RE: Hyponatremia Dilemma 7 minutes ago

Dr. Neumann for your second question. Volemia is defined by the balance of sodium, not body water. patient with hyponatremia due to SIADH are eu...

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RE: DKA in post transplants 1 hour ago

Also now liver and renal function test better but still anemia also send by attachment file could I give other pint of blood thank...

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RE: Hyponatremia Dilemma 3 hours ago

Honestly I do not see why there is a confusion in the diagnosis of CSW vs SIADH In CSW , patients lose a lot of salt in the urine and are usually p...

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RE: Hyponatremia Dilemma 8 hours ago

So no real dilemma exists in diagnosis or therapy of this patient, other than the impediments imposed by the health care system ----------------...

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RE: ig a v vs anca vs ctd 10 hours ago

Thanks prof rodby , prof glassock and dr emilio I this debate of plex should be done in kind loving way . Unity in diversity in my humble opinion...

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RE: ig a v vs anca vs ctd 10 hours ago

Update got virology back after speaking to virologist ( hepatitis /hiv hep b / hep c all negative ) Patient will have one cyclo infusion tomorrow...

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RE: ig a v vs anca vs ctd 10 hours ago

Thanks dr emilio I mean If someone has ongoing infection and bad vasculitis would plex be used till infection clear ( I thought plex was safe in ...

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RE: Hyponatremia Dilemma 11 hours ago

I would argue no. In kidney epithelial transport I know of no nephron segment that secretes Na. In true CSW, to develop hyponatremia the [Na] exc...

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RE: Plar2 +ve With Stroke 11 hours ago

Thanks prof glassock kidney normal size us --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: DKA in post transplants 12 hours ago

The sudden onset of hemolytic anemia us of great concern. What is the Coombs trst, cold agglutinsc, peripheral smear ( for MAHA and "bite cells , h...

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RE: Plar2 +ve With Stroke 13 hours ago

Because of the very high levels of Anti-PLA2R and the uncertainties about the biopsy findings, I would treat with RTX (or Obinutuzumab) plus a shor...

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RE: DKA in post transplants 13 hours ago

Thanks Dr Nauman what about anemia could I give iron specially S transferrine low although the risk of more oxidative side effects from iron ...

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RE: Hyponatremia Dilemma 13 hours ago

For those who do not believe in existence of CSW what would it take to convince you that this entity exists. another question if a patient is trul...

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RE: DKA in post transplants 13 hours ago

Sirolimus also increases insulin resistance and is not recommended for NODAT. In young patients many are EBV negative and Belatacept in EBV negativ...

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RE: DKA in post transplants 13 hours ago

Thanks a lot Dr Daniel ------------------------------ Yasir Sharba MD, DrMed AL Sodre Teaching Hospital Najaf ------------------------------

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RE: DKA in post transplants 13 hours ago

The risk factor for post transplant diabetes is greater with tacrolimus . Rapamune and cyclosporin have lower risk but still a significant risk . b...

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RE: Plar2 +ve With Stroke 14 hours ago

EGFR 17 ml/min --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Plar2 +ve With Stroke 14 hours ago

Thanks prof glassock Anca negative Anti gbm negative Hep b , hep c and hiv negative --------------------------------- Muhammad Soobadar MBChB ...

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RE: DKA in post transplants 14 hours ago

Dear Dr Glassock yes of our patients with NS managed by our paediatrician by steroid only without biopsies and then CKD and renal transplantation...

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RE: DKA in post transplants 14 hours ago

Dear Dr Glassock yes of our patients with NS managed by our paediatrician by steroid only without biopsies and then CKD and renal transplantation...

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RE: DKA in post transplants 16 hours ago

How would information obtained only by performance of a kidney biopsy aid significantly im the overall management of this case? I need to learn ...

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RE: ig a v vs anca vs ctd 16 hours ago

Dr. Soodabar, to answer your questions Yes, PLEX would remove circulating galactose deficient IgA and gdIgA-IgG immune complex but it's not clear...

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RE: ig a v vs anca vs ctd 19 hours ago

Weak and equivocal lambda staining, not confirmed by ParaffinIF with Pronase digestion . Not veryl convincing, in my opinion --------------------...

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RE: ig a v vs anca vs ctd 19 hours ago

It might also be worth pointing out that published guidelines concerning use of PLEX in ANCA vasculitis differ and the 2024 KDIGO guidelines use th...

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RE: ig a v vs anca vs ctd 19 hours ago

Dr. Dastoor- my opinions on the utility (lack of) of PLEX in ANCA vasculitis have been informed by the compelling arguments of Drs.Fervenza and Spe...

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RE: ig a v vs anca vs ctd 19 hours ago

This is lambda restriction is non significant?? ------------------------------ Ahmed Mahedy PhD Banha Faculty of Medicine Banha -----------------...

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RE: DKA in post transplants 20 hours ago

Yes ------------------------------ Sandip] [Das] [PGDHCM] [GO] [Primary Health Care] [Tamluk] [West Bengal] [9564535651] ------------------------...

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RE: ig a v vs anca vs ctd 20 hours ago

Is it possible for @Richard Glassock and @Roger Rodby to state their positions on why they are against and for PLEX , in ANCA vasculitis . That wo...

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RE: DKA in post transplants 1 day ago

Thanks a lot Dr Glassock the c peptide 1.7 ng / ml and anti GAD Ab less than 0.5IU/ml regarding the primary cause of CKD only history of NS...

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RE: DKA in post transplants 1 day ago

NODAT is a common (10-15%) complication of steroid and CNI therapy of KT recipients. Reducing sterouds , reducing Tacrolimus, shifting to CsA or Ra...

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RE: ig a v vs anca vs ctd 1 day ago

An important caveat about RTX (and CYC) therapy of AAV is that HBV -infected patients may suffer from complications of reactivation or enhanced vir...

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DKA in post transplants 1 day ago

Dear All colleagues A 15 years old male presented to me as acidotic breathing he was 2,5 years post renal transplant on prednisone 5 mg EOD , Ta...

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RE: IgA nephropathy 1 day ago

Thank you Dr. Glassock.. I would dare not disagree with you. Honestly your feedback and your posts have made me a much smarter physician, and I al...

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RE: ig a v vs anca vs ctd 1 day ago

I fully agree with Dr. Rodby except for PLEX. This is Pauci-immune necrotizing and crescentic GN. My choice of therapy would be RTX, Avacopan And P...

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RE: IgA nephropathy 1 day ago

Dr. Dastoor- thanks for sharing. Very interesting approach. In the UpToDate formulation both Atrasentan and Sparsentan ) are not part of the prefer...

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RE: Renal denervation 1 day ago

Fewer than 10% of patients studied had stage 3b CKD with 10–15 mmHg office SBP reduction lasting at least 3 years. Very few patients with stage 4 ...

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RE: IgA nephropathy 1 day ago

My indication for use of Iptacopan is similar to Uptodate . This patient is classified as high risk based on . 1. Decline in eGFR that exceeds gr...

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RE: Renal denervation 1 day ago

@Gary Singer what percent of the patients receiving this procedure had CKD 3b or more? "4–7 mmHg in ambulatory SBP and 6–10 mmHg in office SBP...

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RE: ig a v vs anca vs ctd 1 day ago

I would ignore the IgA this appears to be pauci immune crescentic GN most consistent with a vasculitis. I would treat as such with Pexivas prot...

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RE: ig a v vs anca vs ctd 1 day ago

and in this case if she has UTI would colleagues favour plex? would plex remove glycosylated Ig A? thanks for help ------------------------...

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ig a v vs anca vs ctd 1 day ago

question is this ig a vasculitis ? or anca? or both or lupus? ( i dont think lupus no c1q no full house complement) CTD?? would colleagues wait...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Thank you very much Congo red staining is pending DNAJB9 send out, and in progress. No history of NSAIDs use except low dose Aspirin No recent hi...

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RE: IgA nephropathy 1 day ago

Dr. Dastoor- Many thanks for sharing . So far, I have had very little experience with Iptacopan as patients with high risk IgAN respond very well t...

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RE: Renal denervation 1 day ago

Hi-I am one of the nephrologists and HTN specialists at the Stanford HTN Center. I work closely with our center's director Vivek Bhalla and we rece...

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RE: IgA nephropathy 1 day ago

While on the subject of IgA , it has been around 3 weeks since we started using Iptacopan on 3 patients . One patient did his labs today, and for...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Thanks DR. Zuckerman. Very helpful. C3GN seems very unlikely . The EM images should be informative. ------------------------------ Richard Gl...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

My read of the clinical situation is: nephrotic syndrome (10 G protein, Alb 2.6, and edema) who also has renal failure (sCr 2.8). Microscopic hemat...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

As could as I remember she is suffering from Nephritis ------------------------------ Sandip] [Das] [PGDHCM] [GO] [Primary Health Care] [Tamluk] ...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

I am not an expert on C3G, but the C3 staining does not seem to be 2 OOM higher than the other stains . Regardless, if this is confirmed C3G, and...

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RE: ? C3 GN Or Not . If Yes, How To Proceed With Management 1 day ago

Difficult case. The EM findings may help sort this out as the IF is equivocal, but suggestive of mesangial localization of C3 without Ciq. No evide...

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