RE: Anti-gap positive metabolic acidosis 4 hours ago

Also intense thirst and polyuria are often seen in the early phases of salicylate intoxication. The blood salicylate levels should prove to be inte...

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RE: Anti-gap positive metabolic acidosis 5 hours ago

Venus, blood gas is ordered, but not yet obtained. Ultrasound of abdomen is normal. Minimal to no abdominal tenderness.I forgot the blood sugar ear...

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RE: Anti-gap positive metabolic acidosis 5 hours ago

The alkaline urine and HAGMA suggests salicylate intoxication. However, if the urine pH was not tested immediately after voiding , it could be a sp...

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RE: Anti-gap positive metabolic acidosis 7 hours ago

venous BG? ketones? BG? acetylsalicylic acid level? B-hydroxybutyrate ?, BP? imaging for abdominal tenderness? assume no glucose or ketones in urin...

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RE: Latent TB and Membranous Nephropathy 7 hours ago

With a Hemoglobin of 10.8 there is no rush to give EPO. The severe Hypoalbuminemia can be an indication for Warfarin prophylaxis of VTE but the GI ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 8 hours ago

The therapy of polygenic LN is the same as with no famiky members involved. I do not know if Mendelian LN should be treat differently -too rare, no...

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RE: Latent TB and Membranous Nephropathy 8 hours ago

Any one can help me with questions? Appreciate it --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 8 hours ago

If genetic lupus proven does that change management ? And if say children of patient were to have microscopic Haematuria and positive dna would w...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 9 hours ago

Thanks for case Agree with colleagues Is this not a NFH class V MLN with possibly class 2 Did the urine dip have red cell cast ? I would also us...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 11 hours ago

I agree with Dr. Venkat. ------------------------------ Song Liu MD Assistant professor New Mexico University Hospital Albuquerque NM (505) 456-7...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 11 hours ago

I agree with your plans to proceed with complement and genetic studies and deferring biopsy at present. Please do post follow-up information and ed...

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

Dear Professors Glassock and Liu, Thank you. I agree that biopsy and complement/genetic evaluation are complementary. However, since September 1,...

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Anti-gap positive metabolic acidosis 15 hours ago

I was called to consult by phone on an interesting case. I am baffled and I'm hoping you'll be able to help me. 2 year 10 month old male with his...

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RE: Hyponatremia 15 hours ago

Thank you, Dr. Hirsch - I agree that chronic SIADH generally reaches sodium balance and that superimposed gastrointestinal loss or post-diuretic vo...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 16 hours ago

I think the bottom line is if TMA is confirmed and TAC is reasonably implicated it should not be restarted. Belatacept would be indicated IMO rathe...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 16 hours ago

I agree- TAC induced TMA is an idiosyncratic reaction . Difficult or impossible to predict and not dose related, so it can occur or recurr even at ...

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

i don't disagree with restarting tac but FYI CNI associated TMA is not dose related. ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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

Thank you very much. The actual donor is a 23-year-old living-related female. Preoperative typing demonstrated limited HLA matching: 2/10 alleles (...

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

What about not restarting TAC and giving Belatacept instead? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen S...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 18 hours ago

Dr. Al-Saegh: Thanks for the update. Your patient is young. This increases risk of rejection if tacrolimus is withheld for too long. What was the ...

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RE: Hyponatremia 19 hours ago

Agree with Dr's Neilson and Rodby. The standard teaching is that chronic SIADH is a state of Na balance: what goes in, goes out, U Na will reflect ...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 19 hours ago

Thank you. From POD2–POD7, urine output recovered after hemorrhagic shock and has remained satisfactory. Creatinine improved sequentially from 2.31...

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RE: Hyponatremia 20 hours ago

In pure SIADH the urine sodium is a function of diet so it can be anything. I agree with Rodby that a low urine sodium is somewhat unusual. I don't...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

FYI-See Nipp R et al Case Rep Onc Med 2014: 27: 165670 for a very similar case, ------------------------------ Richard Glassock MD, FASN Emeritus...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

Addendum - a meaningful but fairly small subset of Waldenstroms Macroglobulinemia patients display Rheumatoid factor (anti-IgG ) activity of the Ig...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

This new data clearly reclassifies the patients Disease from a MGRS to a neoplastic process demanding specific therapy for Waldenstroms Macroglibuk...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

Update to thread - new molecular result Thank you all for the discussion so far; your insights are most valuable. I suspect this to be clone resi...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

I agree with Dr. Aledan - the EM shoes typical findings of an early rather segmental form of MN, probably Class V LN or conceivably a NELL 1 MN sup...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Thanks Dr. Mohammed- interesting information. I believe that Mendelian inheritance of SLE is very rare - about 1% and most often seen in young chil...

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RE: Hyponatremia 1 day ago

liver disease is a potent stimulus Na (renin) AND water (ADH) reabsorption, I agree I would have a hard time diagnosing SIADH in ANY liver patie...

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RE: Hyponatremia 1 day ago

Can a diagnosis of a "simple " case of SIADH be made with a urine Sodium of < 10mM/L in the presence of severe chronic liver disease ? In short, I ...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

Dr, Dastoor thanks for you kind remarks. Much appreciated. Here are my responses to your questions- 1) differentiation of monoclonal B cell ...

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RE: Hyponatremia 1 day ago

Agree. I have seen cases in which there is an obvious non-volume etiology of ADH release but the U Na is low. For example, with superimposed GI los...

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RE: Hyponatremia 1 day ago

I would like to add the caveat that the UNa as a surrogate for effective circulating volume is only valid if the urine is concentrated. The urine N...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 1 day ago

First , I want to applaud @Richard Glassock. He has this amazing talent , where he simplifies a tortous and complicated case , then interprets it's...

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RE: Hyponatremia 1 day ago

Yes, that illustrates the critical role of the U Na in hyponatremia.If it is high, then you can make the diagnosis of euvolemic ADH release and you...

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RE: Hyponatremia 1 day ago

"NS Saline is not the treatment of choice for SIADH. " Depending on the urine osmolality and unless true volume depleted isotonic saline (NS) may ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 1 day ago

Agree that this is early class V LN and in sub-nephrotic proteinuria and normal renal function, I would use a combination of GC and MMF per KDIGO 2...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

Very complex patient. My impression is that this may well be a disease manifestation of late HCV driven type II mixed Cryoglobulinemia in which the...

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RE: Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

Tough case! Thanks for sharing. On the “reactive paraprotein” conclusion. I would respectfully differ with the haematology assessment. The clone h...

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Refractory type II (monoclonal IgM-Kappa) cryoglobulinemic GN with an atypical renal lymphoplasmacytic infiltrate and rising IgM - Next Steps? 2 days ago

63-year-old Caucasian woman presented to clinic for evaluation of CKD in the context of rising serum Cr. and proteinuria. System review positive fo...

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RE: MPGN Pattern 2 days ago

I agree with Dr. Song- the IC-MPGN pattern-of-injury is most often thec result of an underlying disease, especially in older adults , - auto-immune...

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Hyponatremia 2 days ago

As a non-academic Nephrologist, it is obvious that the confusion in diagnosing and management of Hypontremia persists. I would have treated him as...

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RE: MPGN Pattern 2 days ago

Also request for serum DNAJB9 and stain the paraffin immunohistochemistry for DNAJB9 for FGN. Given the IgG4 positive IF and possible history of m...

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RE: Latent TB and Membranous Nephropathy 2 days ago

would colleagues use EPO or wait for biopsy or stomach polyp in case cancer? i would start EPO small dose and unlikely for polyp to be malignant ...

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RE: Latent TB and Membranous Nephropathy 2 days ago

update OGD- 1mm polyp in antrum biopsied Colonoscopy- Left Sided Diverticulosis PET scan No evidence of occult FDG avid malignancy. Ig G...

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RE: Early post-transplant thrombocytopenia with schistocytes: ATG:CNI-associated TMA or multifactorial? 2 days ago

Dr. Al-Saegh: Over the past few days, what has been the further trends in urine output, serum creatinine, hematological values and hemolysis marker...

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RE: MPGN Pattern 2 days ago

Thank you for sharing this case. My read: IgG-dominant immune-complex MPGN with crescents; low C3 with normal C4 suggests alternative pathway activ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

Why isn’t this class II (not I or V)? ‘Mesangial hypercellularity (of any degree) or mesangial matrix expansion…a few isolated subEPI (or subENDO) ...

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RE: Class 1 Lupus With Nephrotic Range Proteinuria 2 days ago

Thanks Dr. Saja , I am usually not using CNI unless nephrotic and nowadays have been switching to OBI for neohrotics and Belimumbab for non nephrot...

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