RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 39 minutes ago

My gestalt is that hyperkalemia is a function of how well the patient is prepped for the surgery See references Sent from Outlook Files Attached...

View Discussion

RE: 24 hr urine creatinine clearance 1 hour ago

I would love to see such examples in patients with severe secondary hyperparathyroidism with ESRD. They must be as rare as 'hens teeth". Never obse...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 1 hour ago

We have a cohort of patients here , without insurance , or in the country illegally . They are provided with free of cost dialysis, with certain li...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 2 hours ago

------------------------------ Radu Raducu MD MD Sanford Hospital BIsmarck ND (203) 606-7322 ------------------------------

View Discussion

RE: Proteinuria/Hematuria without kidney biopsy 2 hours ago

I wonder if the outcome would have been different if we had not waited for often desired diagnostic greed that we at times strive for or hustle for...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 2 hours ago

IDH is a real problem particularly in elderly patients A blood pressure estimator that runs in real time during hemodialysis using pressure w...

View Discussion

RE: 24 hr urine creatinine clearance 2 hours ago

Dr. Dastoor: I agree with you that examples of very high PTH values with surprisingly near normal SPO4 and SCa values can be found in the literatur...

View Discussion

Onconeph case 2 hours ago

45F with single kidney post right nephrectomy for RCC in 2024. Has been on cabozantinib and nivulomab for lung mets since June 2024. Referred for...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 3 hours ago

Wide fluctuations in BP and heart rate that you describe suggest autonomic dysfunction, especially in the setting of prior spinal cord injury. Is t...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 3 hours ago

Like others, am astounded by the near "normality" of Ca and P with seemingly little binders being used Are the PTH measurements of intact hormone...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 4 hours ago

Sestimibi has been planned as an outpatient . This patient has a low serum calcium , despite tertiary hyperPTH, hence we will use Vit D , prior to ...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 5 hours ago

Like Dr. Venkat I am astounded by the finding of a normal PO4 level in a patientwith such severe secondary hyperparathyroidism on dialysis without ...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 5 hours ago

Dr. Duang- thanks for your response. Experience with Daratumumab for therapy of recurrence of PGNMID in a kindey allograft is limited to anecdotes ...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 6 hours ago

Thank you all for the thoughtful input and generous sharing of expertise on this challenging case. @Dr. Jonathan Zuckerman – Your detailed interp...

View Discussion

RE: Spinal Cord Injury, ANS Dysfunction on HD 9 hours ago

You could use Na modelling. That is use a higher dialysate Na of 145 for the first 1-2 hours , during which time the higher osmolality ( from inf...

View Discussion

RE: 24 hr urine creatinine clearance 9 hours ago

Having now concluded that 24 hour Creatinine clearance may be inaccurate in estimating true GFR, especially with impaired renal function ( since tu...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 9 hours ago

My understanding is that hypokalemia is common in partial obstruction, as tubular function is impaired and losses of K are common. ------------...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 9 hours ago

We have a recent patient admitted for resection of a massive mandibular brown tumor . His PTH is 500 ( 5000 in US terminology) with normal Ca and P...

View Discussion

RE: risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 13 hours ago

Serum calcium of 9.5 (assuming normal SAlb) and SPO4 of 4.7 mg/dL are surprisingly good in the setting of the astronomically high PTH levels posted...

View Discussion

risk of 3.5 parathyroidectomy in ESRD patient with PTH of 8000 14 hours ago

dear friends, 42 year old female with 10 years dialysis vintage, ESRD secondary to presumed hypertension, 7 years on IHD and last 3 years on hom...

View Discussion

RE: 24 hr urine creatinine clearance 17 hours ago

Actual urinary creatinine clearance is the sum of GFR and TS of creatinine. The measured value of urinary creatinine clearance always exceeds measu...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 18 hours ago

@Fouad Chebib My understanding is that Tolvaptan has only been approved for MIC C through E. He is a B without data on serial renal function (to ...

View Discussion

RE: 24 hr urine creatinine clearance 20 hours ago

Grazie Giovanni for the clarification and the references. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -----------...

View Discussion

RE: 24 hr urine creatinine clearance 20 hours ago

Creatine supplementation does not affect renal creatinine secretion, but rather its overall renal excretion. The creatine from dietary supplements ...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 20 hours ago

POTASSIUM HOMEOSTASIS IN OBSTRUCTIVE UROPATHY AND INTERSTITIAL NEPHRITIS RICHARD L. TANNEN Department of Medicine, University California, L...

View Discussion

Spinal Cord Injury, ANS Dysfunction on HD 22 hours ago

Good afternoon, I have a question regarding a 72-year-old patient with lumbar spinal cord injury >20 years ago and BP management on IHD. UF du...

View Discussion

RE: Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Great question and one that we will encounter more frequently as screening genotyping for APOL1 increases. The co-existence of APOL1 high risk alle...

View Discussion

Jynarque for PKD2 with two high risk APOL1 alleles? 1 day ago

Hi, I have a question hoping to survey the crowd for opinions. Pleasant 44 yo M Fhx of kidney disease. Dx with HTN in his 20s. Otherwise healthy. B...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Fully agree, Dr. Glassock. The focus has been on the mechanism for hypokalemia , all the while no treatment for the obstructive uropathy which over...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Without any features of Cushing syndrome or imaging evidence of lung cancer an Ectopic Paraneoplastic ACTH syndrome seems unlikely. What is the rea...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Per the abstract from reference cite "The least interfering drugs are calcium antagonists, alpha blockers, hydralazine, and possibly moxonidine. If...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

"renin undetectable and aldosterone 1.5 indicating primary hyperaldosteronism unless proven otherwise" this is hyporenin hypoaldo state. Apparent M...

View Discussion

RE: hypertension and Hypokalemia not responding to eplerenone 1 day ago

Hi K supplementation requirements is not much (10 mEq), would expect more to suspect ENaC activating process. Still will look into cortisol level (...

View Discussion

RE: A case of tubulointerstitial nephritis 1 day ago

Update on his lab Ca 8.7, alp 86, anti SS-A & B negative, anti-ccp <16 Uric acid 10.6 I have not thought to send for cortisol level since he has ...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Although transplant pathology is not typical, DSA testing is definitely indicated given glomerular capillary wall duplication (occurs in chronic AM...

View Discussion

RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha Kidney Care. Nephrology Consultant- SSMC,PureHealth LLC. A...

View Discussion

RE: pANCA positivity 1 day ago

CRP <1 , hepatitis serologies are negative , ESR not done ------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Se...

View Discussion

RE: Iptacopan Dosing issues 1 day ago

I agree , but i dont think the rise in C3 levles is specific to IgA patients , or patients with diseases of classic or alternative pathways . Eve...

View Discussion

RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Dr. Glassock: Agree with you that multiple auto-antibodies should suggest a drug-induced disorder. However, isn't anti-GBM antibody uncommon in tha...

View Discussion

RE: pANCA positivity 1 day ago

Hepatitis B & C serologies, ESR, CRP? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------------------------------

View Discussion

RE: pANCA positivity 1 day ago

cardiac echo is normal cryoglobulins - awaited RF is negative we are hoping to get a biopsy There are many reports of low complements in ...

View Discussion

RE: 67 year old male with Class IV-V lupus nephritis 1 day ago

So sorry for the delay, Dr. Venturelli - we have sent out the flow cytometry this week and pending. I don't have an APOL1 at this time, but do have...

View Discussion

RE: pANCA positivity 1 day ago

The hypocomplementemia is a bit concerning as this is uncommon in ANCA- associated Vasculitis. The Lupus. Serology makes SLE with nephritis unlikel...

View Discussion

RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Case #1- a mild crescentic GN with a spontaneous resolution is possible, but not if the aGBM antibody remained elevated on serial testing. Cas...

View Discussion

pANCA positivity 1 day ago

My colleague has a 20 year old young male who was referred to him from the Police department , where a routine checkup revealed microscopic hematur...

View Discussion

RE: RECURRENT FSGS POST KIDNEY TRANSPLANT 1 day ago

Question how long after proteinuria occurred post transplant was biopsy showing his histology consistent with FSGS And how long after onset of prot...

View Discussion

RE: Anti-GBM antibody positivity without RPGN - approach? 1 day ago

Is it still possible that your patients have true anti GBM with crescents , but not severe enough to present as RPGN -------------------------...

View Discussion

RE: 24 hr urine creatinine clearance 2 days ago

I agree with Dr. Rubin - where is the evidence that creatine supplement promote Proximal Tubule secretion of creatinine. I need to be educated on t...

View Discussion

RE: A case of tubulointerstitial nephritis 2 days ago

I agree with Dr. Rodby- Sarcoidoisis, Sjogrens, Auto-immune lymphoproliferative syndrome , Leptospirosis IgG4 related disease and TINU (without ...

View Discussion

RE: A case of tubulointerstitial nephritis 2 days ago

I think this patient has prednisone deficiency. :) With the plasma cell rich TIN I thought the IgG4 staining would be positive. The systemic di...

View Discussion