RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 4 hours ago

@Edwin Anand-just FYI-Hepatic vein doppler might help to distinguish etiology of low EABV( HYPONATREMIA) in this case from significant TR ----...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 4 hours ago

thanks Dr. Liu for the article which drives home all the important points -increased RI, reversal in diastolic flow, perinephric usually sub capsul...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 5 hours ago

Thank you very much, Professor Lerman. Her younger brother developed ESKD at nearly the same age and underwent a successful kidney transplant seven...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 5 hours ago

Dr. Lerman: I can recall 2 cases of Page Kidney following kidney transplantation, in the setting of implantation biopsy + early post-transplant sta...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 5 hours ago

Thank you very much, Professor Glassock. We agree that ATG-associated thrombocytopenia/hemolysis is currently the leading explanation; ATG was stop...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 5 hours ago

Here is one article for Page kidney after kidney transplant. ------------------------------ Song Liu MD Assistant professor New Mexico University...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 6 hours ago

Post transplant "Page Kidney" excellent point but never seen it happen in my Transplant Nephrology career . Per literature presents with sudden dec...

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RE: Sarcoidosis? 6 hours ago

Dr. Rodby- do you have a threshold of Scr in Sarcoidosis above which you do not use MTX for therapy. Just curious!! ----------------------------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 6 hours ago

I have customarily avoided Tolvaptan in patients hospitalized with hyponatremia due to chronic liver , especially if the latter is clinically worse...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 6 hours ago

I like the simplicity and the prudent use of laboratory testing!!! Thanks ------------------------------ Richard Glassock MD, FASN Emeritus Prof...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 7 hours ago

Something like...I give 7.5 mg in the AM and check the Na later that day. If it is increasing at an acceptable rate, just redose 7.5 QAM until the ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 9 hours ago

Looks like ATG induced thrombopenia and hemolysis. Should improve gradually. What is happening to the peri-graft hematoma? Watch out for a "Page Ki...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 10 hours ago

@Sheldon Hirsch how do you monitor response to Tolvaptan ?? 1. Decrease in Uosm 2. Increase in urine volume 3. Rise in Pna 4. All of the above ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 10 hours ago

I use talvaptan only in-hospital, not chronically (for hyponatremia), and only (usually just several days) until the Na increases (then stop, to pr...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 12 hours ago

the potential danger in option 2. is relative overcorrection(I continue to assume asymptomatic hyponatremia?) if necessary due to symptoms or ref...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 12 hours ago

thank you for additional details so recipients younger brother had ESRD and successful transplant 7 yrs ago-was brother's donor living vs deceased?...

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RE: AKI & Immune complex GN 12 hours ago

I always thought that the absence of a "full house pattern" means no lupus, but seems Pathology believe in the existence of serology negative, inco...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 12 hours ago

There are only two options 1.give normal saline or 2.diuretic/aquaretic. You tried option 1 and it didn't work, time to try option 2 -----------...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 13 hours ago

Fist something does add up in the urine osms calculation! what was the urine urea? Is he on SGLT2i with severe glucosuria? GI sodium wasting coul...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 13 hours ago

Thank you, Professor Venkat. She had significant residual urine output before transplantation: a documented 24-hour urine volume of 1.21 L with cre...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 13 hours ago

Thank you, Professor Lerman. I share your concern that graft recovery is slower than expected following living-donor transplantation. Her documen...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 13 hours ago

I share Dr. Lerman's concern regarding slow decline of serum creatinine and modest urine output following a living donor transplant. I asked about ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 13 hours ago

Even though urine osm > 500 can predict Free water restriction failure per Dr. Hirsch , if patient is asymptomatic can still observe and escalate i...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 14 hours ago

Concerned creatinine is falling so skowly usually normal after a few days with living donor. Urine output 1.5 l /day seems low -what was pretranspl...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 15 hours ago

Did she make urine before transplant? Total WBC and absolute neutrophil and absolute lymphocyte count trends? If these are falling in addition to h...

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Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 17 hours ago

Dear colleagues, I seek your opinion regarding a 33-year-old, 55-kg woman following living-donor kidney transplantation. DSA and final T/B-cell cro...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

I agree that liver/heart disease/decreased effective arterial volume is the likely etiology, after the failure to respond to 3L saline. I doubt wat...

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RE: Sarcoidosis? 1 day ago

Be very careful with MTX if thexpatient has a reduced eGFR (adjusted for age) . ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Dr. Anand - I believe that your assumption that portal hypertension is required for dilitation of splanchnic vessels (and reduced effective arteria...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Edwin Anand-great case-serial wts?curent serum sodium? if his wt is increasing and BP NORMAL, and serum sodium remains [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Dr. Anand: You had mentioned that the initially low BP improved after IV normal saline and permitted the use of diltiazem and beta-blockers. What...

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RE: Sarcoidosis? 1 day ago

Thank you all for your input. since this seems to be uncharted territory. I will try the methotrexate. --------------------------------- J Gunnell...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Drs. Boobes and Lerman, the 3L of IV fluid that he received on D1/2 was Normal Saline. Unfortunately his urine output was not monitored. His oral f...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

We have new tools available such as Bioimpedence cardiography and Spectroscopy, which are bedside tools to estimate Cardiac output , cardiac index ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

we need to know what type iv fluids were given ( NS? RINGERS? COLLOID ?) hard to believe urine sodium [More]

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Thank you all for this fascinating discussion. Before invoking a rare hepatic or tubular mechanism, I wonder whether the simplest explanation-very ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Thanks Dr. Mellas for raising the "effective arterial volume " deficit as an explanation for renal sodium aviditiy and water retention in this case...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

The history and the following features: · Hypotonic hyponatremia: serum Osm 269 · Strong AVP effect: urine Osm 584 · Strong RAAS stimulation: ...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Both cholestatic CLD (in absence of cirrhosis) & TR could lead to Na (+ H2O) avid state (with persistent, now hypervolemic, hypoNa) by aldo-dep & a...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Based on this very thorough description one must speculate a decrease in effective arterial volume/perfusion as opposed to hypovolemia per se, sinc...

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RE: Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 1 day ago

Just speculating, but could this be "vanishing bile duct syndrome ," and severe enough chronic liver disease to provoke the hyponatremia and low ur...

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Hyponatremia with a low urine Na, no clear cardiac or hepatic explanation 2 days ago

An 83 yr old male with Afib on apixaban, cholestatic hepatitis of unclear etiology (MRI of liver normal, no ductal dilation, bili around 4, AST and...

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RE: FeNa 2 days ago

Thank you for your response, Melanie. If it is still on the Steps, we must talk about it! ------------------------------ Anna Vinnikova, MD Assoc...

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RE: Refractory membranous Nephropathy 2 days ago

Dr. Dastoor - From the descriptions you have provided, I would conclude that this is not immunologically refractory PLA2R mediated MN. Rather the...

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RE: Refractory membranous Nephropathy 2 days ago

Thank you for the new information. So it looks like it is still a case of PLA2R1-MN, where anti-PLA2R1 antibodies may be the culprit of this pathog...

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RE: Refractory membranous Nephropathy 2 days ago

My pathologist just called me , and he just had a conversation with @Samih Nasr at Mayo. It is an IgG4 and anti pla2r on biopsy is positive- done ...

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RE: Refractory membranous Nephropathy 2 days ago

I just read all the above comments on an interesting and very unusual case of MN, which is at least initially PLA2R1-associated MN. I think that th...

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RE: AKI & Immune complex GN 2 days ago

She was not on any meds. that's what I thought, no full house no lupus. What is it though!? ------------------------------ M. Samih, MD, FAC...

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RE: AKI & Immune complex GN 2 days ago

Does the absence of full house ( ie IgM and IgA ) and seronegativitiy rule out Lupus ??? was the patient on any medications ?? ----------...

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RE: Refractory membranous Nephropathy 2 days ago

We are sending this biopsy slides to the Mayo clinic for further investigations ..currently she is on max anti proteinuric therapy with ARB, SGLT2i...

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