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The latest Nephrology Self-Assessment Program (nephSAP) issue, Volume 23: Issue 2 (Jun 2024): Electrolytes and Acid-Base Disorders is now available online.
RE: Paucimmune GN with Low Complements In Young Patient 40 minutes ago
Noted endocapillary proliferation and neutrophils segmentally in some glomeruli. Was EM done on biopsy? If electron dense deposits are noted (despi...
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RE: Primary hyperaldosteronism 1 hour ago
In this case, the adrenal vein samplings do not support the diagnosis of unilateral adrenal disease. The selectivity index was 15 on the left and ...
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RE: Primary hyperaldosteronism 1 hour ago
Suggest checking catecholamine pheo w/u consider ganglioma /paraganglioma ------------------------------ Conjeevaram Kesavan MD, MBBS, FASN Du...
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RE: Primary hyperaldosteronism 1 hour ago
Interestingly, even salt-loading (Na 270 mmol in 24hr urine) did not suppress renin concentration in this patient. With non-suppressed renin and el...
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Fibrillary GN 1 hour ago
66 y/o Caucasian gentleman with HTN, HLD, Gout, OSA-CPAP, CKD stage IIIa [SCr 1.4 -1.6mg/dl]. Noted to have mild proteinuria in 2000 when examined ...
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RE: Post TX TMA 2 hours ago
"Do you think testing of genetic complement mutation would be of value at the moment" if genetic testing reveals a mutation significantly associa...
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RE: Post TX TMA 2 hours ago
More details of the pathology may help assess if the biopsy was also performed in the resolving phase of the disease. In that case the thrombi ma...
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RE: Post TX TMA 5 hours ago
Thank you for your explanation Do you think testing of genetic complement mutation would be of value at the moment ? ---------------------------...
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RE: Binder 11 hours ago
This is obviously a tough ? and agree with many of the points above. If it is acute feedings, not sure I would worry about it too much. For chronic...
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RE: management of PLA2R negative membranous nephropathy 13 hours ago
Agree for conservative approach and I advise to send for serum THSD7A antibodies and stain the biopsy for THSD7A Ag as 5-10% of PLA2R Ab negative M...
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RE: Post TX TMA 14 hours ago
"So for the CNI induced TMA to develop, we should have a another hit" Dr. Emara: Let me clarify regarding the above statement. It has been sugges...
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RE: management of PLA2R negative membranous nephropathy 15 hours ago
Dear Dr. El-Meanawy, Thanks for the suggestions. I will check anti-PLA2R antibody which I have not done. 24 hour urine protein and UPCR are d...
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RE: Post TX TMA 15 hours ago
Thank you. For sharing this case let's summarize primary disease unknown LRDKT and was uneventful tacrolimus trough level acceptable fo...
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RE: management of PLA2R negative membranous nephropathy 16 hours ago
Dear Dr. Glassock, Thank you for much for the suggestions. Yes, there was no LC monotypism seen in the IF. IF stained Glomerular capillary wall...
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Primary hyperaldosteronism 17 hours ago
Apologies in advance for a lengthy presentation 51 y.o. female. Comes in for follow up after recent hospitalisation 2/6/2024-2/14/2024 for hypokal...
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RE: Post TX TMA 17 hours ago
TAC trough levels are low for this 6 month posttransplant and this may explain borderline TCMR. I don’t thick there is specific features for CNI in...
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RE: Paucimmune GN with Low Complements In Young Patient 18 hours ago
Many thanks Dr. Glassock for your nice comments. C3 0.3 g/l (0.9-1.8) and C4 0.06 g/l (0.2-0.4). --------------------------------- Hayder Aledan...
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RE: management of PLA2R negative membranous nephropathy 18 hours ago
I agree with Dr. Glassock that negative PLA2R staining does not rule out PLA2R-Ab mediated MN. Based on 24 protein and UPCR, she is only producin...
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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 18 hours ago
Amiloride not tried yet --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 51377736 -----------------------...
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Apixaban In hd Patient 19 hours ago
Hypothetical scenario - HD pt with left sided av fistula. Patient has new arm swelling right side . Found to be new DVT. We decide to use apixaban...
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RE: Post TX TMA 19 hours ago
I got your point So for the CNI induced TMA to develop, we should have a another hit May be an ischemic event happened during operation and not ...
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RE: Post TX TMA 19 hours ago
The donor was the mother 55 y Mismatch 3/6 PRA : 0% NO technical problem (ischemia time 50 mins) with 1ry graft function and adequate UOP Creat ...
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RE: Hypertension in pregnant patient 21 hours ago
The levels of PRA in pregnancy are not so high and in the average around 4-5 and not much higher with pre-eclampsia. For the moment, I would cont...
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RE: Post TX TMA 21 hours ago
Dr. Amara: What was the degree of HLA-match between donor and recipient? Can you please post a deidentified biopsy report? What was the pretranspla...
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RE: Hypertension in pregnant patient 21 hours ago
The high PRA could be the result of the two vasodilators given together. The combination of hydralazine and nifedipine makes no sense. I would use ...
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RE: Hypertension in pregnant patient 21 hours ago
Neither chronic administration of nifedipine or Labetolol would likely explain the elevated Plasma renin activity, so increased progesterone conseq...
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RE: Diet and creatine in a personal trainer with single kidney 21 hours ago
My opinion. Does the patient have a history of low birth weight? If so, avoidance of a high protein diet is definitely advisable and his BP should ...
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RE: Hypertension in pregnant patient 22 hours ago
labetalol and nifedipine. ------------------------------ Jennifer Waldmann MD Attending Saint Peters University Hospital howell NJ (732) 996-674...
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RE: A Case Of GN In Hepatitis C Positive Patient 23 hours ago
Appreciate your input , pt admitted , hope we can approve inpatient start of Anti-HCV treatment --------------------------------- Aymen Al-Duajil...
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RE: Post TX TMA 23 hours ago
@K.K. Venkat Would you switch to Rapamine in similar conditions early after tx ? (@Mark Lerman)(@Richard Glassock) -----------------------------...
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RE: Post TX TMA 23 hours ago
Despite the prevalence of buzz words like tubular vacuolization and medial necrosis/hyaline change in the literature on CNI toxicity, I am not sure...
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Diet and creatine in a personal trainer with single kidney 23 hours ago
A 50 year old muscular sport trainer with nephrolithiasis, recent total Lt nephrectomy due to RCC. Was used to 1.6 gram kilo protein a day and...
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RE: Post TX TMA 23 hours ago
Any pathological clue to CNI related rather than complement related TMA? --------------------------------- Ahmed Emara MD, MBChB, FASN Ain shams...
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RE: Post TX TMA 23 hours ago
You still think it's extremely rare after significant improvement after switching to rapamine +PLEX and stopping TAC? @Mark Lerman --------------...
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RE: Hypertension in pregnant patient 1 day ago
What medications were being used when the PRA was measured. If BP is well controlled, I think you can wait until after delivery to pursue a further...
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RE: Paucimmune GN with Low Complements In Young Patient 1 day ago
About 10% of PING that are ANCA negative have reduced C3- (see Lionaki D, et al KI Reports, 2021; 6: 2425) . These patients also tend to have more ...
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RE: Hypertension in pregnant patient 1 day ago
Dr Glassock, i wanted to revisit this case as above. the PRA was 60, which def was not expecting. She is now 19 weeks pregnant on hydralazine 10mg ...
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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago
Interesting discussion I'm thinking about more safe alternative and effective potassium sparing diuretics like amiloride 10 mg bid that I person...
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RE: Post TX TMA 1 day ago
Donor was a living kidney donor so donor derived TMA is excluded. Unless platelets were normal. I would always do a AdamTS13 . Probably safe to swi...
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Paucimmune GN with Low Complements In Young Patient 1 day ago
A 36-year-old patient consulted me with epigastric pain, nausea, vomiting, hematuria and hemoptysis (not documented) Negative PMH and FH but curren...
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RE: Post TX TMA 1 day ago
Biopsy was at Day 7 Donor was healthy and young (living) No MAHA in peripheral blood --------------------------------- Ahmed Emara MD, MBChB, F...
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RE: Post TX TMA 1 day ago
Interesting case. Here are some thoughts that come to mind: How early is this post-tx? Consider donor derived TMA (eg donor with motor vehicle ac...
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RE: A Case Of GN In Hepatitis C Positive Patient 1 day ago
Thank you for this important citation ( Gulati K, Kidney Int , 2021) othat I ignored in my response. As you suggest, this is a provocative hypothes...
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RE: Adjunctive acetazolamide therapy for the treatment of Bartter syndrome 1 day ago
I agree with Dr. Rodby that Spironolactone dose should be higher up to 300 mg/day and also can use Amiloride with incremental dose up to 40 mg. Hav...
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Post TX TMA 1 day ago
acase of 30 y M ESRD of unknown etiology, underwent LRKT with induction basiliximab and TAC/MMF/psl Early post op, pt had slow graft function ( cre...
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RE: A Case Of GN In Hepatitis C Positive Patient 1 day ago
The regimen I mentioned is based on this observation paper (Kidney Int. 2021 Dec;100(6):1316-1324) where they used the combination of Rituximab and...
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RE: A Case Of GN In Hepatitis C Positive Patient 1 day ago
Interesting suggestion. Not yet supported by any RCT data. Casal Moura M et al showed (in an observational uncontrolled study ) equivalence for a R...
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RE: A Case Of GN In Hepatitis C Positive Patient 1 day ago
I wonder if Cytoxan would be preferred over Rituximab in this particular case. Is there enough data to support Rituximab use when the creatinine is...
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RE: Binder 1 day ago
I suspect that powdered Ca Carbonate or Ca Acetate would have the same effect. ------------------------------ Richard Glassock MD, FASN Laguna Wo...
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RE: management of PLA2R negative membranous nephropathy 1 day ago
If you want to understand the nature of the Auto-antigen (? Etiology) of this MN lesion , the best next step is Laser Dissection /Mass Spectometry ...
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