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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: Monitoring Response After Rituximab 47 minutes ago
@Richard Glassock And this was for specific disease (vasculitis) Don't know if we can generalize for other indications -----------------------...
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RE: Monitoring Response After Rituximab 1 hour ago
Please not that the outcomes are the same with or without dosing according to CD19+ B cell counts. This is an economic not a patient centered benef...
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RE: Keto acid analogue in incremental hemodialysis and peritoneal dialysis patients 1 hour ago
Should be Ariyanopparut, S. et al. Scientific Reports 2023; 15: 15459. Sorry for the mispell. ------------------------------ Richard Glassock MD,...
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RE: Monitoring Response After Rituximab 1 hour ago
@Prem Chandran So you monitor CD19 after 3 months of the infusion? not before that, right ? And if after 3 months CD19 >0 , you give additional 50...
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membranous nephropathy 2 hours ago
Dear all I would like opinion from my esteemed nephrology teachers and colleagues about a case with membranous nephropathy based on AntiPla2R bu...
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RE: 12-year-old child on Dialysis 2 hours ago
Update about the case: The highest peak serum creatinine was 4.9 last Friday, but it decreased to 4.4 today compared to the previous week. I ap...
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RE: How to diagnose hyperaldo. in ESRD? 3 hours ago
@Prem Chandran Here is the conversion document I created to clear the confusion over the units conversion for Aldo/ Renin. As you know Renin ...
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RE: How to diagnose hyperaldo. in ESRD? 3 hours ago
@Richard Glassock That is a good point. I agree that genetic testing should be done, given how early his HTN developed. He is under the care of ano...
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RE: Keto acid analogue in incremental hemodialysis and peritoneal dialysis patients 4 hours ago
Dr Glassock: I am having a heck of a time in getting this report you cited: Ariyanoparrut S, et al. Scientific Reports 2023; 13:14529)By any chance...
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RE: Monitoring Response After Rituximab 4 hours ago
Plz see attached report of the French Vasculitis group, a multi-center study. I have used their recommendations to avoid over-dosing ---------...
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RE: Male KTR Seeking To Have Children 4 hours ago
specific adjustments to immunosuppressive therapy are not typically required for sperm donation, a thorough review and consultation with healthcare...
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RE: Keto acid analogue in incremental hemodialysis and peritoneal dialysis patients 10 hours ago
Good Question. I suppose that you are asking whether the addition of oral keto-analogues to a low-protein (plant based ) dietary regimen will causa...
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RE: Male KTR Seeking To Have Children 10 hours ago
We don't, although the product insert suggests so. A couple of relatively small studies have shown no increase in risk of teratogenicity. ------...
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RE: Solute diuresis - post obstructive diuresis how long does it last? 18 hours ago
IMO, the important question in cases like this is whether the negative balance is physiologic or pathologic. I always presume and treat as physiolo...
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Keto acid analogue in incremental hemodialysis and peritoneal dialysis patients 19 hours ago
Dear Prof and Doc, I have several patients with incremental hemodialysis and peritoneal dialysis. They still have significant urine output. They...
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RE: Monitoring Response After Rituximab 21 hours ago
Great Question. Unfortunately , I do not know of widely accepted or consensus view on this subject in relation to the three disorders in which Ritu...
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Solute diuresis - post obstructive diuresis how long does it last? 21 hours ago
57-year-old male, No significant PMHx. Presented 2 weeks ago with inability to urinate for the past 4 days and intermittent fever. Found to have Se...
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RE: IgA Vasculitis in an adult 1 day ago
For how many days has SCr been stable around 3.1 mg/dL? I bring this up because if SCr has plateaued for several days, it means that UCr excretion ...
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Monitoring Response After Rituximab 1 day ago
Do you monitor response after Rituximab by measuring CD19 depletion ? Or repletion to predict relapse ? Especially in those don't show good clinic...
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Male KTR Seeking To Have Children 1 day ago
35 y male 1 year After LRKT, stable graft function asking about drug modification to plan having a child You still shift your male patients from M...
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RE: IgA Vasculitis in an adult 1 day ago
Thanks for sharing the interesting case. To sum it up Positive multiple serologies Glycosuria Creatinine out of proportion to biopsy finding...
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RE: IgA Vasculitis in an adult 1 day ago
Patient never had gross Hematuria. ------------------------------ ChiragVaidya ------------------------------
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RE: IgA Vasculitis in an adult 1 day ago
No previous UAs available at this point. ------------------------------ ChiragVaidya ------------------------------
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RE: IgA Vasculitis in an adult 1 day ago
No gross hematuria. Biopsy read as IgA Nephropathy ( Oxford- M1, E0, T0, C1). Anti DNA Ab - 41, ANA - 1:1280 ------------------------------ Chira...
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RE: IgA Vasculitis in an adult 1 day ago
Patient doesn't have any pulmonary symptoms at this point. No cough, SOB and O2 sat is normal. ------------------------------ ChiragVaidya -----...
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RE: IgA Vasculitis in an adult 1 day ago
Most recent CRT level is 3.1. There is acute tubular injury as well along with fibrinoid necrosis. ------------------------------ ChiragVaidya -...
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RE: Nephrotic range proteinuria, steroid resistant FSGS ? Genetic, steroid treatment cessation 1 day ago
Good questions (as usual) Dr. Venkat. I would expect that the NPHS2 mutation is homozygous, as the condition is autosomal recessive. If it is a het...
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RE: IgA Vasculitis in an adult 1 day ago
Regarding the possibility of ANCA-associated crescentic GN superimposed on IgA nephropathy suggested by Dr. Glassock: Have you looked at any and al...
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RE: Nephrotic range proteinuria, steroid resistant FSGS ? Genetic, steroid treatment cessation 1 day ago
Dr, Sundaramurthy: What about the thin BM abnormality - did genetic testing show COL-4 alpha-3, 4, 5 mutations also? Was the NPHS2 mutation homozyg...
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RE: Post-partum HELLP v. aHUS 2 days ago
"I got the medication approved via our high-cost pharmacy committee overnight and am initiating eculizumab today" Congratulations, I think there ...
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RE: Post-partum HELLP v. aHUS 2 days ago
I want to thank everyone for their incredibly helpful input. As an update, patient today remains oliguric with ongoing transfusion requiring anemia...
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RE: Nephrotic range proteinuria, steroid resistant FSGS ? Genetic, steroid treatment cessation 2 days ago
Thanks Dr Glassock , appreciate it . --------------------------------- Dhivya Sundaramurthy MD, MBBS Des Moines IA (989) 964-9508 --------------...
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RE: IgA Vasculitis in an adult 2 days ago
Good point Dr. Rodby- such patients usually have gross hematuria . Was this present in this case? Can you post the full pathology report (de-identi...
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RE: IgA Vasculitis in an adult 2 days ago
2 of 10 glomeruli had crescents yet creatinine 0.92 (June '23) -> 2.23 (June '24) -> 2.98-> 3.1 RPGN with "only" 20% crescents? The AKI seems a ...
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RE: Nephrotic range proteinuria, steroid resistant FSGS ? Genetic, steroid treatment cessation 2 days ago
My personal experience with NPHS2 mutation related FSGS and Nephrotic syndrome is that these patients are nearly universally steroid resistant, and...
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RE: Nephrotic range proteinuria, steroid resistant FSGS ? Genetic, steroid treatment cessation 2 days ago
Update : I started weaning prednisone slowly and he is on the last couple of weeks of prednisone 10mg. Proteinuria plateaued around 4 g but albumin...
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RE: Post-partum HELLP v. aHUS 2 days ago
Sorry, I might have missed it but I did not see if schistocytes are present. Of course, lack of schistocytes does not mean it is not TMA. Two studi...
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RE: IgA Vasculitis in an adult 2 days ago
The diagnisis of IgA V is based on both clinical and histopathological finding, such as a leucocytoclastic cutaneous vasculitus, arthralgias or abd...
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RE: Post-partum HELLP v. aHUS 2 days ago
@Richard Smith @Carla Nester Dear Carla and Richard. Almost a decade has elapsed since you questioned the clinical utility of the MAC assay (Am J...
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RE: Post-partum HELLP v. aHUS 2 days ago
Thank you Dr. Java for your prompt response. ------------------------------ Mario Rubin, M.D. Houston TX (000) 000-0000 -------------------------...
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RE: Post-partum HELLP v. aHUS 2 days ago
https://www.ajkd.org/article/S0272-6386(15)00498-9/fulltext https://www.mayoclinicproceedings.org/article/S0025-6196(18)30663-3/fulltext Dr. Rub...
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RE: Hypertension urgency 2 days ago
Like any paroxysmal disease, in which the episode frequency is difficult to predict, prevention is key, but poorly understood. If the BP is entirel...
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RE: Post-partum HELLP v. aHUS 2 days ago
@Prem Chandran Can you please share the published key data on the membrane attack complex assays to guide the use of eculizumab? Thank you ----...
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RE: Post-partum HELLP v. aHUS 2 days ago
@Anuja Java Can you please share the published key data on the clinical utility of the membrane attack complex assays? Thank you --------------...
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RE: Hypertension urgency 2 days ago
I think you need to confirm HTN by ABPM or HBPM. After long term follow up of these patient with high office BP (WCH) and hypotension on ER oral an...
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RE: Post-partum HELLP v. aHUS 2 days ago
With respect, I have to disagree. C5b-9 assay is the closest that the complement chemists have to offer to decide on whether or not the patient is ...
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RE: Post-partum HELLP v. aHUS 2 days ago
I would not recommend deciding Ecu used based on the sC5b-9 assay. sC5b-9 levels by themselves are not reliable. Infact, sC5b-9 levels can be highe...
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RE: Post-partum HELLP v. aHUS 2 days ago
I would recommend sending blood for a C3b-9 assay. I have no conflict of interest but Mayo labs have the shortest turnaround time. If the test is p...
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RE: Hypertension urgency 2 days ago
Thank you for your inputs. Any recommendation for further management? Is it safe to keep potential hypertensive without medication? ---------...
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IgA Vasculitis in an adult 2 days ago
I have a gentleman who is 59 YO who presented with RPGN clinically. Work up as outlined below. Diagnostic work up so far: #Lupus panel (June...
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