dialysis brother has visible haemat...

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RE: Nephrology Certification Exam 20 hours ago

Having some experience with Certifying Boards and Accreditation agencies and having written hundreds of questions fro Certifying examinations, I fe...

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RE: Nephrology Certification Exam 21 hours ago

The ASN board review course has ~ 500 practice questions, >100 "Pearls" : > 100 ists of things you should know about a given topic, and > 200 flash...

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RE: Nephrology Certification Exam 21 hours ago

Here is my advice Attend a review course as this helps you focus on the material and get in the exam frame of mind. I have done the exam twice no...

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RE: Nephrology Certification Exam 22 hours ago

@Hithem Fargaly it is worthwhile spending extra study time reviewing acid-base/electrolyte disorders. You will encounter a lot of questions invol...

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RE: Nephrology Certification Exam 1 day ago

Roger, I am retired and grandfathered for internal medicine and nephrology certification, but I do maintain my MOC. Curious, has there ever been a ...

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RE: Nephrology Certification Exam 1 day ago

Full disclosure, I was Co-Director of the ASN Board Review course from 2017-23, so I am biased. But there are so many study tools (way beyond lec...

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RE: Low value care in nephrology 1 day ago

Here're 2 lists from the AAP Pediatric Nephrology community and the ASN rom the Choosing Wisely effort. https://publications.aap.org/aapnews/news...

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RE: Nephrology Certification Exam 2 days ago

Read a good recent book on Clinical Nephrology . Attend a sponsored Board Review course , like the one offered by the ASN ----------------------...

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RE: Global glomerulosclerosis vs. FSGS 2 days ago

What methods were used. Whole exome sequencing panels can miss certain types of mutations (gene re- duplication for example) and MUC1 is not includ...

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RE: Global glomerulosclerosis vs. FSGS 2 days ago

As mentioned in the initial post, "Genetic testing in first patient no significant mutations and no mutations of uncertain significance." Genetic t...

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RE: Global glomerulosclerosis vs. FSGS 2 days ago

I would definitely do genetic testing , including UMOD and MUC1 in Patient #1 Patient #2 might also benefit from genetic testing as thus might be...

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RE: AAV 2 days ago

Please see following reference for rituximab + oral cyclophosphamide + corticosteroid protocol: https://pmc.ncbi.nlm.nih.gov/articles/PMC5932132/ ...

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RE: AAV 2 days ago

Thanks prof glassock. There is no mention of oral cyclophosphamide and iv rituximab that I can see Bw --------------------------------- Muhammad...

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RE: Central diabetes insipidus with a nephrogenic component? 2 days ago

The only clear " evidence" supporting a central DI is the MRI finding (a decline in the "bright spot" in the posterior pituitary ), but according t...

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RE: AAV 2 days ago

See the Gulati et al protocol (Kidney Int, 2021 ) provided by Dr. Rodby provided, I think that PLEX is optional, but that is only a personal opinio...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

Thank you Dr. Rubin for sharing this! Hussain Abde Ali Karimi Clinical Assistant Professor of Medicine Renal Electrolyte | Department of Medici...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

I have learned lots of more information about DNAJB9 and fibrillary GN by streaming a GlomCon lecture on the subject (link enclosed) given by Dr. M...

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RE: Global glomerulosclerosis vs. FSGS 2 days ago

Some additional information on these 2 cases: Neither patient is an agricultural worker or from the Balkan area. Case #1 (SCr 3.5 mg/dL; normal UP...

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RE: AAV 2 days ago

Would cyclophosphamide 750 mg iv and rituximab 1g on d1 and same on d14 be a sensible regime( + iv/oral steroids ) +/-avacopan If using iv rituxi...

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Nephrology Certification Exam 2 days ago

Hello everyone, What is the most effecient method to prepare for the nephrology certification exam? I appreciate your advice. Thanks.

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RE: Low value care in nephrology 2 days ago

I would hope we are not doing low value care on a "regular basis ." who determines “value?” The person doing the work or the person asking for...

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RE: Central diabetes insipidus with a nephrogenic component? 2 days ago

"The Fenske study suggests that hypertonic saline can help differentiate between polydipsia and central DI better than water deprivation alone when...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

Urine osmolarity below 100, is quite unusual for NDI and is more compatible with CDI. Persistent polyuria and submaximal urine osmolarity on desmop...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

The Fenske study suggests that hypertonic saline can help differentiate between polydipsia and central DI better than water deprivation alone when ...

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Low value care in nephrology 3 days ago

I am working on a talk about low value care in nephrology; that is, things we do as routine in nephrology that have no proven value or that have be...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

I would consider allowing his usual salt and protein intake to get insight into what has been going on at home The important thing now is to hold...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

READY. I'M GOING TO BE ADMITTED TO TAKE THE WATER DEPRIVATION TEST AND REDO THE 24-HOUR COLLECTION. THIS WAY I CAN ALSO LIMIT SODIUM AND PROTEIN IN...

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RE: AAV 3 days ago

I don't disagree with the "full court press" as suggested by Dr. Rodby, but we need to recognize that PLEX is associated with an increased risk of ...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

Boy!!! This case had been very instructive for me. Read the post carefully. Be suspicious when data don't fit. Starting all over as suggested by Dr...

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RE: Clot/ Debris In Right Jugular Vein 3 days ago

Although it could be a clot , it is difficult to tell based on this image alone. A clip would be helpful. The possibility is that the near-field ga...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

ALL WERE COLLECTED FROM 24H URINE ------------------------------ Thaisa Valverde MD, MSc ARACAJU 557999911168 ------------------------------

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RE: AAV 3 days ago

Thank you ------------------------------ Toni Sabbouh MD, FASN Philadelphia PA (703) 717-1666 ------------------------------

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RE: AAV 3 days ago

Did he have sinus issues for long time before his presentation? ------------------------------ Ashraf El-Meanawy , MD, MS, PHD, FASN Professor of...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

I assume all urine tests were done on spot urine samples and preferably to de done on 24 hour urine sample to have accurate assessment of osmolar l...

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RE: AAV 3 days ago

I would use the attached (retrospective uncontrolled) regimen with rituximab and oral CYC. I have no problem with the plex, even if unproven, see a...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

Agree 100% with @Sheldon Hirsch. These cases get murky and you have to start from scratch Off DDAVP for a day at least a day overnight wate...

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RE: Central diabetes insipidus with a nephrogenic component? 3 days ago

IMO, a lot of the data presented here seems hard to interpret and/or inaccurate--for example, you can not have a sOsm of 247 with a Na of 144 as re...

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RE: Central diabetes insipidus with a nephrogenic component? Friday, January 17 @ 8:42 AM

Of course Dr. Mellas is correct . The serum Sodium and Posm are incompatible with each other. I chose the Posm, but thus was likely a biased choice...

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RE: AAV Friday, January 17 @ 7:35 AM

Thanks for your replies ------------------------------ Toni Sabbouh MD, FASN Philadelphia PA (703) 717-1666 ------------------------------

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