Ramez R. Sunna

Internist and a proud Nephrologist. Ex-chief fellow at St Louis University.

[Ramez R. Sunna @Ramsun2891]

.@askrenal 2/2

kidney bx showed medullary angitis with hemorrhage. No crescents, neg IgA stain. IFTA 80% with some DN changes !!! Any experience in treatment ? Pulse steroids +|- Rituxin ?!! Any studies ? I found one case report published

[Ramez R. Sunna @Ramsun2891]

.@askrenal I have a 52 ys old WF. Hx od dm,htn, daily nsaids use presented with worsening RF for 6 months period. Dx with covid 19 3 months ago. Gfr now 16, UPCR 21 gm, no RBCs in urine. Hb 8.1, platelets 108. All autoimmune workup neg. ANCA neg.

[Ramez R. Sunna @Ramsun2891]

Any updates on how to treat ALECT2 amyloidosis ?!

[Ramez R. Sunna @Ramsun2891]

@askrenal
Scr mid 2, stable for a yr.
C3,c4 wnl
Kappa 72, lambda 38, ratio 1.8
No M spike#how to proceed ?
Mmf + pred ? Vs obs in light of severe fibrosis ?

[Ramez R. Sunna @Ramsun2891]

@NephRodby @ASNCommunities @GlassockJ Glad i triggered that wonderful debate 🥸🤔

[Ramez R. Sunna @Ramsun2891]

@askrenal MN pt s/p Rituxin frustrated that his Covid Antibodies are neg after his 2 Covid vaccine dose ( vaccine given 2 months after Ritux dose). Any role in repeating vaccine or a booster shot ?!!

[Ramez R. Sunna @Ramsun2891]

@GovParsonMO @MissouriOA Child day cares all on waitlist where we should send our kids? I am a health care worker and on front line defense against Covid..we managed to stay safe during last yr...but plz allow me to say that this decision to send everyone to work physically at mass is a bit hasty

[Ramez R. Sunna @Ramsun2891]

@GovParsonMO @MissouriOA @GovParsonMO i respect this decision but should give a longer window for employees to tidy up their schedules. We have a 1 yr old baby and my wife who is a state employee is pregnant and due in August...she is high risk for Covid and we dont even have day care arrangements yet.

[Ramez R. Sunna @Ramsun2891]

ER taught me somth new today...u can treat DKA-induced hyoerkalemia with....( fill in the blanks) !

[Ramez R. Sunna @Ramsun2891]

The ‘perfect’ proteinuria !! Full mark

[Ramez R. Sunna @Ramsun2891]

@askrenal #nephjc how common is RPGN superimposed on membranous nephropathy ? Would u still use the MENTOR Ritux vs pulse steroids to slow down the progression ?

[Ramez R. Sunna @Ramsun2891]

@AhmedArslanMD Nephrologist is the engine..
Urologist is the plumber...
Both work for the benefit of the other !

[Ramez R. Sunna @Ramsun2891]

@askrenal #nephjc 45 yrs male hx of solitary kidney due to wilms tumor rdx with membranous. Alb 2.5, 5 gm prot.Pla2r 59.Edema controlled, scr prog worsening from 1.5 to 3.4 in a week. Trying to control bp with acei. Besides renal vein US, use Pontecelli? Is he at mod risk ?

[Ramez R. Sunna @Ramsun2891]

@GlassockJ @hswapnil @askrenal Yes dr G...all the secondary workup was neg. Prob he had PKD from before...i was just curious to know if anything in the PKD genetics can trigger the presumed MN to flare . I started the usual MN basic therapy and will see if that works !! I was just hoping there s a way to bx it

[Ramez R. Sunna @Ramsun2891]

@askrenal #nephjc 39 yrs AA male with 12 gm protein, gfr 73, PLA2R +ve. Neg proteinuria worku. US with numerous bil cysts...Strong family hx of PKD. Is kidnry biopsy totally contraindicated ? Treat blindly as Membranous ? Any correlation bw PKD and PLA2R ?!

[Ramez R. Sunna @Ramsun2891]

@NephRodby @dr_niraliramani Hyponatremia nights are worse than newborn ‘gassy’ nights !! U wake up evey hr to check on it !!

[Ramez R. Sunna @Ramsun2891]

#askrenal @NephJC any contraindication for kidney biopsy in horseshoe kidney ?

[Ramez R. Sunna @Ramsun2891]

#askrenal @JcNeph any data on using ESA with ckd patients who have essential thrombocytosis and non iton def anemia ? Does it increase chances of clotting ?!

[Ramez R. Sunna @Ramsun2891]

@fernandbteich Prob she breast fed Benzos as a kid !!

[Ramez R. Sunna @Ramsun2891]

Got disappointed from my patient today...she is 3 substances short of completing the ‘full house' collection.