RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 11 minutes ago

It is likely low turnover, though not sure how much a biopsy will change therapy if confirmed. As previously mentioned, would stop the Tums and any...

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RE: arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 47 minutes ago

Achieving dry weight is essential. However, if patient has surge of BP only during dialysis, consider slower rates of UF. Often, patients with kidn...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 hour ago

Upon further review of the original post, I agree with the other respondents that severe secondary hyperparathyroidism is not likely present and co...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 6 hours ago

Note comment on diarrhea, aluminum quite constipating. Does he have pancreatic insufficiency? Above all stop tobacco and Calcium input. Jorge Rom...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 11 hours ago

Dear Dr. Riaz Reading about your patient reminded me of quite a few I saw like that. Since he's noncompliant with phosphate binders , is he doing...

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RE: arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 13 hours ago

Could probably consider challenging the dry weight of the patient. And adding non dialyzable beta blockers could be a good next option once CCB and...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 16 hours ago

Dear Dr. Riaz Reading about your patient reminded me of quite a few I saw like that. Since he's noncompliant with phosphate binders , is he doing...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 17 hours ago

As mentioned, I may try tenapanor at 20 mg once a day for a 7-10 days and then if no diarrhea, titrate it up. My clinical experience is that the di...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 17 hours ago

I have no experience with STS for tumoral calcinosis. Any other testimonials, other than the N=1 from Dr. Hirsch.? When you “cut into” this stuff...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 20 hours ago

I have not had good gi luck with tenapano but Dr Sprague was in the clinical trials and keeps saying the diarrhea is self limiting and I don't doub...

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RE: DKD & Immune Complex GN on biopsy 22 hours ago

EM had 3 glomeruli. One had segmental sclerosis. The other two were intact. ------------------------------ Hema Sheelvanth MD, MS Atlanta GA ...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 22 hours ago

I appreciate the additional input from Drs. Negrea, Sprague, Rodby and Hirsch. Seems like, surgery does not appear to be an effective option. Unfor...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

I agree with Dr Rodby. I don't think we really know how STS works--I doubt it is much of a Ca binder--but it seems to work for CUA and some evidenc...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

Gonna give my two cents here Pth 2-300 I dont think that is the problem, and calcimimetics or pth-ectomy will help I like the idea of more aggr...

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arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 1 day ago

I have a 44-year-old patient who has been on dialysis for two months and has hypertension that is consistently accompanied by severe headaches, and...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

Clearly a very difficult case. I agree with Professor Glassock and would not proceed with surgery as healing is generally poor and can result in fu...

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RE: Is Hypertonic Saline appropriate here 1 day ago

I am not sure the "acute vs chronic" issue is outdated as much as sometimes hard to know as an outpatient (and therefore, warranting caution). In t...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

I find it interesting that with such high phosphorus, his PTH is only 200-300 (presume pg/ml?). This would limit adding calcimimetic as an adjunct ...

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RE: Is Hypertonic Saline appropriate here 1 day ago

A few minor points; [Na] remains an effective osmole, while [Glu] has a transient effect on s osm and tonicity. I understand the concept of expan...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

Thank you all for your comments . Very useful. Will definitely cover with anti proteinuric drugs and consider anti B cell therapy. Best Daniel ...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

I agree with Dr. Glassock that stopping CNI may increase proteinuria. Hope is whatever component of reversible CNI-toxicity is still there can be e...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

Once you taper the CNI do not be surprised if the proteinuria increases. CNI have a direct anti-proteinuric effect on glomeruli, quite independent ...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

While you pursue alternative immunosuppressants such as obintuzumab or ACTHAR, since DSA is negative repeatedly and since there is no other evidenc...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 1 day ago

Thank you, Dr Glassock. Yes, we have tried almost all available binders. However, their use is limited by pt's c/o "diarrhea" and after experienci...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

The patient is homozygous for a COL3 VUS, yet the mother is negative on screening. I presume that same VUS in a heterozygous state should be detect...

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RE: Novel COL4A3 Variant and Kidney Transplantation 1 day ago

Dear colleagues, Thank you for your valuable comments. Regarding the sibling's renal biopsie electron microscopy unfortunately was not performed,...

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RE: Case of FSGS with IgM and C3 post transplant 1 day ago

Thank you so much Dr Glassock very helpful. ------------------------------ Daniel Guevara-Pineda MD West Hartford CT ---------------------------...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 2 days ago

Tough case. But I doubt that surgical removal of these extra osseus calcinosis deposits is a viable option, as wound healing would likely be poor a...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

On balance, I favor a recurrence of permeability factor related Primary FSGS in this case. If EM was performed on the early graft biopsies.this mig...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

Also primary NOS disease was in the nephrotic range prior to transplant. Post transplant proteinuria pick at 4gr improved with RAS blockage Get O...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

Thank you I thought about that possibility therefore i run a renasight which is negative Get Outlook for iOS

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

As Dr. Awais mentioned , DFE with non nephrotic range proteinuria raises the tiny possibility of genetic FSGS ------------------------------ Dr....

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

Thank you for sharing this paper dr Venkat this make the diagnosis and management much for complex to date i dont have clear diagnosis for this p...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

Also, please see following reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC5577650/#:~:text=There%20were%20significant%20positive%20correlati...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

From Google AI: "Yes, secondary focal segmental glomerulosclerosis (FSGS) can show IgM deposition. While IgM staining is commonly associated with p...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 2 days ago

Thank you , Dr Venkat. L spine x ray showed diffuse osteopenia and Hip xray no significant arthropathy ( per report ) Alk phos is normal - 43 ...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

My bad, now I understand your point , to consider that the donor had a COL4 variant , the evaluation of the donor was not done in US , I do not hav...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

thank you Dr Nauman Mother lives in India , from what I gather in the family history , she is doing very well We have a completely negative R...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

This may be a long shot but lack of nephrotic range proteinuria despite diffuse FPE, mother to child donation, I wonder if its genetic FSGS rather ...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 2 days ago

Serum alkaline phosphatase and bone-specific alkaline phosphatase? Are hand, skull and spine x-rays suggestive secondary hyperparathyroidism? Besid...

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RE: Is Hypertonic Saline appropriate here 2 days ago

Dr. Abdullah: As I am sure you know, use of IV sodium bicarbonate therapy in metabolic acidosis is a controversial topic. It is generally agreed th...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

thank you Dr Venkat for your comment very much appreciated 1 : is a possibility but his tacro trough have been rather low running 4 to 6 , also ...

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

"There is striped interstitial fibrosis with proportional atrophy involving ~40% of the cortical tissue............................ IgM shows 2+ se...

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treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 2 days ago

Hello, I wanted to get some advice/opinions on how to proceed with management of this unfortunate ESKD pt. 63-year-old male, on PD since Augu...

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RE: Novel COL4A3 Variant and Kidney Transplantation 2 days ago

Genetists at our institution typically test the whole family unless someone does not consent. This makes interpretation of VUS easier. Though I und...

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Registration Kidneycon 2026 2 days ago

Nephrologists & Trainees Transform Kidney Care Together- 10 years of all things kidney- mentoring and network building..travel grants open. http:/...

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KidneyCon Invite! 2 days ago

http://kidneycon.org/registration please come and also share with tour trainees. KidneyCon is around the corner..- Nephrologists & Trainees Transfo...

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Case of FSGS with IgM and C3 post transplant 2 days ago

Dear Colleagues , I would appreciate your input and advice on this complex case , my apologies for this long post 36-year-old Male with proteinu...

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RE: DKD & Immune Complex GN on biopsy 2 days ago

80% glomeruli sclerosed ... 90% IFTA... Plan for transplant --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of...

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RE: Is Hypertonic Saline appropriate here 2 days ago

I am not sure if I would give IV Na Bicarbonate, given it's Na load . Would try to get away with slow correction of the acidosis with oral Na Bicar...

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