Mohammad Atari
@MohammadAtari12
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Father, Husband, Nephrologist, Transplant Nephrology.
Metairie, LA
Joined February 2021
#askrenal do you allow your CKD stage 2-3 patients to take NSAIDs for a few days (2-3) after dental implant procedures?.
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Is this IgA-lambda nephropathy vs IRGN IgA-Lambda and C3 co-dominant vs I am dealing with 3 different pathologies triggered by infection (IgA-Lambda nephropathy + C3-dominant IRGN + ACR)?.
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C3 and C4 normal, SPEP with polyclonal hypergammaglobulinemia. The patient has OM and an abscess (Bacteroid pyogenes) in his foot.
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IF: Glomeruli with granular mesangial staining for IgA (+3), C3 (+3-4), and lambda (+2). Kappa negative in the glomeruli. Kappa and lambda stain equally through the tubulointerstitial compartment.
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LM: mesangial expansion and hypercellularity. Tubules contain erythrocytes and degenerated pigmented casts. Focal medullary erythrocytes extravasation.
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It seems that we need higher doses of furosemide relative to spironolactone in the setting of renal impairment to avoid hyponatremia.
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I think the diuretic regimen used to treat ascites in patients with cirrhosis and elevated creatinine with the combination of spironolactone and furosemide 100/40 mg ratio should be revised, @VelezNephHepato. I am noticing hyponatremia that improves with stopping spironolactone.
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