RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 1 hour ago

Thank you for sharing this challenging case. From my perspective, I would consider this SLE-associated secondary TMA with complement amplificatio...

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 3 hours ago

With the strong evidence of serological activity of LN , I am not very confident that a repeat biopsy will contribute much to treatment decision ma...

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RE: anti gbm serology postive with fever and raised inflammatory markers 3 hours ago

Almost 4 weeks dialysis dependent and still not anti-GBM negative. The prognosis for recovery of renal function is very poor, but only the treating...

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RE: anti gbm serology postive with fever and raised inflammatory markers 5 hours ago

22nd July dialysis dependent Post plex ( 3rd or 4th anti gbm level >8) --------------------------------- Muhammad Soobadar MBChB UK -----------...

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RE: PR-3 ANCA with lung involvement 6 hours ago

The reason i brought up the Rituxvas trial was that they used in the Rituximab arm, IV Cyc day 1 and day 15 .. i thought this was the only rct evid...

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RE: PR-3 ANCA with lung involvement 6 hours ago

the CYCLOPS trial compared IV to oral CYC in vasculitis in a RCT. The only differences were a lower cumulative dosage in IV and an increae in relap...

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RE: PR-3 ANCA with lung involvement 7 hours ago

Daily oral CYC was the standard for lupus until the NIH started IV CYC monthly infusions for SLE which gained popularity bc of adherence and ease. ...

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 7 hours ago

Dear Dr. Mohammed, Thank you for your helpful advice. I have also been considering a repeat kidney biopsy and will likely proceed. We will also i...

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 7 hours ago

Dear Professor Glassock, Thank you so much for your feedback on my case. The patient has not received standard triple therapy because treatment...

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RE: Obstructing Urinary Stone 9 hours ago

Glad she has done well! Would have loved to know what creatinine was prior to stone removal. Just regarding our discussion 😁 -------------------...

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RE: PR-3 ANCA with lung involvement 11 hours ago

Thank you Prof. Glassock! --------------------------------- Mark Nader MD Germantown TN (201) 805-2000 ---------------------------------

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RE: Obstructing Urinary Stone 16 hours ago

Both the patient and myself were concerned about the ill effects of untreated presumed complete unilateral urinary tract obstruction by a stone at ...

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RE: PR-3 ANCA with lung involvement 16 hours ago

Oral was the way CYC was delivered in the trial. There pr is no proven advantages of IV over oral CYC in outcome studies of Vasculitis. In a compli...

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RE: Obstructing Urinary Stone 20 hours ago

Exactly why an elevated creatinine above baseline in your patient with stone producing unilateral hydronephrosis ( mild to moderate ) on US was con...

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RE: PR-3 ANCA with lung involvement 20 hours ago

@Richard Glassock , is there a reason you prefer oral cyclophosphamide in this case as opposed to IV cyc x 2 doses such as in the rituxvas trial? A...

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RE: anti gbm serology postive with fever and raised inflammatory markers 21 hours ago

How long has he been oliguric and requiring dialysis?. Is his antiGBM antibody negative pre-PLEX? ------------------------------ Richard Glassock...

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RE: is it lead poisoning? 21 hours ago

This is glomerular proteinuria and a near normal plasmal lead. I do not think that further testing is needed. ------------------------------ Ric...

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RE: is it lead poisoning? 22 hours ago

0.11 umol/L <0.1 ------------------------------ Muhammad Soobadar MBChB UK ------------------------------

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RE: anti gbm serology postive with fever and raised inflammatory markers 22 hours ago

@prog glassock do you agree for continuing cyclo and plex for now? ------------------------------ Muhammad Soobadar MBChB UK -------------------...

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RE: anti gbm serology postive with fever and raised inflammatory markers 22 hours ago

Timeline 4/08 first dose methlypred and on weaning pred He has finished 9 session of plex on Monday 19/08 first one 5/08 Cyclophosphamide 150 mg ...

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RE: Pd Question. 1 day ago

"I can't really comment about when a mesh is used, but we routinely continue with PD after a hernia repair. We will keep the patient dry for a few ...

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RE: anti gbm serology postive with fever and raised inflammatory markers 1 day ago

May discuss with Pulom team if can go for bronchoscopy and BAL screen for any co-existing infection ------------------------------ Saja Mohammed...

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RE: Obstructing Urinary Stone 1 day ago

Reflex vasospssm in the contralateral kidney in acute urinary tract obstruction is stil a hypothesis, in my opinion. The serum creatinine level doe...

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 1 day ago

If the platelet count is now above 100, I suggest repeating the kidney biopsy. Based on the initial presentation and biopsy findings, the patient l...

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RE: Pd Question. 1 day ago

I would hold PD for at least 24 hours after a pancreatic biopsy, and maybe more if it was a difficult procedure. Roger is right that PD patients ca...

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RE: Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 1 day ago

Is it correct that this X patient has not received standard "triple therapy " (MMF + Steroids + Obinutuzumab or Voclosporin or Belimumab) ) for sev...

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Lupus-associated TMA with no response after four weekly doses of eculizumab: withdraw or continue? 1 day ago

Dear colleagues, I'd like to share a diagnostically challenging case from our nephrology unit, on which I would value the community's input. Case p...

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RE: anti gbm serology postive with fever and raised inflammatory markers 1 day ago

What is your question? Is the serum anti-GbM still positive. How long has the patient been oliguric and on HD. How many PLaeX sessions has he recei...

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RE: anti gbm serology postive with fever and raised inflammatory markers 1 day ago

@ prof glassock any thoughts on this issue please 🙏🏼 --------------------------------- Muhammad Soobadar MBChB UK -----------------------------...

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RE: Intersting case-Need your opinion 1 day ago

I totally agree Prof Glassock. This case has taught me a lot ------------------------------ Jagadeesh Kurtkoti MBBS, MD SOUTHPORT ---------------...

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RE: Intersting case-Need your opinion 1 day ago

Dr. Kurtkoti- remarkable and highly instructive case. Thanks for the FU. It looks like we should retire the use of Eculizumab for C-mediated TMA an...

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RE: Intersting case-Need your opinion 1 day ago

Dear all, Just an update on this lady. She improved soon after the swithc from Eculizumab to Ravulizumab. She came off dialysis and creatinine is...

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RE: How to interpret VISIONARY Trial data on Sibeprenlimab 1 day ago

This is the proverbial "64,000 Dollar " question!!a, So far as I know, the final 24 month data from the VISIONARY trial have not yet been published...

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RE: How to interpret VISIONARY Trial data on Sibeprenlimab 1 day ago

@Roger Rodby@Richard Glassock thanks for your responses. So , this woupd lead to my second question in that would you consider Sibeprelimab as th...

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RE: How to interpret VISIONARY Trial data on Sibeprenlimab 1 day ago

Without some sort of adjustment for severity of disease at randomization (e.g a prognostic score ) the eGFR slopes (in placebo arm ) between trials...

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RE: PR-3 ANCA with lung involvement 1 day ago

With a presenting serum creatinine of 1.3mg/dL (maximum) can a multi-drug, PLEX based regimen really be justified? In my opinion, this patient will...

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RE: PR-3 ANCA with lung involvement 1 day ago

I would consider attached ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associ...

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RE: Obstructing Urinary Stone 1 day ago

Thanks. No NSAID. Only Opiods- I don't agree that acute total unilateral obstruction will not alter the serum creatinine concentration. The data fr...

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RE: ICI induced IgAV 1 day ago

I suspect the AKI is as much from the RBC casts and ATN than the 17% crescents, I have no problem with ritux but might wait it out a bit longer -...

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RE: Pd Question. 1 day ago

Do we need to hold pd for pancreatic biopsy using percutaneous US/CT technique ? I would, PD can be skipped for days typically without a problem ...

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RE: Obstructing Urinary Stone 1 day ago

"One of the reasons for acute rise in creatinine following unilateral obstruction is reflex vasospasm in the contralateral kidney due to pain or ? ...

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RE: Obstructing Urinary Stone 1 day ago

what did serum creat do? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas T...

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RE: Obstructing Urinary Stone 1 day ago

Just an opinion. I would not wait a week. The patient is going to have ureteroscopy and stone removal tomorrow. ------------------------------ Ri...

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Pd Question. 2 days ago

Dear colleagues , Do we need to hold pd for pancreatic biopsy using percutaneous US/CT technique ? Do we need to hold pd in APKD patient with haem...

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RE: ICI induced IgAV 2 days ago

I would consider adding RTX at this point. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine...

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RE: Modality Of Imaging For Decline In Kidney Function 2 days ago

Depends on the purpose of the imaging? ------------------------------ Ashraf El-Meanawy , MD, MS, PHD, FASN Professor of Medicine Director of Dia...

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ICI induced IgAV 2 days ago

I would kindly appreciate your opinion on this patient 64M with history of NSCLC diagnosed last year s/p left upper lobectomy, has been on durval...

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RE: PR-3 ANCA with lung involvement 2 days ago

This patient should receive RTX and Steroids according to the PEXIVAS protocol. In my opinion, PLEX is not indicated and the addition of CYC is not...

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RE: How to interpret VISIONARY Trial data on Sibeprenlimab 2 days ago

Your hypothesis may be incorrect, the placebo rate of eGFR decline will likely vary according to the risk profile of the randomized subjects, which...

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RE: is it lead poisoning? 2 days ago

What are the units used by your lab? It this level further testing may not be needed. ------------------------------ Richard Glassock MD, FASN Em...

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