RE: renal limited anti-GBM disease 4 hours ago

For reasons that are not well understood. Diabetic patients can have false positive antibody tests by ELISA. The tests should bd repeated with West...

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RE: renal limited anti-GBM disease 8 hours ago

I forgot to mention that the rest of his immunology panel was negative including MPO and PR3 ANCAs. ------------------------------ Sara Almutar ...

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renal limited anti-GBM disease 8 hours ago

Dear colleagues, I would appreciate your opinion on this case. I have a 36 year old gentleman, known to have type 2 diabetes since the age of...

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RE: Post infectious MPGN 10 hours ago

The CRP 0.6, procalciton 2, ESR 75. wbc 6.7 50% PMN. --------------------------------- J Gunnell, MD Attending Nephrologist ---------------------...

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RE: Post infectious MPGN 12 hours ago

Patient noticed swelling about 2 months ago, the process started before that. He's certainly nephrotic. 24 hours urine protein? If serum creatine ...

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RE: to pulse or not to pulse?? 18 hours ago

I'd like to take the chance to ask the community the following question: How often, in this type of patients, do you start induction therapy wit...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 23 hours ago

@Cristian Pedreros ------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: Post infectious MPGN 1 day ago

I think you need to dig more searching for occult infections such as WBC scan as bone, joint and spine infection can be missed. What are the levels...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

isn't the answer simpler than all that? you have a dialysis bath that is lower in HCo3 to account for the citrate becoming HCO3 and thus you dial...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

Hi everyone: There are two ways to explain the acidosis in citrate accumulation: Explanation according to Stewart's physicochemical model In Stew...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

Excellent discussions. Question to Dr Goldfarb in regard to lactic alkalosis, the elevated AG and no metabolic acidosis. If one infuses HCO3 the ...

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RE: Post infectious MPGN 1 day ago

I agree with Dr. Zuckermans well considered interpretation. There is no MPGN pattern of injury. There is no need to consider a "superimposed " MCD....

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RE: to pulse or not to pulse?? 1 day ago

Given the clinical circumstances in this case, I doubt that PLEX is needed for therapy. ------------------------------ Richard Glassock MD, FASN ...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

Pedro, very much appreciate you citing and attaching our article about citrate. ACD, or acid citrate dextrose, used to anticoagulate RBCs, includes...

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RE: Post infectious MPGN 1 day ago

Thank you for the input. To clarify, the patient has not had previous urine/renal studies because he has been "healthy". In hindsight he believes t...

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RE: to pulse or not to pulse?? 1 day ago

Dr. Soobadar the colleagues' recommendation against PLEX is based on the fact that there are no data from large randomized study (PEXIVAS) that dem...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I agree this is confusing. My thoughts are that if you have an anion gap, you by definition have an acidosis (HAGMA). However, I agree that it...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I think this one is due to correlation between a common clinical outcome (patient with liver disease and AKI or ESKD put on CRRT with citrate antic...

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RE: Post infectious MPGN 1 day ago

Based on the provided path report this is not MPGN pattern injury (unless I am mis-reading something). This is a diffuse exudative GN (prominent ne...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

That is an interesting question. If citrate, as HCO3 equivalent, is not metabolized and accumulates, then the anion gap will rise. If the [Na] rema...

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RE: Post infectious MPGN 1 day ago

Dr. Gunnell that doesn't seem to me a clear MPGN rather a diffuse proliferative GN (C3 dominant type). If I'm not mistaken, pronase digestion, m...

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how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I prepare presentation about CRRT. while i read about regional citrate anticoagulation, i can not explain how the sodium citrate can cause metaboli...

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RE: Post infectious MPGN 2 days ago

Dr. Glassock: I suggested the possibility of a superimposed new podocytopathy on preexisting glomerulopathy for the following reasons: 1. Such seve...

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RE: Post infectious MPGN 2 days ago

Dr. Venkat - interesting suggestion, but I do not know how one can distinguish between a superimposed Primary diffuse Podocytopathy and a secondary...

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RE: Post infectious MPGN 2 days ago

With such massive proteinuria a diffuse effacement of the foot processes would be expected as a reaction to severe capillary wall injury in MPGN . ...

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RE: Post infectious MPGN 2 days ago

What was the baseline SCr before current SCr of 1.7 mg was documented? Do you have any past urine studies showing abnormalities? How much weight ha...

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RE: Post infectious MPGN 2 days ago

Does the LM show a clear MPGN pattern of injury (with double contour capillary walls)? ------------------------------ Richard Glassock MD, FASN L...

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RE: Post infectious MPGN 2 days ago

If the Pathologist will not do a Paraffin IF, at least have the biopsy studied for IgG subclass distribution. If the heavy chain is monoclonal this...

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RE: Post infectious MPGN 2 days ago

what are your thoughts on the 21gm of protein and diffuse foot process effacement? There is no evidence of infection. Pathology insists no value to...

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RE: Post infectious MPGN 2 days ago

I have not seen this much proteinuria with diffuse foot process effacement. with no evidence of infection is there any role for steroid. Pathology ...

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RE: Post infectious MPGN 2 days ago

Any time I am told of a PIGN, and especially if C3 is predominant, I consider C3 GN. This may have too much other Igs to consider C3GN , but I ALWA...

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RE: rituxan and Obinutuzumab 2 days ago

As proteinuria is a marker for poor cardiokidney outcome and tend to admit that those patients with nephrotic-range proteinuria without nephrotic s...

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RE: Post infectious MPGN 2 days ago

Occasionally the Frozen IF IgG can show weak but positive IgG deposition in patients with concealed PGMID. C3 deposition by frozen IF is typically ...

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RE: Blood flow to dialysate flow ratio for full saturation 2 days ago

Hey Dr. Omar and team -- I agree almost entirely with everything that is said. Like Dr. Rodby initially said, keeping blood flow at least...

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RE: Post infectious MPGN 2 days ago

I requested the pronase digestion but the pathologist told me they only do it when the staining is negative on IF and did not think it would be hel...

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RE: Post infectious MPGN 2 days ago

The SPEP, ANA and RF are normal. Blood and urine cultures are negative. No murmurs. --------------------------------- J Gunnell, MD Attending...

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RE: Post infectious MPGN 2 days ago

I think I would also ask the kidney pathologist to perform a Pronase digestion of a paraffin embedded specimen to test for concealed monoclonality ...

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RE: Post infectious MPGN 2 days ago

Can you post the de-identified kidney biopsy report. Did the serologic investigation include ANCA, Rheumatoid factor,, serum FLC and ANA? . Any new...

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

We are looking at Indian subcontinent population. Hopefully we will have data to share early next year --------------------------------- Bajinder...

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

Agrred - ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

Valiga study also supports value of sub-classifying S lesions in IgA and there cohart was mostly European --------------------------------- Baji...

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Post infectious MPGN 2 days ago

I have a 76yo male patient with no other medical problems admitted with anasarca which started about 3 weeks prior. His serum Cr 1.7. There have be...

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RE: rituxan and Obinutuzumab 2 days ago

He had partial remission to 2 grams from 7. Renal function normal. Biopsy shows minimal sclerosis or fibrosis. Now up to 5.5 grams by ration and 7 ...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Sorry for delayNot will rule out infection, but it also tells me to treat this patient like vasculitis even if there is a dual pattern of injury on...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I think this us correct, but the likelihood of an infection cause of crescentic GN was already very low in this patient. Nevertheless, anti MPO sta...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I think the idea of the dr reen is that if ANCA is positive by immunohistochemistry, this rules out infection-related --------------------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Ok -thanks- I just do not understand how the results (MPO + or - ) will help management in this case- please clarify. Important issue! -------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 3 days ago

Kidney biopsy does some deposits If immune staining is done in those deposits may help --------------------------------- Bajinder Reen MD Etobico...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 3 days ago

Thanks Dr. Reen. Interesting paper. I just don't see how a study of MPO in the deposits in this case would help refine the diagnosis (and therapy )...

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