RE: Osteoporosis In Stage 5 Ckd 5 minutes ago

Hypocalcemia may develop even with underlying adynamic bone disease, and low low PTH level? Bone Alkaline phosphatese was 10 mg/L ( normal 6-20) -...

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RE: Osteoporosis In Stage 5 Ckd 1 hour ago

Based on the low PTH level and normal total AP, it is likely that she has Adynamic Bone Disease. Further investigation with bone turnover Biomarker...

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Osteoporosis In Stage 5 Ckd 1 hour ago

75 year old lady with diabetic nephropathy and stage 5 CKD not on dialysis( eGFR of 12 ml/min) , was referred from ortho. department for opinion. ...

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RE: Polyuria 10 hours ago

If she does not have nocturia, I really doubt this is a urinary concentration problem, also her U SG is 1.010 suggesting isosthenuria I suppos...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 11 hours ago

CAPS- serious involvement of 3 or more tissues / organs. -thrombopenia, skin necrosis and gangrene and kidney involvement (not proven because kidne...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 13 hours ago

Thank you prof . Glassock I would appreciate your guidance—given my limited experience, could you explain what key features made you lean toward ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 13 hours ago

Here's my considerations From a diagnostic standpoint: A more sensible method (serum immunofixafion) should be performed to identify a small...

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RE: Polyuria 15 hours ago

This patient is exhibiting Pollakiurua , not really Polyuria. Intrinsic bladder pathology needs to be evaluated. ------------------------------ ...

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RE: Polyuria 15 hours ago

Urine output about 3ml/kg/hour, which is modestly increased as is the frequency of voiding , but the urine is not of very low specific gravity. We ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 15 hours ago

Tough question. No good answers, I would slightly favor a biopsy approach,, of involved skin/muscle and bone marrow (for atheroembolic disease or c...

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Polyuria 15 hours ago

Requesting opinion on this case: An 8 year old girl was brought by parents with complaints of polyuria. She was noted to have polyuria since 7 mon...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 16 hours ago

Thank you prof Dr.Glassock And Dr . Venturelli In this case of triple-positive APS with digital ischemia/ulcers and positive cryoglobulin, SPEP sh...

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RE: Postural hypotension 16 hours ago

Thanks Dr. Kesavan. There is no phimosis. Will do a magnesium level and anemia workup as suggested. ------------------------------ Jaison George...

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RE: Postural hypotension 16 hours ago

Thanks Dr. Campese ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Membranous Nephropathy 17 hours ago

I am concerned about the progressive decline in eGFR and am inclined to biopsy now rather than waiting, but observation is OK if the eGFR trajector...

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RE: Membranous Nephropathy 18 hours ago

Thanks for the replies. Correct finally PLA2R is < 4 since January and < 4 even in March. Proteinuria worse and now Cr worsening. Question is s...

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RE: Postural hypotension 18 hours ago

I was not seriously considering Shy-Drager syndrome in this patient but mentioned it out of academic interest and definitely did not relate it to t...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 18 hours ago

Excellent suggestion Dr. Venturelli! This might very well be a Crystal forming variant of Type I (monoclonal ) cryoglobulinemia but this would nit ...

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RE: Membranous Nephropathy 18 hours ago

If I understand this, the PLA2R is now [More]

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RE: Dialyzer reaction 19 hours ago

Try the Nipro Cellentia series. We had a patient tolerated NxStage (even with 3L UF) but 15 minutes into regular HD would drop BPs to 60s systolic ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 19 hours ago

Is there a monoclonal gammopathy? Consider Crystal-cryoglobulinemia Another possibility could be atheroembolic renal disease, the more chronic an...

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RE: complex case of nephrotic syndrome in liver transplant patients 19 hours ago

"And only in January 2026 that urine acr 73.84 mg/mmol( with steroids and rituxan)" Was there already a downward trend in UAlb/Cr, UPr/Cr and SCr...

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RE: Membranous Nephropathy 19 hours ago

With a worsening eGfR I do not think that use of a CNI would be a wise decision. Just an opinion. ------------------------------ Richard Glassock...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 19 hours ago

In addition, the sFLC ratio is near to the lower limit of normal for thus degree of CKD suggesting but not proving a lambda MGUS- probably not wort...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 20 hours ago

The anti-phospholipid assays indicate triple positivity compatible with Primary anti-Phospholipid antibody syndrome and a high risk of arterial or ...

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RE: Membranous Nephropathy 22 hours ago

A repeat biopsy might be helpful to rule out superimposed FSGS. Immunological remission maybe followed by clinical remission after several months...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 23 hours ago

Antiphospholipid Antibodies * Anti-β2 glycoprotein I IgG: >100 U/mL * Anti-β2 glycoprotein I IgM: 4 U/mL * Anticardiolipin IgG: >120 GPL-U/mL * An...

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RE: Membranous Nephropathy 23 hours ago

According to a LabCorp description the anti-PLA2R IgG test is an ELISA that has not been validated for monitoring. I would use the standard quantit...

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RE: Membranous Nephropathy 1 day ago

Is the PLA2R IgG the IFA assay for anti-PLA2R antibody. If so, this test is more sensitive than the ELUSA . I n this case I would pay attention to ...

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RE: Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

Clinically, 4-disease processes present . 1) "malignant " atherosclerosis ,2) primary anti-phospholipid syndrome , 3) Cryoglobulinemia , Type I or ...

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Digital Ischemia with CKD in a 70-Year-Old: Atherosclerosis vs Triple-Positive APS vs Cryoglobulinemia? 1 day ago

* 70-year-old male, heavy smoker * Known history of: * HTN * Type 2 DM (HbA1c ~7.6%) * Dyslipidemia * Hypothyroidism * Parkinson’s disease * ...

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RE: Postural hypotension 1 day ago

Or unless the patient has concomitant volume depletion and autonomic dysfunction ------------------------------ Vito M Campese Professor Emeritus...

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RE: Membranous Nephropathy 1 day ago

Thank You for your reply. The test is from Quest diagnostics. PLA2R Ab, ELISA is a quantitative test while PLA2R IgG is a qualitative test (Posit...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Could you add a graph of UACR or UPCR to correspond with her course since stopping the Sirolimus ? You only show graphs of serum albumin and eGFR ....

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RE: Treatment uncertainty with Secondary TMA in Advanced HIV 1 day ago

These findings seem most consistent with HIVICK - immune complex disease due to HIV infection.he needs aggressive tgerspybdirected to the HUV and H...

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RE: Membranous Nephropathy 1 day ago

Very complex case. If I understand correctly the serum anti-PLA2R antibody levels have decreased to undetectable levels ([More]

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RE: Postural hypotension 1 day ago

Thanks Dr. Venkat for the advice. I shall stop fludrocortisone. ------------------------------ Jaison George MD, MBBS Kollam, India ------------...

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RE: Postural hypotension 1 day ago

Shy-Drager Syndrome, , now called Multisytem Atrophy (MSA) , is a very rare condition , not found as a complication of long-standing diabetes , usu...

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RE: Postural hypotension 1 day ago

Thanks Dr. Leung, The supine BP was taken with midodrine. His hyponatremia was never symptomatic. ------------------------------ Jaison George M...

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RE: Postural hypotension 1 day ago

Thanks Dr. Glassock. He is not on beta blocker. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Postural hypotension 1 day ago

Does patient have any neurological symptoms or signs Could it be Shy Drager Syndrome Severe autonomic neuropathy if not from Diabetes mellitus ...

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RE: VIH persistence of serology showing low-level HIV antibodies (2.64) by ELISA and a negative viral load in an old patient 1 day ago

Most 4th generation Anti-HIV antibody tests are claimed to have 99.5% specificity ( 0.5% false positive rate. ) if a 4th generation assay was utili...

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RE: complex case of nephrotic syndrome in liver transplant patients 1 day ago

Thanks prof glassock . Sorry late reply March 24 sirolimus started August 24 normal urine pcr August 25 urine pcr 4g with low albumin and sirolimu...

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Membranous Nephropathy 1 day ago

44 year old Hispanic male with gout, HTN diagnosed with membranous nephropathy 8/2023 – KIDNEY, BIOPSY: - MEMBRANOUS NEPHROPATHY, PLA2R ASSOCIA...

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RE: VIH persistence of serology showing low-level HIV antibodies (2.64) by ELISA and a negative viral load in an old patient 1 day ago

I would do another antibody test for HIV to see that this is not a false positive. If that is negative, and the HIV RNA is also negative, that woul...

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VIH persistence of serology showing low-level HIV antibodies (2.64) by ELISA and a negative viral load in an old patient 2 days ago

Dear colleagues, could you please give me your opinion on this patient? This 94-year-old patient was started on dialysis in December 2022 following...

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RE: Postural hypotension 2 days ago

Long standing Diabetes mellitus seems poorly controlled Any information on any complications such as retinopathy peripheral neuropathy gastropares...

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RE: Dialyzer reaction 2 days ago

Interesting case. What were the serum sodium and urea levels prior to starting the hemodialysis session? If you are confident that the early in...

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Treatment uncertainty with Secondary TMA in Advanced HIV 2 days ago

A middle aged male with PMH HIV (not on HAART), seizure disorder, hypertension, and neurosyphilis treated years prior presented after two witnessed...

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RE: Postural hypotension 2 days ago

You might want to stop the medication with the Mitaconozolole as it might be aggravating the symptoms ot orthostatic hypotension. ---------------...

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