RE: Sarcoid assoc Ca stones 1 hour ago

I think I would favor a trial of ketoconozole while monitoring urine calcium exterminator rate. Just an opinion not based on evidence. What is the ...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 1 hour ago

This problem can be, potentially at least, minimized by a careful explanation to the family members what a "trial of dialysis" really means ,before...

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RE: decision to stop dialysis in patients who lack capacity and family members have divergent views. 1 hour ago

My only advice in these situations is to say if this were my family member I would not dialyze as putting the patient through dialysis will decreas...

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

I was wondering about that. Have your hematologist tried daratumumab to target the CD38 cells. It has been reported to be successful in rituximab r...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 2 hours ago

Dr Peterson, Thank you for posting the 24 hr urine data. I assume the PTH and vit D data you provided are all within the reference range for your l...

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RE: Biopsy dilemma in setting of severe refractory ITP 5 hours ago

The ITP is a very long saga. She failed everything including rituximab( but very short trial with lots dropping to 3000). Splenectomy at Mskcc fail...

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RE: Pd Question 6 hours ago

Request for CT Known Polyctic liver and Kidbey. Cystitis and infceted kidney cyst drain by radiological drain . Now deteriorating GCS , increasin...

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decision to stop dialysis in patients who lack capacity and family members have divergent views. 7 hours ago

Frail HD patient with worsening dementia and worsening frailty and no capacity lives in care home dialysis consultant felt to stop dialysis ...

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Sarcoid assoc Ca stones 7 hours ago

60-year-old diagnosed with cardiac sarcoid 10 yrs ago presented w bradycardia req PPM and is maintained on methotrexate and low does prednisone. Al...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 23 hours ago

It's a reasonable option but would not be my first choice. If she could lower her "average USA" UNa of 186 that would be preferable. Adding to her ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 23 hours ago

Thank you so much for these incredibly thoughtful insights! It is worth noting that even with recombinant insulin, patients can develop antibodies...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 23 hours ago

Thanks Dr. Asplin and Goldfarb. Would you add a thiazide in this case because of a borderline increase in urinary Calcium excretion.? Just curious-...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Puzzling case. There are very rare case reports of ICGN from insulin therapy in Type I DM ((anti-insulin Antibody, not with recombinant Insulin . )...

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RE: uTi In Anuric Hd Patients 1 day ago

Cystitis in ESRD can happen and is very challenging to treat. If you can get few CCs of urine and culture, do. If not use a 3rd gen cephalosporin w...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Here is the Litholink from 1/2026 ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208)...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Regarding the cystinuria genotype. Heterozygous SLC7A9 mutations, like this patient, and not SLC3A1 mutations, can cause an increase in cystine exc...

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RE: uTi In Anuric Hd Patients 1 day ago

I do not routinely examine dialysis patient's bladder or do post-void scans. These steps + obtaining catheterized specimen from bladder should be c...

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

I think rituximab is a good plan. It could treat both so if the kidney function does not improve, at least the ITP could be in remission. However, ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Thank you both Drs. Venkat and Dr. Rodby. Our pathologist mentioned just a trace of C3 deposition. I will check RF as well. ----------------...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Q1. What is the known duration of type-1 diabetes? -> She was diagnosed with T1DM ~ 20 years ago. Q2. Does she have diabetic retinopathy? ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Dr Venkat's point of : "Personally, not impressed with severity of IC-GN findings in the biopsy as explanation for wosening proteinuria" is well ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

@John Asplin "Urinary aklalinization with K citrate can aggravate stone formation" My probable oversimplified understanding of Medullary ...

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RE: Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Questions: 1. What is the known duration of type-1 diabetes? 2. Does she have diabetic retinopathy? 3. SAlb trend? 4. Were the random/spot urine sa...

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RE: Approach to flank pain ( my case series) 1 day ago

Allow me to opine If clots can be seen from gross hematuria in severe glomerular disease such as IgAN, it must be extremely rare. Why wou...

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Nephrotic range proteinuria with IC-mediated glomerulopathy 1 day ago

Good morning/afternoon/evening, everyone! I have a 31-year-old female patient with type 1 diabetes mellitus who developed sub-nephrotic range prot...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Thanks Dr. Asplin . I was impressed with the medullary sponge kidney, the family history and the stone composition results. The existence of an aut...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Yes I will try to do that later today ------------------------------ Emily Petersen MD, FASN Kootenai Clinic Nephrology Coeur D Alene ID (208) 2...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

I should have mentioned that the genetic test indicated that inheritance could be autosomal dominant or recessive ------------------------------ ...

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

Dr Petersen, This is a very interesting case. Would you be able to scan a deidentified copy of her 24 hr urine so we can look at all the numbers....

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RE: Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

This case would benefit from advice from Drs. Goldfarb and Asplin. Medulkary Sponge Kidney is associated with Calcium Phosphate stones and can have...

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RE: uTi In Anuric Hd Patients 1 day ago

That’s helpful Do we routinely examine dialysis patient bladder / do post void scan ? How anuric is anuric ? 24 hr volume is not often measured i...

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Patient with recurrent calcium phosphorus stones and medullary sponge kidney, with genetic testing positive for cystinuria 1 day ago

44 yo female patient with recurrent kidney stones, approximately 5 symptomatic stones per year for many years, off and on, and has had obstructing ...

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RE: Pd Question 1 day ago

Thanks prof venkatShe is in her 50 Active on tx list ( now suspended ) Gram -ve bacilli on cyst fluid and blood cultures urine culture pending Not...

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RE: Lupus nephritis III/IV 1 day ago

Thanks dr Marwan. Not sure about this one . Feels risky to stop everything and have a flare in pregnancy But if stops and patient stable serologi...

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RE: Lupus nephritis III/IV 1 day ago

Thanks prof rodby @ prof glassock how long would you wait after switching to aza assuming serological remission and no active urine sediment ( one...

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RE: Lupus nephritis III/IV 1 day ago

thank you all for your input. I actually have this same scenario a lady who is planning pregnancy who has been on remission for >5 years, serologie...

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RE: Lupus nephritis III/IV 1 day 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 p...

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RE: Lupus nephritis III/IV 1 day ago

Conversion from MMF to AZA would be acceptable practice if she is in a complete clinical and immunological remission (normal protin excretion, eGzf...

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RE: Approach to flank pain ( my case series) 1 day ago

Thanks-Dr. it has been a long time since I first read this seminal paper which was one of the first to draw attention to the close connection...

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RE: Approach to flank pain ( my case series) 1 day ago

Upon further reading and searching, urine clots, although described in IgA vasculitis (see attached) are quite rare in IgA but, according to Chat G...

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RE: Lupus nephritis III/IV 1 day ago

@ prof glassock ( question not addressed to me) I would switch to aza and steroids and monitor lupus markers ( complement , ds dna, urine for blood...

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RE: Approach to flank pain ( my case series) 2 days ago

Gross hematuria/clots have been described in association with IgA . See attached. ------------------------------ Mario Rubin, M.D. Houston TX (...

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RE: Pd Question 2 days ago

Dr. Soobadar: How old is your patient? If she is a candidate for kidney transplantation, given the severity of her cyst infection, nephrectomy (as ...

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RE: uTi In Anuric Hd Patients 2 days ago

I can think of several situations wherein UTI may occur in an anuric ESKD/dialysis patient: 1. As already pointed out by Dr. Rodby, some "anuric" p...

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RE: uTi In Anuric Hd Patients 2 days ago

UTIs are often related to stasis and that is certainly something you will see in an ESRD patient, Yes I have seen what I thought to be cystitis in ...

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

"Pan diuresis" (polypharmacy of all diuretics known to mankind given all at once) is in my experience a good segway to severe azotemia and ESRD." ...

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RE: Approach to flank pain ( my case series) 2 days ago

I have 'Never" seen gross hematuria with "clots" in IgAN. If the history is reliable In doubt that the hematuria is due to igAN without any LM abno...

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

Her BP is starting to rise! I have switched her to UF only for the past 24 hours and will continue for the next day or so as electrolytes are the s...

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RE: Approach to flank pain ( my case series) 2 days ago

@ prof glassock how do explain case 3 biopsy ? Do you think its ig a ? Kr --------------------------------- Muhammad Soobadar MBChB UK ----------...

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RE: Approach to flank pain ( my case series) 2 days ago

Thanks really helpful. Will mention it to urologist Kind regards and thanks for help --------------------------------- Muhammad Soobadar MBChB ...

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