RE: Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 20 minutes ago

What is his Body Surface Area.? A non-BSA indexed eGFR might be normal. If you do not have access to Iohexol measured GFR or Cystatin C eGFR , then...

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Evaluating GFR in an Athlete Receiving Creatine Supplementation and Isotretinoin 1 hour ago

Patient: Male athlete • Creatinine: 113 µmol/L • eGFR (CKD-EPI): 70 mL/min/1.73m² • Other labs (blood & urine): Normal • Medications: • Creati...

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RE: Electrolyte Issue 6 hours ago

Not much does that, GI (can be surreptitious) v RTA v surreptitious carbonic anhydrase inhibitor abuse 1) Get urine K/Cr ratio to deter...

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Electrolyte Issue 6 hours ago

Dear team , Any resource /paper /guideline to approach low k and acidosis please ? Best wishes

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 8 hours ago

I'm curious, what prompted the renal biopsy in this diabetic? If the BM (you will preservere) is negative what to do? If special staining cannot ...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 8 hours ago

Thanks heap Dr Cunha for the reference. I really appreciate it. Best, Hong ------------------------------ Siev Hong Lor PharmD Pharmacist Liv...

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RE: Hyponatremia in HF 14 hours ago

Right - and just to be clear, I was suggesting to individualize. And perhaps I should have been more clear about mentioning that the specific scena...

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RE: Hyponatremia in HF 19 hours ago

Roger, zero disagreement. Na [More]

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 19 hours ago

Thanks Dr Glassock for your comments To my knowledge B-cells were not stained for IgG and cytogenetic analysis was not done. I will check serum I...

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RE: Diffuse Lymphoid infiltrate on native kidney biopsy w/o lymphoproliferative disorder. 19 hours ago

Hi Dr Balan Thanks for the comments. Immunohistochemical analysis of the tissue showed CD20 + cells with dim staining for CD5. Findings concernin...

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RE: Hyponatremia in HF 21 hours ago

I agree- treating hyponatremia of 125-133 mmol/L may be "overkill " (pun intended) is such patients, but decisions have to be made on a case by cas...

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RE: Hyponatremia in HF 21 hours ago

Sheldon epiphenomenon. I can still remember learning that word in college. It is such an important concept perfectly applied here. But hypoNa ...

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RE: Hyponatremia in HF 1 day ago

Years ago we used to commonly say that hyponatremia simple reflected worse prognosis in cirrhosis and CHF and didn't need excessive attention. I be...

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RE: Hyponatremia in HF 1 day ago

"Increasingly I am the latter for people whose definitive management is get a device, get a new organ, get an inotrope, or consider comfort care." ...

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RE: Hyponatremia in HF 1 day ago

Yes a reasonable point about treating the pt and not the numbers In this case hard to know if persistent Nausea reflected hf and gut edema bs the s...

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RE: Hyponatremia in HF 1 day ago

From a practical perspective I agree with Dr. King but exploring the pathophysiology is always of interest. ------------------------------ John M...

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RE: Hyponatremia in HF 1 day ago

So I can't add anything smarter to the reasons mentioned for prolonged + refractory hyponatremia. But whenever I see folks with severe HF, severe...

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RE: Refratory nephrotic syndrome? 1 day ago

is anyone doing Anti nephrin antibody quantification? I have a similar case- for academic curiosity Ragu ------------------------------ P...

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RE: Hyponatremia in HF 1 day ago

Assuming all infused Na is osmotically active and the body fluid compartments are in osmotic equilibrium, then an average of 500 ml of 3% NaCl per ...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 1 day ago

I suggest to see the guidelines of reumatology on this matter: Bass AR, Chakravarty E, Akl EA, Bingham CO, Calabrese L, Cappelli LC, Johnson SR, ...

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RE: Refratory nephrotic syndrome? 2 days ago

yes, the pre treatment pet was positive ------------------------------ Liliana Cunha Hospital Vila Franca de Xira Amadora -----------------------...

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RE: Refratory nephrotic syndrome? 2 days ago

Could you please help on the literature on RTX for MCD and lymphoma. ------------------------------ Liliana Cunha Hospital Vila Franca de Xira A...

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RE: Hyponatremia in HF 2 days ago

I think they has to be it but it's a really huge salt load we did not have multiple urine sodium's but those we had consistent with lots of electro...

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RE: Refratory nephrotic syndrome? 2 days ago

I have send Anti-Nephrin antibodies to quantification. I did think this could be related to lymphoma. I will discuse to his hematologist adding o...

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RE: Hyponatremia in HF 2 days ago

Dr Friedman's point is the great excuse (I think it is real) for when Pna just doesn't make sense with what goes in and out. Your urine output is...

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RE: Hyponatremia in HF 2 days ago

I would suspect that the water infused with the iv drips is being retained thus blunting the effect of hypertonic salt infusions. Based on the las...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 2 days ago

Probably safe but not very effective. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 2 days ago

Thank you Dr Balan and Dr Glassock for your feedbacks. I was actually curious if it is worthwhile / safe to give the person hepatitis B vaccines...

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RE: Acute interstitial nephritis 2 days ago

Thank you very much. Very interesting . I may need to simplify initiate IS therapy with either AZA or MMF . I really cannot implicate any medicati...

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RE: Refratory nephrotic syndrome? 2 days ago

Goof point, but the pathogenesis might be an IgG antibody directed to a Nephrin like epitope shared by T lymphocytes and podocytes and the source o...

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RE: Hyponatremia in HF 2 days ago

Yes the na was <20 on 3% and with balloon pump and lasix drip now at 126-130 with one day of tolvaptan despite monomial decrease in uosm-to 185 b...

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RE: Refratory nephrotic syndrome? 2 days ago

@Richard Glassock: Since this patient had a T-cell lymphoma treated with CHOP, wouldn't cyclophosphamide be a better choice than mycophenlate as a ...

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RE: Refratory nephrotic syndrome? 2 days ago

Thanks Dr. Friedman. KIRREL2 is also expressed in both Podocytes and Lymphatic tissue. This might be a paraneoplastic anti-KIRREL2 or Anti-Nephrin ...

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RE: Hyponatremia in HF 2 days ago

Could this have to do with infused Na moving into non-osmotic exchangeable tissue Na compartment as seen (subclinically) on Na-MRI? Is UNa still < ...

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RE: Acute interstitial nephritis 2 days ago

The commonest etiology of recurrent AIN in this study at 32% was ‘idiopathic’. https://pubmed.ncbi.nlm.nih.gov/33564419/ -----------------------...

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RE: Refratory nephrotic syndrome? 2 days ago

Was pre-lymphoma treatment PET +ve? According to this study, 15% of T-cell lymphoma = non-FDG-avid. https://pubmed.ncbi.nlm.nih.gov/20009002/ Not...

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RE: Hyponatremia in HF 2 days ago

"The Tension Sensors" located in carotids and renal arteries mandates ° Volume conservation as the top priority for innate survival. In Engl...

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RE: Acute interstitial nephritis 2 days ago

My guess, and it is only a guess, is that the "response" to long term anti-microbial is a "red herring". Contrary opinions are welcome. --------...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 2 days ago

Great response Dr. Balan. The issue with RTX is "reactivation" of latent HBV replication, in previously exposed and HBV infected individuals. There...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

Very helpful indeed . Just the kind of data that would allow an evidence based decision. Very, very informative discussion. Thanks Very much to you...

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RE: Potential donor with compound heterozygous mutations in CFHR1/3 and CFHR1/4 3 days ago

I received the following response from Dr. Smith: Daniel Walls, one of the bioinformatician's in the MORL, has looked into this question. Using Al...

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150+ Applications, Still No Luck: Is Academia's Postdoc Market Getting Harder, or Is It Just Me? 3 days ago

I'm currently searching for a postdoctoral position in immune-metabolic research (gut microbiome, macrophage polarization, sepsis-AKI) starting sum...

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RE: Acute interstitial nephritis 3 days ago

I think here Dr Glassock's diagnosis of TINU seems spot on. The presence of fever and constitutional symptoms at the most severe episode with no ev...

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RE: Hepatitis B Vaccine in ANCA (immunocompromised) 3 days ago

Vaccination takes time to attain efficacy. Ideally you would need a full regimen over 6 months or an accelerated intradermal regimen (which is not ...

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RE: Refratory nephrotic syndrome? 3 days ago

This is an important finding, indicating a possible anti- podocyte antibody pathogenesis. I would start to taper steroids and add RTX, ---------...

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RE: Refratory nephrotic syndrome? 3 days ago

Yes, it has a "fine dusting" in the IgG on IF ------------------------------ Liliana Cunha Hospital Vila Franca de Xira Amadora -----------------...

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RE: Refratory nephrotic syndrome? 3 days ago

Very tough case. MCD is more strongly associated with Hodgkin's Lymphoma than Non Hodgkin's Lymphoma (NHL) and occurrence of MCD is not clearly rel...

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RE: Hyponatremia in HF 3 days ago

Adding day 5 in 1874 3% 800 out 2175 serum 122 117 120 t ------------------------------ David Charytan MD, MS, MSc Norman S. Wikler Professor o...

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Hyponatremia in HF 3 days ago

Wondering if people can provide any explanation for failure to improve in this hyponatremia case 60+ year old male with ttr amyloid HF and EF [Mo...

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Refratory nephrotic syndrome? 3 days ago

Dear colleagues, I will like to share a difficult case that I have been seeing. It is a 49-year-old male patient, born and residing in Mozambique,...

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