RE: " Super" Severe Resistant HTN in CKD 4 patient 9 hours ago

When/if available, zilebesiran might be a great option for the RAS-mediated element of his HTN given its VERY prolonged duration of effect without ...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 12 hours ago

Agree with the many excellent comments but to mention the issue of volume, the expansion of the ECFV in most patients with hypertension is subclini...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 12 hours ago

Thanks Roger We may be at least partially talking about two different things. My comments/references were about resistant HTN in general. This ca...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 13 hours ago

Sheldon, Again just because BP responds to volume removal does not mean it is just volume I think this is a different bird than 95% of our pati...

View Discussion

RE: Hyponatremia 13 hours ago

Urea will work, as long as you achieve steady state you will excrete the urea you make and take, and you BUN will increased, will level off, grante...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 13 hours ago

addendum (ugh): In reviewing the Talor article, turns out I exaggerated. Nurses were involved but treatment decisions in both groups were made by a...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 14 hours ago

I agree with Roger that volume is not always the culprit in resistant HTN, but it very commonly is. The evidence for that is strong and it is compl...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 15 hours ago

Digging deeper RNs inform me they checking his mouth after swalliwing pills but he routinely goes to bathroom after taking pills be has bee...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 17 hours ago

I agree with Dr. Hirsch that it would be very difficult to imagine such as huge increase in blood pressure primarily due to "volume overload". The ...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 17 hours ago

Not to beat a dead horse, (overly quote an very odd case report) but our patient that eventually required nephrectomy was always controlled on IV C...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 17 hours ago

@Jonathan Slater: is the patient refusing IV access or is it difficult to obtain IV access? If BP is easily controlled with IV medications in much ...

View Discussion

RE: Hyponatremia 17 hours ago

I do not think it will work very well due to the low GFR and urea will surely build up in the blood but urea per se is not toxic so IMO, the treatm...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 18 hours ago

I suspect the TMA was during the severe TMA episode, and even if biopsy showed TMA Im not sure what you do with that. However you are correct in th...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 19 hours ago

Did you check complement gen mutations for aHuS there are good data of aHUS associated with resistant HtN and TMA . Your patient already has evid...

View Discussion

RE: MPGN/Lupus/DKD - biopsy. 21 hours ago

Thank you all. BMI - roughly 28. No other clinical symptoms, mild LFT derangement that is associated with her worsening of metabolic syndrome w...

View Discussion

RE: MPGN/Lupus/DKD - biopsy. 21 hours ago

"I would definitely continue the MMF. I might also consider adding Belimumab(off label) if the Anti- Ro antibody persists." @Richard Glassock: Gi...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 21 hours ago

I our case report I attached earlier, renal denervation (surgical) markedly lowered the BP but it only lasted a short time, thus the decision to re...

View Discussion

RE: Diabetic nephropathy with positive congo red 23 hours ago

DsDNA : 0 ------------------------------ Mustafa Ahmad MD, FASN Consultant Nephrologist King Fahad Medical City Riyadh 966568310309 ------------...

View Discussion

RE: Diabetic nephropathy with positive congo red 23 hours ago

Thanks for the feedback. Apologies for the wrong title- it happened because I wanted to post another patient as well with diabetic nephropathy an...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

I think renal denervation is an option to consider here. ------------------------------ M.N. Alhosaini ------------------------------

View Discussion

RE: Hyponatremia 1 day ago

What is the patients BMI and BSA? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

View Discussion

RE: Hyponatremia 1 day ago

Is administration of urea for hyponatremic patient advised in chronic kidney disease patients? ------------------------------ Wael Jebur MD, FAS...

View Discussion

RE: MPGN/Lupus/DKD - biopsy. 1 day ago

Taken together, the findings in this case support the notion of a forme fruste of Sjogren Syndrome and not SLE , IgAN, or Mixed Connective Tissue D...

View Discussion

MPGN/Lupus/DKD - biopsy. 1 day ago

Hi all, Trying to discern the treatment approach for this 54yo lady of Aboriginal background w metabolic syndrome (variable DM control, HTN, obes...

View Discussion

RE: Diabetic nephropathy with positive congo red 1 day ago

No results for Congo red stain found in report. No features of Diabetic Nephropathy. Need more information on nature of 'organized subendothelial e...

View Discussion

RE: Hyponatremia 1 day ago

Pain and NSAIDS may have played a role. Often, in hospitalized patients, reduction in food (protein) intake may play a role caused by a reduction...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

I agree with the usual attention to volume in resistant HTN but this case is beyond anything I've ever seen. You could easily have volume excess ...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Appreviate the feedback thus far and we will definitely need to reassess the volume issue I forgot to include thst he is on bumex 2 mg bid lung...

View Discussion

RE: Diabetic nephropathy with positive congo red 1 day ago

"Hep B, C , HIV negative." Were HBV core antibody tests also negative? If testing for HBV and HCV was done with antibody screening only, need to...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Read the attached It was one of the most rewarding and most "think outside of the box cases" of my career. I could have never "pulled the...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Agree with Dr. Aledan that control of volume excess is very important. If clinical volume assessment is equivocal, worth checking BNP, and ultrason...

View Discussion

RE: " Super" Severe Resistant HTN in CKD 4 patient 1 day ago

The main cause of HTN and difficult-to-control HTN in CKD is volume overload so the mainstay treatment should include diuretics (both combination o...

View Discussion

RE: Diabetic nephropathy with positive congo red 1 day ago

The tile is diabetic nephropathy with positive congo red, but the content of the case is cryoglobulinemic GN. What was serum RF? Need to rule out...

View Discussion

RE: Hypokalaemia 1 day ago

Urine Na and Cl are high on-diuretics and low off-diuretics. --------------------------------- Hayder Aledan MD, FASN Assistant Professor Basra Ne...

View Discussion

Advocating for Dr Alawieh 1 day ago

Dr. Topf & others, You are not posing any QUESTIONS nor raising any nephrology topic to the forum but rather advocating for the ASN to support a ...

View Discussion

" Super" Severe Resistant HTN in CKD 4 patient 1 day ago

Looking for help in managing a 38 y/o Hispanic Male whose is currently in Jail and now remains in the hospital with unresponsive severe HTN and sta...

View Discussion

RE: Hypokalaemia 1 day ago

I agree with Dr Mellas , could it be surreptitious vomiting rather than diuretics ( urine Cl expected to be high ) ? ---------------------------...

View Discussion

Immigration/deportation 1 day ago

Many of you have probably seen this shocking story:https://www.nytimes.com/2025/03/16/us/brown-university-rasha-alawieh-professor-deported.html A...

View Discussion

Diabetic nephropathy with positive congo red 1 day ago

37 years old gentleman referred to us in 1/2025 with proteinuria and hematuria. No history of DM, HTN, connective tissue disease or clinical f...

View Discussion

RE: Hypokalaemia 2 days ago

Urine: chloride <20, uOsm 611, uNa <20, uK 95, uCreat 39.9 Note: U Cl reported as < 20 suggesting the complete absorption of all NaCl which must ...

View Discussion

RE: Hypokalaemia 3 days ago

I have another view of this complex and interesting case. A few years of polyuria, nocturia and incontinence may suggest hypokalemia is the main d...

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 3 days ago

Thanks everyone really helpful --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 3 days ago

That's an astute thought Dr Salman. There does seem to be cross reactivity between antibodies to bacterial dsDNA and calf thymus dsDNA. The latter ...

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 3 days ago

Do bacteria have double stranded DNA? " Yes, bacteria, like other organisms, utilize double-stranded DNA (dsDNA) as their genetic material, typi...

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 3 days ago

This is endocarditis related gn with autoimmune markers until proven otherwise, did you by chance get a Rheumatoid factor? It is not false positive...

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 Friday, March 14 @ 9:19 PM

I think she has TINU or Behçet's Dz triggered by a serious infection + endocarditis. It appears that broken DS-DNA particles exposed by the injur...

View Discussion

RE: Hypokalaemia Friday, March 14 @ 4:37 PM

Urine: chloride <20, uOsm 611, uNa <20, uK 95, uCreat 39.9 Renin/aldosterone ratio 48 and 61 The low U Na and K and elevated U som needs o be exp...

View Discussion

RE: Hyponatremia Friday, March 14 @ 3:37 PM

As Dr Rodby said about NSAIDs (a million takers, almost no hyponatremia), the same could probably be said about RASIs and thirst. Her low GFR wil...

View Discussion

RE: Relevance Of Ds DNA Positivity With Negative Ana And Normal C3/c4 Friday, March 14 @ 3:32 PM

Anti- ds DNA antibodies (as well as ANCA and very rarely antiGBM antibodies) can be observed in infective endocarditis. They usually disappear with...

View Discussion

RE: Hyponatremia Friday, March 14 @ 3:07 PM

I assume she has no DM and her RBS is normal as hyperglycemia can cause thirst. If Hyponatremia was due to NSAIDs, it may be associated with hyper...

View Discussion