RE: Membranous Nephropathy with Rapid Progression 1 hour ago

Actually 900 mg in 600 ml. Yes that seems to be the consensus. Because the changes seem much more drastic than the course of the disease. Probably ...

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RE: Is Hypertonic Saline appropriate here 1 hour ago

What is UPC and UAC ? Is this AKI or Diabetic nephropathy (CKD) ? agree with careful 3% saline for symptomatic hyponatremia. Agree with renal US. ...

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RE: Is Hypertonic Saline appropriate here 1 hour ago

Hi, how are her vitals? any concerns for salt wasting nephropathy? did you by any chance check cortisol levels? ------------------------------ Di...

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RE: Lupus Nephritis 2 hours ago

Hi, given her age, I would try MMF+ pred + belimumab with ACEi/ARBs and HCQ. I have limited experience with obinutuzumab. ----------------------...

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RE: Hyponatremia 2 hours ago

Interesting discussion. I like the piz/tazo idea, though I'm not aware of such cases being described in the past. Though best demonstrated when e...

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RE: Is Hypertonic Saline appropriate here 3 hours ago

@Roger Rodbythanks for your response . However I would use Effective osmolality to guide treatment , rather than corrected Pna . My reasoning is ...

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RE: C3G- pre and post Pegcetacoplan 3 hours ago

@Richard Glassock In a large series of anti CFH mediated C3GN no cases were associated with genetic abnormalities in CFHR. There is just one c...

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RE: C3G- pre and post Pegcetacoplan 5 hours ago

National Complement centre sorry --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Membranous Nephropathy with Rapid Progression 6 hours ago

Did you mean 24hr urine protein of 600 mg in volume of 900 cc? Stable urine output ~ 1.0 L/day despite being on dialysis for ~ 1 month suggests ...

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RE: Lupus Nephritis 6 hours ago

Standard of care is evolving, butI would prefer "triple therapy " for initial treatment of this patient - Steroids, MMF (or CYC-EuroLupus ) + OBI- ...

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RE: Renal thrombotic microangiopathy 6 hours ago

There is strong possibility high vegf factor is involved (second biopsy and comment)Measurement pf vegf is important Bajinder Reen Sent from my iPh...

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Lupus Nephritis 8 hours ago

18 years Patient female with no PMHx and no FHx presented with bilateral leg edema and morning periorbital edema. Examination showed malar rash. I...

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RE: Hyponatremia 9 hours ago

An unexplained osmolal gap has been reported to occur in children with nephrotic syndrome presumably due to plasma-volume contraction, similar to y...

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RE: Renal thrombotic microangiopathy 10 hours ago

I think you have convincingly demonstrated that a circulating permeability factor is involved, which is smaller than an antibody. Possible treatmen...

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RE: Membranous Nephropathy with Rapid Progression 12 hours ago

He has been on hemodialysis for around a month now. 24 hr urine protein with volume of 600 ml in 900cc and PLA2R titres are negative now. -------...

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RE: C3G- pre and post Pegcetacoplan 12 hours ago

Self paying patient , Peg is 40% cheaper than Iptacopan ... At this stage of his disease am not sure will have more benefit ---------------------...

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RE: C3G- pre and post Pegcetacoplan 14 hours ago

What about trying a switch to Iptacopan? Not an evidence based opinion. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA ...

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RE: Is Hypertonic Saline appropriate here 15 hours ago

Blood urea and SCr are essentially unchanged over ~ 24 hours despite normal saline infusion suggesting parenchymal renal disease, acute or chronic....

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RE: C3G- pre and post Pegcetacoplan 18 hours ago

Thanks for case and contribution from colleagues If this is MPGN/c 3 gn and the fact that most gloms were sclerosed and similar in biopsy 2. Does...

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RE: Is Hypertonic Saline appropriate here 1 day ago

Agree that the best treatment for this symptomatic hyponatremia is hypertonic saline. I saw many cases like this with CKD and most on thiazide diu...

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RE: Is Hypertonic Saline appropriate here 1 day ago

With an elevated BUN I prefer to just look at the "corrected" Pna. Corrected for the BG, instead of the effective (tonicity) osmolality. here ar...

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Is Hypertonic Saline appropriate here 1 day ago

A patient referred for second opinion She is 54 year old female , no Pmhx presented with fatigue , nausea and vomiting on 10th March Her labs ...

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RE: Hyponatremia 1 day ago

I see this reasonably often: a surprisingly high s osm--an unexplained osmolar gap--with no explanation and a pre-test probability of near -zero (b...

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RE: Renal thrombotic microangiopathy 1 day ago

Dear Dr. Reen Thank you for your input. In 2024, we tried tocilizumab (instead of siltuximab) based on a presumptive diagnosis of "atypical" TAFRO...

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RE: Hyponatremia 1 day ago

She was started on 3% Nacl and we continued furosemide iv. He Pna this morning is now 128 mmol/l Measured serum osm = 301 Uosm = 240 Calculated So...

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RE: Hyponatremia 1 day ago

The fact the U Na is 60 meq/L suggests she does respond to diuretics with a natriuresis. The Uosm 250-280 looks like a loop diuretic effect. Depend...

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RE: Renal thrombotic microangiopathy 1 day ago

Hemoadsorption can remove vegf. If vegf levels are available. Will be helpful --------------------------------- Bajinder Reen MD Etobicoke ON (9...

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RE: C3G- pre and post Pegcetacoplan 1 day ago

I think that CHFR1-3 deletion mutations are also associated with C3GN and anti-Factor H auto-antibodies.., not just aHUS. A liw seum C3 is usually ...

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RE: Hyponatremia 1 day ago

Great suggestion Dr. Balan. Seemingly easy to confirm or deny. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388...

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RE: Renal thrombotic microangiopathy 2 days ago

May be consider situximab if not tried --------------------------------- Bajinder Reen MD Etobicoke ON (905) 453-0821 --------------------------...

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RE: Renal thrombotic microangiopathy 2 days ago

If it was atypical Tafro May be you are removing VEGF which may be elevated in Tafro @Bill Whittier had one patient with VEGf (if man get pregnant....

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RE: Renal thrombotic microangiopathy 2 days ago

Dear community, I would like to provide a follow-up on this patient. With ongoing plasmapheresis, the patient maintains normal kidney function, w...

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RE: Hyponatremia 2 days ago

One of the possibilities could be the piperacillin tazobactam. Preparation in 10 ml dilution will give you an osmolality of 1278 most/kg and, if gi...

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RE: C3G- pre and post Pegcetacoplan 2 days ago

Can you post the genetic report of this patient? Out of curiosity, not that this is going to change the management but would like to see what copy ...

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RE: Hyponatremia 2 days ago

Although it cannot explain the isotonic hyponatremia in this patient, since she is on IV furosemide + PO metolazone, need to know if she has become...

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RE: Hyponatremia 2 days ago

I must assume that an AGMA was excluded in thus case but this should be documented by laboratory results. ------------------------------ Richard...

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RE: Hyponatremia 2 days ago

is there any high anion gap acidosis? any reason to think of ketoacidosis or d-lactic acidosis? this can increase the unmeasured osmoles. ------...

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RE: C3G- pre and post Pegcetacoplan 2 days ago

Thinking generically (and very simplistically), with progressively decreasing GFR in chronic GN, the balance between the following factors may affe...

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RE: renal limited microangiopathy 2 days ago

No they did not report factor H antibody. they just reported antigen ------------------------------ Swathi Pullela DO KDMS Nephrology & Hypertens...

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RE: case of IG A Nephropathy 2 days ago

Thank you Dr Glassock and Dr venkat for your input/ advice Immunoflirocence was negative for IG G and complement ! Her BMI has been 31-32 BP was...

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RE: Hyponatremia 2 days ago

But where is the hypotonicity . That is the issue here. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -...

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RE: Hyponatremia 2 days ago

Diuretic-induced hypotonic hyponatremia --------------------------------- Abed Elhakam El-Lababneh MD Undergraduate student Al-Yarmouk Universit...

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RE: Hyponatremia 2 days ago

Is it possible that the increased Osmolal Gap is the consequence of unmeasured osmoles accumulating in CKD? Just curious, as tge Osmolal Gap tends ...

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RE: Hyponatremia 2 days ago

I think the VBG rules out pseudohypoNatremia this is not Hyperosmolar hyponatremia (glucose and mannitol) i doubt this is possible but dod you ...

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RE: C3G- pre and post Pegcetacoplan 2 days ago

Dr. Dastoor- thanks for this post. A careful reading of the NEJM paper of Pegcetacoplan in C3GN (Fakhouri F, et al 2025) discloses that this kind o...

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C3G- pre and post Pegcetacoplan 3 days ago

This is a case of a 19 year old boy from India . He was found to have sudden onset of proteinuria around 18 months ago His serologocal workup , i...

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Hyponatremia 3 days ago

57 year old lady admitted with Right sided heart failure , Pul Htn, hx of CAD , ascites and CKD with baseline creatinine of around 2 mg /dl She w...

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RE: case of IG A Nephropathy 3 days ago

In my opinion , the IgA deposits seen in many healthy living donors (typically without IgG or C3 deposits) should not be regarded as "igANephropath...

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RE: case of IG A Nephropathy 3 days ago

Maybe- but if IgG and C3 are absent it looks more like the pattern seen in healthy living transplant donors . Could be just aggregated gdIgA withou...

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RE: NBLU 2026 3 days ago

Thanks Dr. Aliano. The ASN is supporting NBLU again this year with travel support for attendees. Fellows receive $350 in travel support, though ...

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