RE: Help me make sense of this 24 hr urine study for stones. 7 hours ago

What is the patient's BMI or waist circumference? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Me...

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RE: Post Partum TMA 8 hours ago

I believe in interpreting the clinical picture to reach a diagnosis more than other parameters. This is a lady who had a preterm delivery at her ho...

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RE: Potential donor with mutation in NR3C2 Gene 10 hours ago

This is a follow-up on the case: her aldosterone level was 5.3 ng/dL (reference range 0–30), and plasma renin activity was 0.763 ng/mL/h (reference...

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RE: Help me make sense of this 24 hr urine study for stones. 13 hours ago

@john asplin ....thanks for the amazing review on citrate and bicarbonate metabolism . I always assumed that in addition to citrate being converted...

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RE: Help me make sense of this 24 hr urine study for stones. 13 hours ago

The patient is consuming a high sodium diet, around 5 grams per day, he must be using the salt shaker liberally. This needs attention. I guess that...

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RE: Help me make sense of this 24 hr urine study for stones. 13 hours ago

Dr. Asplin, Thank you so for much for the response. The patient reports he only meats one portion of meat (Like the size of a hamburger patty) 4 ...

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RE: Post Partum TMA 13 hours ago

Thai case has all of the hallmarks of aHUS, even though Post-Partum RCN is strongly suggest. A full reading of the kidney biopsy is not yet availab...

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RE: Post Partum AKI 14 hours ago

What did the kidney biopsy show? Thanks. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medici...

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RE: Post Partum AKI 17 hours ago

A patient with 13 gm of proteinuria , low albumin, with generalized edema and acute kidney injury (AKI), showing fast deterioration. Is there any h...

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RE: Post Partum TMA 17 hours ago

Thank you for sharing this case. It presents significant challenges, as postpartum Thrombotic Microangiopathy (TMA) could be associated with Thromb...

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RE: Help me make sense of this 24 hr urine study for stones. 17 hours ago

Dr Dastoor, As for a combo of Kcitrate and Kbicarb, I view it no differently than Kcitrate. The increase in urine citrate is from the alkali load...

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RE: Help me make sense of this 24 hr urine study for stones. 18 hours ago

What is the density (Hounsfield units) of the stones on the CT? While this doesn't discriminate perfectly among stone compositions, [More]

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RE: Help me make sense of this 24 hr urine study for stones. 18 hours ago

Would you consider replacing K citrate and Na bicarb with Sybnial ( k citrate and K bicarb) ... What's your experience with drug in stone managemen...

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RE: Help me make sense of this 24 hr urine study for stones. 18 hours ago

Note high BUN and Sodium -- likely due to high animal protein intake (? likely processed meat which recently has been labeled as a carcinogen). E...

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RE: Help me make sense of this 24 hr urine study for stones. 18 hours ago

In order to interpret the urine I'm going to make a few assumptions: 1) The patient has formed uric acid stones in the past and that is why he is t...

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RE: SIADH conundrum 19 hours ago

I do not use urine osmolality. Using osmolality will give you solute free water clearance, which includes urea as a solute in it. Using urea for tr...

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RE: SIADH conundrum 21 hours ago

I still adhere to the teaching of Dr. Rose (see page 252 of the 3rd edition of his book). ------------------------------ Mario Rubin, M.D. Houst...

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RE: SIADH conundrum 21 hours ago

@John Mellas You are absolutely correct. We all "estimate" an ADH effect using the calculation you have so nicely reinforced. On the other hand, ...

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RE: Post Partum TMA 21 hours ago

I agree with Dr. Balan's cogent comments - Classic post.Partum RCN initiated by abruptio placenta or marked intra- or post-partum hemorrhage is not...

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RE: SIADH conundrum 21 hours ago

Mellas is correct that it is the electrolyte-free water clearance and not the free water clearance that is most useful. the free water clearance re...

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RE: SIADH conundrum 22 hours ago

The attached paper is certainly relevant and more precise from a strictly physiologic perspective. The formula is a little bulky for bedside use an...

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RE: Post Partum TMA 23 hours ago

Most of the TMA in a post partum bleed with severe AKI is secondary to DIC. What was the prothrombin time and partial thromboplastin time at diagno...

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RE: SIADH conundrum 1 day ago

@Kambiz Kalantari Please clarify how you can calculate CH20 (free water clearance) without actually measuring the urine osmolality (see below). A...

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RE: SIADH conundrum 1 day ago

I agree with you that this is SIAD from encephalitis. I also like what you are doing now. If the patient is responding well with no changes in ment...

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RE: Total Hip Replacement in ESRD 1 day ago

She clearly should have a hip replacement, though healing may be a bit delayed, it should not be to complicated ------------------------------ St...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Small underpowered uncontrolled study of moderate non-renal, non-organ threatening disease. 50% ANCA negative - No cases of RPGN. outcomes based on...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

Probably has high acid excretion .. his urine Na , urine uric acid , urine sulphates , UUN are all high or on the higher side which will necessaite...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

@John Asplin ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chicago IL (773) 505...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Dr. Soobadar -in regards to the use of campath -I am not a liver transplant specialist but review current guidelines campath is not recommended for...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Dr. Soobadar: Our center doesn't use alemtuzumab (Campath) for kidney transplantation. I have no personal experience with this drug. What I posted ...

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RE: Help me make sense of this 24 hr urine study for stones. 1 day ago

I assume the Magnesium is being given as the citrate salt. Is this the case. This might explain the urine findings.even though K Citrstr is being g...

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Help me make sense of this 24 hr urine study for stones. 1 day ago

70 year old man with Hypertension , Diabetes Mellitus Type II, CKD 2/3, , Hyperlipidemia , Depression , atrial fibrillation, Peripheral Vascular Di...

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RE: Total Hip Replacement in ESRD 1 day ago

I would keep looking, she is 30. https://www.sciencedirect.com/science/article/pii/S0972978X23000685 ------------------------------ R...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

The recurrence rate of ANCA vasculitus in kidney transplants is already so low that it might be difficult to ascertain if the induction regimen mak...

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RE: Applications for Travel Support to ASN Kidney Week 2026 Now Open 1 day ago

Dear all, As a reminder, applications for the ASN Kidney Week 2026 travel support grants will close on Wednesday, June 10, 2026. Please spre...

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Applications for Travel Support to ASN Kidney Week 2026 Now Open 1 day ago

Hi all, Travel support applications for the world's premier nephrology meeting, ASN Kidney Week, are now open and will close on Wednesday, June 10...

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Applications for Travel Support to ASN Kidney Week 2026 Now Open 1 day ago

Hi all, Travel support applications for the world's premier nephrology meeting, ASN Kidney Week, are now open and will close on Wednesday, June 10...

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RE: Total Hip Replacement in ESRD 1 day ago

I can understand the surgeon's reluctance if it is an elective cosmetic procedure. This patient is in considerable pain with greatly restricted mob...

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RE: Total Hip Replacement in ESRD 1 day ago

Dr Glassock, I agree, the avascular necrosis and the pain and limitations she has are surely from previous steroid use and not renal osteodystrophy...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Thanks prof venkat . Really helpful points In your practice then do you give Campath in patients who have Anca vasculitis and get transplant ? My...

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RE: Post Partum TMA 1 day ago

Sachin: What were the complement studies that were sent? Was there a C5b-9. My understanding is that systemic TMA & Renal limited TMA can co-exit, ...

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RE: Post Partum TMA 2 days ago

With a kidneys showing cortical necrosis and no active hemolysis, I think it would be safe to stop complement inhibition and observe. She may still...

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Post Partum TMA 2 days ago

Wondering if you would continue with complement blockade in this situation. 25 year old female no past medical history, with NO prenatal care, pr...

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RE: Total Hip Replacement in ESRD 2 days ago

I would imagine that the bilateral osteonecrosis is related to steroid therapy of SLE and not CKD-MBD. Her problem can likely be cured by hip repla...

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RE: Total Hip Replacement in ESRD 2 days ago

The following reference is relevant to the question raised by Dr. Hirsch: https://pubmed.ncbi.nlm.nih.gov/35389908/ Wonder if bone densitometry...

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RE: Total Hip Replacement in ESRD 2 days ago

Great Question Dr. Hirsch- i don't understand the rationale behind refusal of Orthopefic Surgeons to offer this young woman with a life altering di...

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RE: complex case of nephrotic syndrome in liver transplant patients 2 days ago

I have no idea about the clinical relevance of the "equivocal " IF findings for C3, C1q and Lambda. Please discuss this with your renal pathologist...

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RE: IgA nephropathy with crescents 2 days ago

Dear Colleagues, I appreciated your discussion regarding therapy in patients with IgA nephropathy (IgAN) presenting with crescents on kidney biops...

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RE: SIADH conundrum 2 days ago

This is SIADH. I would use low dose tolvaptan and adjust accordingly. You cannot continue with HTS indefinitely. ------------------------------ J...

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RE: complex case of nephrotic syndrome in liver transplant patients 2 days ago

Please see the following from AI: "Campath is a monoclonal antibody designed to target the CD52 protein. Because CD52 is found on the surface of ...

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