RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 3 hours ago

Why not give a blood transfusion? With so much recent inflammation it seems unlikely that the patient would respond to Epo or Iron anyway. Would su...

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RE: IgA nephropathy recurrence post transplant 8 hours ago

@Daniel Guevara-Pineda: Has SCr returned to baseline in your patient? What is the most recent urine protein/creatinine ratio? What are the recent t...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 11 hours ago

I agree - the lack of any response to steroids and CNI increases the likelihood of a FSGS lesion and reduces, but does no eliminate. the possibilit...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 12 hours ago

Thnaks for the great point. RVT was ruled out by CT scan with contrast (although not angiogram but radiologist said renal vein looked pretty clear ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 13 hours ago

RVT might lead to persistent proteinuria...and might mask/attenuate some level of therapeutic response? An off chance...but also maybe an additiona...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 13 hours ago

What does the master of Kidney Biopsy and its complications say about this case and Transjugular Kidney Biopsy specifically? Dr. Whittier? -----...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 14 hours ago

The risk may depend on current serum albumin? Why is it urgent to remove the fibroids? Any suspicion that she may have a genetic cause? May be ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 14 hours ago

Interesting suggestions Dr. Luyckx. Just curious, what difference in the approach to treatment of this patient woukd be generated if a search for R...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 14 hours ago

Thank you all. Lady has no major medical background apart from uterine fibroids and history of nsaids for dysmenorrhea. Hence we thought MCD. But 4...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 14 hours ago

Another option is attempting a transjugular vein renal biopsy see attached reference to Safety and Efficacy of Transjugular Renal Biopsy Performed...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 15 hours ago

https://pubmed.ncbi.nlm.nih.gov/34767026/. Patient is on Apixaban for Atrial fibrillation and history of stroke ------------------------------ Sa...

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IV Iron and ESA during infection including Covid to Hemodialysis patient 15 hours ago

76 age white man with ESRD on hemodialysis 3 days a week for more than 8 months, admitted to the hospital for MSSA bacteremia after procedure on va...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 16 hours ago

am presuming you have ruled out a malignancy and/or renal vein thrombosis? Any role for genetics? What is the lady's background? --------------...

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RE: Hypokalemia and hyperparathyroidism 16 hours ago

I think Dr Glassock is spot on. Nephrocalcinosis seen in MSK can be mixed up with Nephrocalcinosis seen in Barrters. We have a case of genetically ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 17 hours ago

@Sivaramakrishnan Ramanarayanan how long since PE and how long on steroids and CNI? UPC now? might consider Temporary IVC filter prior to holding...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 17 hours ago

This rise in serum albumin and the dramatic decline in AntiPLA2R antibody cannot be ignored as a "response" to RTX that predicts later clinical rem...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 17 hours ago

The answers to many of your questions can be found in Bobart SJ, et al CJASN 2023; 18; 1283-1293. ------------------------------ Richard Glassock...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 19 hours ago

The issue here is that is the goal, certainly remission of proteinuria, nephrotic syndrome, hypoalbuminuria. Can we really expect things to resol...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 21 hours ago

how much time its expected for the full effect of Rituximab, then to consider it as failure of therapy? is that applicable for all diseases where...

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RE: Hypokalemia and hyperparathyroidism 1 day ago

Thank you for all your replies. She is 29 year old female. Her serum albumin is 40 gm/L, unfortunately, no urine osmolarity was measured and ...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

True, but this patient is responding clinically . Some patients never respond clinically (with a remission of proteinuria ) despite a full immunolo...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

While decrease in PLA2R-Ab levels may predict remission in MN patients treated with RTX, the full normalization of proteinuria can take more time ....

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

High thrombotic risk warrants minimal anticoagulation interruption. • Prefer UFH bridging if switching from DOACs or warfarin. • Hold anticoagula...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Agree with Dr Rodby, in Pre-Ritux era, steroid+CNI was the most widely used empiric therapy in this scenario but now it is Ritux. What was Albumin...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

Im not so sure I agree wit this approach, in spite of improving albumin, based in this: "PLA2R-Ab (RE/ml, ULN= 14): 890 (2024) -> 573 (5/2024) ->...

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RE: Could piezo channels guide tubule formation the way they guide root growth in some plant species? 1 day ago

ADDENDUM Observation of Honey Moon Phase [hypertrophic glomerulo-pathy] of diabetic nephropathy. This third observation is probably associated ...

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RE: low IgG and rituximab 1 day ago

Agree with IVIG and Rituximab or preferably obinutuzumab ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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RE: Anca Negative Vasculitis 1 day ago

How long has the patient been on dialysis - 3 months? What did her urine look like during the AKI pre HD? Does the patient make urine now? ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Of course you want a biopsy, but that may be delayed or too difficult. it is always tough in this situation. for a biopsy you would have to stop ...

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Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Dear all If a patient presents with massive PE in the context of Nephrotic syndrome, how long to wait before interrupting anticoagulation for kid...

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RE: Anca Negative Vasculitis 1 day ago

If the described biopsy can be interpreted as ANCA vasculitis, then anything could be anything! It sounds like some arterionephrosclerosis with eos...

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RE: Anca Negative Vasculitis 2 days ago

Thanks very much Dr. Zuckerman for your helpful comments. They are right "on point". We need to see the actual photomicrographs. (Deindentifief , o...

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RE: low IgG and rituximab 2 days ago

"Could this HypoG be aggravated through the nephrotic syndrome?" Interesting question which is not easy to answer. The volume of distribution of ...

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RE: Anca Negative Vasculitis 2 days ago

I agree, the biopsy description does not provide convincing findings for a diagnosis of an ANCA negative pauci immune GN. It's hard to know what to...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 3 days ago

Yes I would, He is responding, be patient. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------...

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RE: Seeking Expert Opinion on HIV-Associated Immune Complex Glomerulonephritis (HIVICK) Treatment 3 days ago

Dear Dr. Glassock, We have already initiated antiretroviral therapy (ART) with PJP prophylaxis. The patient has been doing well so far and has sho...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 3 days ago

Thanks a lot! Indeed, plasma albumin is rising (g/L): 25 (4/2024) -> 27 (5/2024) -> 34 (12/2024) -> 35 (02/2025). Would you give 1 g rituximab ...

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RE: Hyponatremia 3 days ago

No there has been a trend not to give chlorothiazide/metolazone in addition to furosemide for patients with volume overload with hyponatremia as th...

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RE: Could piezo channels guide tubule formation the way they guide root growth in some plant species? 3 days ago

I have no idea Other than Observation of clinical cyst growth in PKD patients cAMP / caffeine related etc. Observation of ARBs would favor c...

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RE: Duration for monthly hemodialysis visit 3 days ago

Thank you all for the reply. I appreciate it. ------------------------------ Hithem Fargaly ------------------------------

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RE: Case of RPGN 3 days ago

1-Any MAHA like findings in the peripheral blood smear? Mild normocytic anemia with mild anisopoikilocytosis, polychromasia and mild thrombocytopen...

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RE: Anca Negative Vasculitis 3 days ago

No crescents by LM- a questionable '"cellular " lesion by EM- no necrosis. Insufficient findings for diagnosis of "ANCA negative Vasculiis ", in my...

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RE: Anca Negative Vasculitis 3 days ago

No other cause --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Anca Negative Vasculitis 3 days ago

Crescent , negative if , severe Aki dialysis dependence . Limited biopsy sample( ct guided biopsy due to bmi) Pauci -immune crescentic gn? What a...

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RE: Case of RPGN 3 days ago

Ruling ou endocarditis (including Bartonella )is a good idea, but it seems unlikely with a normal leucocyte count, normal RF and normal serum Compl...

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RE: low IgG and rituximab 3 days ago

I would give IVIgG and treat with RTX. Other opinions welcome. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 38...

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RE: Anca Negative Vasculitis 3 days ago

Why so you think that this oatient has ANCA negative Vasculitis as a cause of AKI.? ------------------------------ Richard Glassock MD, FASN Lagu...

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RE: ANCA vasculitis with abnormal CT chest/AKI 3 days ago

Thank you , Dr Glassock. ------------------------------ Asad Riaz Indianapolis IN ------------------------------

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RE: Electrolyte Case 3 days ago

38 Female complex history summarised Sepsis ,Multi Organ Failure and cardiac arrest at Lincoln in 2019.(2019 on ITU where her TTKG suggested sig...

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Anca Negative Vasculitis 3 days ago

70 female . Bg basal cell cancer and IBS. Presented with aki. Baseline 0.8 presentation 21/10/24 then creatinine 2.43 and 30/10/24 started dialysis...

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