RE: pre medication before IV iron 2 hours ago

At the present time no premedication is recommended fir patients about to receive Ferumoxytol IV. (Except in persons with asthma ). Ferumoxytol sho...

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pre medication before IV iron 3 hours ago

Before administering IV iron (ferumoxytol here), for anemia of chronic kidney disease, what Criteria do you follow for deciding premedication to pr...

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RE: IgA Vasculitis in an adult 4 hours ago

Dr. Vaidya: Can you please post a further update on this patient - further SCr and UPr/Cr trends? Did the patient receive rituximab and if yes, do ...

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RE: Iv iron in setting of infection 8 hours ago

Yes, we depend our clinical judgment, like if the patient was hypotensive and had symptomatic anemia in the clinical setting of severe sepsis or se...

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RE: Iv iron in setting of infection 8 hours ago

Yes actually this was much concerning me What if Hb dropped less than 7 g/dl on follow up especially with ongoing IV fluid infusion such young...

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RE: Iv iron in setting of infection 9 hours ago

What is the threshold Hemoglobin level that one should use for deciding between IV iron and blood transfusion in cases like this? I assume that suc...

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RE: Iv iron in setting of infection 1 day ago

Till now no obvious source of infection or such severe anemia she had spikes of low grade fever 38 at night over last 9 days as per mother ...

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RE: Iv iron in setting of infection 1 day ago

In cases of severe infections, severe sepsis, septic shock and lactic acidosis, I tend to transfuse with this level of Hb; otherwise, in the case o...

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RE: Iv iron in setting of infection 1 day ago

1) Unless septic, I don`t thing there is much risk in giving her IV iron (just an oppinion). In case she has a bacterial UTI I would give antibioti...

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RE: Genetic Testing and Kidney Disease 1 day ago

Hi! Thank you for your question. This webinar is not sponsored. We hope to see you there! ------------------------------ Cesia Portillo KH...

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RE: Iv iron in setting of infection 1 day ago

I would think if there is urgent need for immediate increase in Hb it would make sense to transfuse. If no such immediate need exists then oral iro...

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RE: Iv iron in setting of infection 1 day ago

With this sever iron deficiency, she need IV iron. This is still an area of debate. Risk benefit analysis should always be in play. -------------...

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RE: Iv iron in setting of infection 1 day ago

The other important question is why such severe anemia? Part of malnutrition? Or is it menorrhagia? Need to understand the underlying cause to plan...

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RE: Iv iron in setting of infection 1 day ago

She is 15 years old female Low BMI came to emergency department with fever 38.5 with no other symptoms labs revealed . Influenza A positive ...

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RE: Iv iron in setting of infection 1 day ago

The concern that some bacteria use siderophores to multiply is justified. Siderophores are nonfunctional at physiologic pH (7.35-7.40) so in the se...

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RE: Iv iron in setting of infection 1 day ago

I can see no reason not to treat such severe iron deficiency. What kind of infection? What organ/organs are involved? Are antibiotics being co-admi...

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Iv iron in setting of infection 1 day ago

Dear prof Can We start IV iron therapy in cases of severe iron deficiency anaemia Hb 7.1 mg/dl iron 1 ferritin 8 ng/ml (low) T. Sat 3% ...

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RE: Polyuria, is this ADH deficiency? 1 day ago

Thanks to all of is for your very helpful comments! Answers to yoir questions: he works as a clerk at the county administration no baseline ...

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RE: Thrombo-embolic Risk In Travel With Patient 2 days ago

If the adult patient had proven MN or MCD with a serum albumin [More]

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RE: Transplant Question 2 days ago

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

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RE: Thrombo-embolic Risk In Travel With Patient 2 days ago

Thanks prof glassock and if patient had nephrotic syndrome let’s say not biopsied yet and travelling would you give prophylaxis LMWH or treatment d...

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RE: Thrombo-embolic Risk In Travel With Patient 2 days ago

With a normal serum albumin there is no added risk of VTE with this degree of albuminuria . ------------------------------ Richard Glassock MD, F...

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Thrombo-embolic Risk In Travel With Patient 2 days ago

59 male Preserved kidney function. Urine acr 2.7 g normal albumin . Bg liver cirrhosis . Urine dip no blood. First biopsy was not adequate. He wou...

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RE: Polyuria, is this ADH deficiency? 2 days ago

Good point Dr. Rodby- this clinical scenario- a dietary induced polyuria from over -consumption of protein and salt is a fairly common in my experi...

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RE: Infection related GN / paraprotein 2 days ago

He was transferred from another facility and yes, efforts are made to trace the slides and the full report of the biopsy. Working up for MM. Thanks...

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RE: Infection related GN / paraprotein 2 days ago

Since PR3 is the more common ANCA seen in endocarditis , I would assume this is an Infection related GN until proven otherwise. Culture negative...

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RE: Infection related GN / paraprotein 2 days ago

It seems from empirical considerations that there are 2 processes that may or not be related. Occam may not like this but: Underlying MM that ha...

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RE: Infection related GN / paraprotein 2 days ago

Can you please post deidentified kidney biopsy report? Besides crescents, were there endocapillary proliferative and exudative (PMNs) changes sugge...

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RE: Transplant Question 2 days ago

Another point to keep in mind when treating post-kidney transplant polycythemia with ACE-I or ARB: On long-term treatment, patients can become anem...

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RE: DIABETIC NEPHRPATHY 2 days ago

It is a "balancing act" between avoiding kidney failure and achieving the CV benefits (mainly reduced stroke and heart failure ). Some compromises ...

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RE: Polyuria, is this ADH deficiency? 2 days ago

Could be a combined NaCL + Urea osmotic diuresis. All dietary induced. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (...

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RE: Transplant Question 2 days ago

Thank you for a very important question. I completely agree with you that some degree of iron deficiency has to develop i with PTE who are receivin...

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RE: Polyuria, is this ADH deficiency? 2 days ago

Thanks a lot for your comments! On an additional inquiery, the patient denied taking protein supplements, but admitted taking omega 3 fatty acids, ...

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RE: DIABETIC NEPHRPATHY 2 days ago

Dr. Glassock's comment earlier in this post - It tells a familiar story- too rapid and aggressive therapy of hypertension in a patient with DKD lea...

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RE: Polyuria, is this ADH deficiency? 2 days ago

I agree with above. The osmoles likely Na. Yes, 10 g Na intake is high, the highest that I have seen was 27 g which almost 69g NaCl. 24 hour sodium...

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RE: Polyuria, is this ADH deficiency? 2 days ago

What is the baseline UOsm because the value presented is after 12 hr fast? Any 24 hr collection to document polyuria? What is the Copeptin levels l...

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RE: Polyuria, is this ADH deficiency? 2 days ago

Based on the spot urine and a U volume of 4 L/day this equates to 10g Na excretion or > 20 g NaCl. One must assume this reflects salt intake which ...

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RE: Polyuria, is this ADH deficiency? 2 days ago

A better approach is to measure UOSM in a 24 hour urine collection. (Or another suitably timed collection) so that UOSM excretion rate (per day or ...

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Infection related GN / paraprotein 2 days ago

I have a patient, 48 year old man, with constitutional symptoms for the past 1 month, presented with rapidly increasing serum creatinine – RPGN. No...

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RE: chronic lymphocytic leurkia and kidney disase 2 days ago

thanks for your kind responne , i will repeat us and count cysts. workup for paraproteinemia initiated last visit ----------------------------...

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RE: Polyuria, is this ADH deficiency? 2 days ago

Dear Dr. Glassock, many thanks for your almost instantaneous reply! Just to make sure I presented things right: It was a spot urine in the morn...

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RE: chronic lymphocytic leurkia and kidney disase 2 days ago

No proteinuria . No hematuria. Makes MGRS unlikely. The CLL in thus case may be a "red herring", but we need more imaging to evaluate the Cysts and...

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RE: chronic lymphocytic leurkia and kidney disase 2 days ago

Honestly, I would bet against ADPKD in this patient, since at his age kidney cysts are as common as thyroid cysts. His eGFR is over 30, so the Pei ...

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RE: Thiazide Induced AKI 2 days ago

In my experience, chlortalidone (usually 25 mg Monday, Wednesday and Friday) is the best diuretic for non dialysis dependend CKD. I regularly get p...

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RE: Polyuria, is this ADH deficiency? 2 days ago

U/P Osmolal ratio > 1.0. U Osm excretion rate very high. (1900-2500 mOsm/d- 3-4 X normal) . This is an Osmotic diuresis. What is the nature of the ...

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RE: Transplant Question 2 days ago

@ Dr. Lerman, don't you think iron deficiency, at least of some extent, is desireable / unavoidable in such cases? Pathophysiologically, there is...

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Polyuria, is this ADH deficiency? 2 days ago

Dear experts, may I please have your oppinion in this case: - 37 y. Caucasian male - referred for arterial hypertension; dipper; work up unrema...

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RE: DIABETIC NEPHRPATHY 3 days ago

Thanks- Dr. Hirsch -what I was trying to say is the labels we place on patients with Diabetes ( Type 2 especially) and CKD using clinical and labor...

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RE: Genetic Testing and Kidney Disease 3 days ago

Who besides KHI and ASN is sponsoring (funding) this Webinar? Just curious. ------------------------------ Richard Glassock MD, FASN Laguna Woods...

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RE: Is Renal biopsy indicated at this stage or not? 3 days ago

I see pts with family history of CKD/ESRD and mild renal abnormalities . Before genetic testing I take a more detailed history as to patents co-mor...

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