RE: Postural hypotension 6 minutes ago

Thanks Dr. Campese. I stopped fludrocortisone but did not stop midodrine. Serum Magnesium is normal. ------------------------------ Jaison George...

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RE: Postural hypotension 7 hours ago

Did you stop midodrine? Did you measure serum Mg or, even better, erythrocyte Mg content? The patient is diabetic and has glycosuria. This leads fr...

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RE: Osteoporosis In Stage 5 Ckd 8 hours ago

I again agree with Prof Glassock as I do not think there would be decreased chance of hypocalcemia, though not sure if it would be worse. The botto...

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RE: Postural hypotension 9 hours ago

He feels better after stopping fludrocortisone and adding oral potassium supplements. His serum free light chain assay is normal (kappa 53.42, lamb...

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RE: Polyuria 20 hours ago

Thank you Dr. Mellas. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Canine amyloidosis treatment options 20 hours ago

this is amazing! Can you post a picture of the 🐕? Mostly for fun since he responded to therapy? Does HIPPA apply to your veterinary patients...

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RE: Polyuria 20 hours ago

The data is most consistent with mild, daily, and possibly excessive intake of water as evidenced by the pNa of 136 and U osm 146 suggesting an app...

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RE: Canine amyloidosis treatment options 21 hours ago

Hi everyone, I just wanted to give an update on this dog for anyone who was interested. The dog has been receiving 4mg/m^2 of chlorambucil onc...

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

Hard question , because I can't factor in patient values or know whether UACR was trending downward ,But maybe 6 months. Your hypothesis of "l...

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

Thanks prof glassock how long would you wait for ? @ prof glassock if you have time for my not very cleve question question is in her case if she...

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

I do not think that we will ever know for sure, but the data available strongly suggests that this is Sirolimus induced diffuse Podocytopathy not a...

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

@ prof glassock and prof venkat you make a very important and good point . i did post a picture of acr on graph above but will display a clearer...

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RE: Membranous Nephropathy 1 day ago

“Later modified ponticelli regime failure” meaning it did not work Thanks for case and opportunity to learn / discuss --------------------------...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Normocomplementemic iC-MPGN makes IRGN less likely. Why not start steroids and MMF awaiting further studies ? Time in nephrons. -----------------...

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RE: Membranous Nephropathy 1 day ago

Sorry I missed that he was on coumadin prof glassock Was his level therapeutic over time ?And if so no need to exclude RVT Just curious what modi...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

No- I think just ithe opposite. Greater risk of hypocalcemia from Denosumab in presence of adynamic bone disease. Concomitant Hyperparathyroidism...

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RE: Membranous Nephropathy 1 day ago

Why? He is already in Warfarin. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------------...

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RE: Membranous Nephropathy 1 day ago

And what about excluding renal vein thrombosis before a kidney biopsy ? Kind regards --------------------------------- Muhammad Soobadar MBChB ...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

Dr Glassock no hematuria now, eGFR is same. ------------------------------ Awais Nauman HMC Doha ------------------------------

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Thank you for your reply . So do you agree that using prolia would result in less hypocalcemia in adynamic bone disease than in hyperdynamic bone d...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Actually, adynamic bone is usually associated with relatively low calcium as the bone is unable to take up or release calcium. There is also decrea...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Thank you for your replys. But having adynamic bone disease would result in hypercalcemia!! due to less uptake of calcium by the bone (ie no conseq...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

I am sorry, her complements are normal , not low... I am considering complement based therapies , but with normal complements , no complement profi...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Again, I agree with the comments by Prof Glassock. Denosumab, decreases bone turnover by inhibiting RANKL, thus decreasing osteoclast formation. De...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

How "low" are complements? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Chica...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Would you consider therapy with Iptacopan or Pegcetacoplan. ? Just curious. Any opinion, Dr.Rodby? ------------------------------ Richard Glassoc...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Good Question. To best of my knowledge, It inhibits new bone formation and reduces the delivery of calcium to the ECF from bone. Both bad news in A...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

Thank you for your replys, May I enquire about the mechanism of hypocalcemia in the setting of hypoparathyroidism with consequent adymamic bone di...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Her Creatinine just returned , it is worsening . Seems to now correlate with her biopsy I think i would be now inclined to pulse steroid her . ...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Low C3 and C4 (if both were decreased ) suggests classical pathway activation and not compatible with a post-streptococcal IRGN. RF level may help ...

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RE: Polyuria 1 day ago

Thank you so much Dr. Rodby for the opinion. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: FSGS vs C3G and Canavan Disease 1 day ago

Her Complements are low , she has not had a RF done , will request it tomorrow .. todays first meeting was a bit tense with the husband , wife and ...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

I agree with Dr. Rodby. The Canavan disease mutation is likely a red-herring. The LM has feature of MPGN and the EM will be very helpful- the diffe...

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RE: FSGS vs C3G and Canavan Disease 1 day ago

The IF says only IgA in casts but the Comment says IgA 1+ I think there is a bit too much Igs for C3 GN? An infection related GN is always a ...

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RE: Polyuria 1 day ago

"The serum osmolality is 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. I was wondering if there is a component of partial cen...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

I totally agree with Prof Glassock, especially with the relatively low bone alk phos and PTH, she likely has low turnover disease and Prolia, or ot...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

"If plumbing is bad in the kitchen, it is bad in the bathroom too". Renal vascular disease is highly expected. The biggest risks for this patient...

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FSGS vs C3G and Canavan Disease 1 day ago

Saw a 32 year old female for the first time . She was seen by a colleague around 2 weeks ago Was initially seen in the ER with a 3 week history o...

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RE: Polyuria 1 day ago

Additional data: The serum osmolality report came as 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. Serum Ca is 9.6mg/dl, se...

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RE: Polyuria 1 day ago

Thanks Dr. Rodby for the opinion. She does not have salt craving. There are no symptoms of androgen excess. ------------------------------ Jaiso...

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RE: Polyuria 1 day ago

Thank you so much Dr. Glassock. The serum osmolality is 288mosm/l, urine osmolality is 146 mosm/L. The serum sodium is 136. I was wondering if ther...

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RE: Pauci-Immune GN, Chronic, Minimally Active 1 day ago

The proteinuria may be due to the FSGS lesions noted in the kidney biopsy. Is the patient on optimal anti-proteinuric therapy with RAS inhibitor, s...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

I am presuming that the bone specific Alkaline Phosphatase level in this patient was 10 mcg/L not 10mg/L. Values for Bone-specific alkaline phospha...

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RE: Osteoporosis In Stage 5 Ckd 1 day ago

I think this patient is at very high risk of developing serious hypocalcemia after Denosumab and would avoid its use . This is an opinion only. The...

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RE: Polyuria 1 day ago

Agree with others that this most likely represents increase urine frequency . May consider looking for hypercalciuria and hyperuricosuria as can be...

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RE: Pauci-Immune GN, Chronic, Minimally Active 2 days ago

Follow up on this case. EM: Rare mesangial and few sub epithelial electron dense deposits seen. Minimal foot process effacement. She was started ...

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RE: Osteoporosis In Stage 5 Ckd 2 days ago

Hypocalcemia may develop even with underlying adynamic bone disease, and low low PTH level? Bone Alkaline phosphatese was 10 mg/L ( normal 6-20) -...

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RE: Osteoporosis In Stage 5 Ckd 2 days ago

Based on the low PTH level and normal total AP, it is likely that she has Adynamic Bone Disease. Further investigation with bone turnover Biomarker...

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Osteoporosis In Stage 5 Ckd 2 days ago

75 year old lady with diabetic nephropathy and stage 5 CKD not on dialysis( eGFR of 12 ml/min) , was referred from ortho. department for opinion. ...

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RE: Polyuria 2 days ago

If she does not have nocturia, I really doubt this is a urinary concentration problem, also her U SG is 1.010 suggesting isosthenuria I suppos...

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