RE: Biopsy dilemma in setting of severe refractory ITP 30 minutes ago

"I find it interesting all the past random you were positive. It is now negative." what was positive that is now negative? ------------------...

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RE: Biopsy dilemma in setting of severe refractory ITP 38 minutes ago

Cryoglobulins are negative ------------------------------ Deborah Fein MD Nephrologist Pattner and Grodstein MD Englewood NJ 201-567-0446 ------...

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RE: Biopsy dilemma in setting of severe refractory ITP 39 minutes ago

Over the past years, she has had 3 BMbs. another one is now planned in coordination with Hematology understanding renal issues. I find it interesti...

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RE: Monosodium Urate Stone (MSU) 1 hour ago

Thanks so much for such a thorough reply! He will be following up with urology soon and the plan is to repeat 24 hour urine collections in steady s...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 hour ago

Hematology is closely following. In the past platelet transfusions, actually result in more antibodies and lowering of platelets so he is trying to...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 hour ago

Yes they are negative ------------------------------ Deborah Fein MD Nephrologist Pattner and Grodstein MD Englewood NJ 201-567-0446 -----------...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 hour ago

Sorry to go backward, but did the cryoglobulins ever come back? certainly the neg RF agues against a cryoglobulin as most are IgM related, but ...

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RE: Biopsy dilemma in setting of severe refractory ITP 3 hours ago

I would seek help from experts in the blood bank and consider platelet transfusion indication and potential contraindications and risks in this cas...

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Functional Classification of Dialysis-Dependent ESRD in Disability Frameworks 5 hours ago

I am a clinician managing End-Stage Renal Disease and have a specific question regarding the functional classification of dialysis-dependent patien...

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RE: Biopsy dilemma in setting of severe refractory ITP 7 hours ago

Final crops are negative only Sjogrens AB A positive with ACR 12 and UPCR 1.2 gms and random UPEP negative I suspect TIN from Sjogrens. better...

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RE: CMT with nephrotic syndrome 9 hours ago

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

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 21 hours ago

The elevated CO is a consequence of systemic vasodilatation and would represent a compensatory elevation in order to attempt to enhance kidney perf...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 21 hours ago

Overdosing on Thiamine? why not. You don't injure a patient with a big dose of that. "Pan diuresis" (polypharmacy of all diuretics known to manki...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 23 hours ago

No AV shunt, nor old wound that woudl cause an avf type bypass situation to my knowledge. Interesting re adding tolvaptan to the heavy hitter di...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 23 hours ago

Hgb level low at 10.9, alkphos is ok, no liver disease (LFT's ok, US liver ok) labs suggestive of subclinical hyperthyroidism (TSH high at 10.9 mcI...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 23 hours ago

I shall ignore the wet beri beri consideration, how great would that be if it were that simple? If not and the CO is accurate, is there any other...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Interesting suggestion. How do you factor the increased cardiac output into this formulation? ------------------------------ Richard Glassock MD,...

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RE: Monosodium Urate Stone (MSU) 1 day ago

Hi Dr Sarfaraz, Less than 0.5% of stones are composed primarily of NaUrate, so fairly uncommon. As you might guess, there are no trials of treat...

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RE: CMT with nephrotic syndrome 1 day ago

Thanks- i missed the fact that she is very tiny. What is her height (in cm) so her kidney size can be better understood. With a body weight of 40kg...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

I would take a slightly different approach as to pathophysiology. The history of hypertension, DM, with proteinuria suggests diabetic kidney diseas...

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RE: CMT with nephrotic syndrome 1 day ago

Thank you Dr Glassock. Indeed very challenging situation. She only weighs 30 kg so her small kidneys are probably proportionate to her size, e...

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RE: CMT with nephrotic syndrome 1 day ago

With bilateral small shrunken kidneys I would not do kidney biopsy but I would do genetic studies to better define the type of Charcot Marie Tooth ...

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RE: CMT with nephrotic syndrome 1 day ago

Thank you Dr Glassock for your valuable opinion. Yes I came accross INF-1 FSGS which has poor prognosis here unfortunately. My worry is tha...

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RE: CMT with nephrotic syndrome 1 day ago

I would manage without a kidney without a kidney biopsy in this case. But I would perform genetic testing to confrim CNT with FSGS due tovan autoso...

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CMT with nephrotic syndrome 1 day ago

Hi everyone, I would appreciate your opinion on this case 41-year-old lady with Charcot-Marie-Tooth syndrome, T2Dm since 2010 well controlled no c...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Thanks Dr. Glassock. AI says: "In wet beriberi, the typical mean pulmonary artery pressure (mPAP) iselevated, frequently presenting in the range of...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Answer- marked pulmonary arterial hypertension is a typical finding in "wet " Beri-Beri heart disease, I would give her megadoses of Thiamine now. ...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Dr. Venkat- are you considering "wet" Beri-Beri here?. Is pulmonary hypertension compatible with this. Why is this not " just" severe edema with Ne...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

High output heart failure: Hemoglobin level? Hyperthyroidism? Vitamin B1 deficiency? Liver disease? Pagets? In addition to obesity, the above are...

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RE: Monosodium Urate Stone (MSU) 1 day ago

@John Asplin I'm assuming thats the right doc to tag 😅 ------------------------------ Nimra Sarfaraz, DO (516) 637-3820 nimras@gmail.com --...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

I had her on diuril, acetazolamide, farrxiga, midodrine. On lasix drip had about 3 L of UOP and then when transitioned to oral meds between 500-150...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

She's on no BP meds and even with midodrine SBP remained in 120s Her RHC findings finalized as below CI > 5 CO 14 Wedge 20 Mean PAP 29 ...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Nephrotic edema to diabetic glomerulosclerosis (presumed by not proven ) can be a real challlenge. I had success with high dose Furosemude (IV), me...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 1 day ago

Ultrafiltration is an excellent option for a case like this. Remove a couple of liters a day until euvolemia and decongestion is acchieved. Ultra...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 2 days ago

What other medications.? In patients such as these i typically stop calcium channel blockers/ vasodilators and find they often duress with a higher...

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RE: Lupus nephritis III/IV 2 days ago

All good points Dr.Masri. I think an active surveillance based on a combination of home-based monitoring snd periodic serology is s reasonable stra...

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RE: Lupus nephritis III/IV 2 days ago

In a case of a " good candidate" for stopping maintenance therapy; maybe we can consider a combined surveillance strategy ( monthly labs ) and dail...

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RE: Atypical Nephretic nephrotic syndrome 2 days ago

Thank you very much for your insightful comments and valuable input, I agree with your assessment. At this stage, I plan to continue the patient on...

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pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 2 days ago

Hi all! I have a 65F Bcr 1.2-1.6 recently, DM HTN with pulmonary hypertension coming in with very very severe edema, she was weeping from her ext...

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RE: Lupus nephritis III/IV 2 days ago

Some patients with class III or class IV LN on biopsy have severe clinical presentation with marked increase in SCr (including RPGN-like course) an...

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RE: Lupus nephritis III/IV 2 days ago

Drs. Hirsch and Rodby- what would you do if your 25 year old patient with Class IV LN in a complete clinical remission for 1 year on MMF 2.0 gms pe...

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RE: Monosodium Urate Stone (MSU) 2 days ago

Dr.Asplin can fill us in on this very rare cause of urinary stones. I suppose that it is managed in the same way as uric acid stones - K citrate sn...

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RE: Lupus nephritis III/IV 2 days ago

This is to be sure, absent an RCT, mostly speculative, but IMHO, the argument behind Dr Rodby's approach (which I share) is that negative serology ...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Until we can get the kidney biopsy catheter back, we cannot perform it safely and we have abandoned it. By the way, it takes a radiologist about 5 ...

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RE: Lupus nephritis III/IV 3 days ago

Good thread . Lot of good advice. I use serology, rather than repeat KB to determine when it is "safe" to discontinue IS in patients with treated "...

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RE: Lupus nephritis III/IV 3 days ago

I am in the longer than shorter camp and I have patients on indefinite maintenance, but that is hardly a universal opinion and dare I say may be un...

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Lupus nephritis III/IV 3 days ago

General question , I believe was also discussed previously but I wanted to see general opinion/practice among different doctors here. how long d...

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RE: Atypical Nephretic nephrotic syndrome 3 days ago

EMs are still pending , if you see mesangial deposits that may go along with the almost full house IF which is not typical for PLA2R MGN. Was there...

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RE: Biopsy dilemma in setting of severe refractory ITP 3 days ago

Thanks Dr.Leung. Very helpful detail. I assume that you have abandoned the procedure at the Mayo Clinic for kidney biopsy . ---------------------...

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RE: Atypical Nephretic nephrotic syndrome 3 days ago

This is a fairly common conundrum in clinical practice. One disease (Reverend Ockham's Razor) or two( (Hickams dictum )? Hard to tell in this case....

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