RE: EPS 1 hour ago

If the patient is "asymptomatic" you and she are lucky and I suppose even the more reason to continue it, fibrosis is slow and insidious, and I wou...

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RE: Chronic TMA 3 hours ago

Yes hypertension is well controlled with 2 anti hypertensives. ------------------------------ Payal Gaggar MD, DM Nephrology Asst prof Nephrology...

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RE: Chronic TMA 4 hours ago

ANA blot is negative and no systemic features of connective tissue disorder. ------------------------------ Payal Gaggar MD, DM Nephrology Asst p...

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RE: Chronic TMA 4 hours ago

Thank you for inputs and sharing the article Prof Rodby. ------------------------------ Payal Gaggar MD, DM Nephrology Asst prof Nephrology Nizam...

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RE: EPS 4 hours ago

Dr Rodby One of the dilemma that I have is how to follow up after tamoxifen is started because the patient is asymptomatic right now . I might ...

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RE: Chronic TMA 5 hours ago

Dr. Gaggar: Is no hypertension well controlled in your patient? I assume ANA and other systemic sclerosis-related auto-antibodies are negative. Scl...

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RE: EPS 5 hours ago

Even if tamoxifen is a "Hail Mary", EPS is a devastating disease without an accepted therapy (other than getting off PD and possibly transplanting)...

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

@William Whittier You have been summoned to give us the 2026 opinion on transvenous renal biopsy (from Dr Glassock above). I myself (sharing an...

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RE: Chronic TMA 5 hours ago

We see a lot of less obvious renal TMAs here, cases suggestive in the kidney biopsy (TMA is such a pattern of injury diagnosis with such a long lis...

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RE: Chronic TMA 6 hours ago

APLA, protein C, S, Antithrombin 3 , all are within normal limits. Will see this paper. Thanks for the inputs Prof Glassock. --------------------...

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RE: Chronic TMA 6 hours ago

See Keratishvili D, et al KI Reports, March 2026. This patient seems to have a chronic Renal limited TMA. have you evaluated him for anti-phospholi...

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Chronic TMA 10 hours ago

A 39-year-old male with a 4-year history of hypertension presented with impaired renal function (serum creatinine 1.76 mg/dL [155 µmol/L], eGFR 50 ...

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RE: Biopsy dilemma in setting of severe refractory ITP 16 hours ago

Cryoglobulins just ordered. RF to be repeated. Details of prior RF no known since initial evaluation at other hospital. Hep C negative previously. ...

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RE: EPS 20 hours ago

Thank you. I was curious because the ISPD does not provide a specific dose or regimen for tamoxifen in EPS. As the authors of the UpToDate card sta...

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RE: EPS 21 hours ago

Dr. Rubin up-to-date mentions a dose of 10 mg three times a day for at least three months which is why I decided on that dose and the duration. s...

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RE: EPS 21 hours ago

@Salil Mangi I am curious, how did you come up with 3 months? The suggested initial dose is 20 mg for 6-12 months with adjustments according to c...

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RE: Reference values for blood anion gap 22 hours ago

While we re-read the classical jewel attached, let's see what the main source says! @Michael Emmett ------------------------------ Mari...

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RE: EPS 22 hours ago

Thank you, Drs Glassock,Rubin,Bargman and Rodby for your input. I am going to put the patient on Tamoxifen for 3 months and hope that it helps. s...

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RE: Reference values for blood anion gap 22 hours ago

I have looked into this nd the best answer I could find was also this: From UPTODate "Historically, the normal range for the AG has been 12±...

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RE: Hypercalcemia in a Critically Ill Patient with MAC Infection 22 hours ago

Did he have any evidence of rhabdomyolysis as a cause of his dialysis-dependent AKI, such as elevated CPK, severe hypocalcemia and severe hyperphos...

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Reference values for blood anion gap 23 hours ago

Hello, I seek guidance on what has changed, if anything, with the reference range for blood anion gap. On recent LabCorp reports, I see the refer...

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Encourage fellows to volunteer as case report reviewers for Kidney Week 2026! 1 day ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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Volunteer by April 29 to serve as a case report reviewer for Kidney Week 2026! 1 day ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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RE: EPS 1 day ago

let's face it, EPS is devastating and tamoxifen is pretty benign so I would absolutely use it... The reports of using sodium thiosulfate (referre...

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RE: hemodialysis 1 day ago

12.5-25 G mannitol IV given through hd port before start of HD.We used to do it not infrequently back in the day at UVA to prevent disequilibrium s...

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RE: Hypercalcemia in a Critically Ill Patient with MAC Infection 1 day ago

These findings are more suggestive of immobilization hypercalcemia , but the absence of 1,25 dihydroxy vitamin D suppression is a bit atypical. Do ...

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RE: EPS 1 day ago

Thanks Dr. Bargman. Very helpful advice. My enthusiasm for steroids and Tamoxifen was misguided, probably because of my paucity of "hands-on ";expe...

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Hypercalcemia in a Critically Ill Patient with MAC Infection 1 day ago

We would appreciate insights from colleagues regarding the following challenging case of hypercalcemia in an ICU patient. Case Summary: A 76-year-...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

@Azam Mughni In addition to ECMO and as previously suggested, your patient may have a superinfection (PJP, fungus) and requires, if not already d...

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RE: EPS 1 day ago

Thank you Dr. Bargman for your customary valuable input. The unpredictable role of Tamoxifen in ESP reminds me of the one of Thyosulfate in calciph...

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RE: EPS 1 day ago

I agree with Dr. Rubin that it sounds like she is in the fibrosing phase of EPS and there is little indication for corticosteroids (unlike in the i...

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

Dr Fein For cryo do we know cryocrit Are cryo class 1,2 or 3 What is Rheumatoid Factor and HepC status It seems pt already received Rituximab T...

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RE: EPS 1 day ago

Dr. Rubin is quite correct in his suggestion for avoiding high dose steroids in the management of the late, predominantly non-inflammatory fibrosin...

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RE: EPS 1 day ago

If not done already, I will have IR place a percutaneous cholecystostomy ASAP. Personally I would avoid steroids at this stage (he is well beyond t...

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RE: EPS 1 day ago

With this history , clinical findings and imaging this is very likely EPS progressing in the absence of PD. This is not an uncommon occurrence. I w...

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EPS 1 day ago

I have a 60 year-old Latin American female with a history of hypertension and ESRD for which she was on peritoneal dialysis for six years. The peri...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

A relatively large observational cohort study of solid organ transplant with severe COVID showed no beneficial effects on outcome using Tocilizumab...

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RE: Another lithium patient 1 day ago

I was not suggesting that you should biopsy him but my intention was to add to the differential diagnosis of the glomerular component of his protei...

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RE: Another lithium patient 1 day ago

Thank you for that. He does not have nephrotic syndrome at this point. UPCR fairly stable on empagloflozin and valsartan. He is very resistant , fo...

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

I did see it mentioned as a safer option. I have no experience with the procedure but could ask our IR team. On Wed, Mar 25, 2026 at 8:51 PM Debora...

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

I really appreciate your comments and wisdom

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

Thanks prof glassock and prof sprague --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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

Dr. Whittier- what are your current views on transjugular kidney biopsy in patients with severe Thrombopenia contraindicating percutaneous or open ...

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RE: hemodialysis 1 day ago

@ prof rodby cool stuff. Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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

If serology is negative and biopsy would potentially change management any thought about transjugular kidney biopsy ? ---------------------------...

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RE: hemodialysis 1 day ago

Thanks for update What is mannitol prime? Can you explain this regime to me? Kind regards --------------------------------- Muhammad Soobadar M...

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RE: hemodialysis 1 day ago

Hi, we had palliative->wants to continue. To be honest I find this academically stimulating. I am hoping we can find a happy dialysis regimen for...

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RE: hemodialysis 1 day ago

Dr Junejo Is your Pt able to consent? Does he/she really want dialysis support? Given overall pathology supportive care may be a good choice. If I ...

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RE: hemodialysis 1 day ago

could also look for carotid disease. while not exactly the same symptoms, https://pmc.ncbi.nlm.nih.gov/articles/PMC12103909/#:~:text=This%20w...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

I'm sorry to hear about this case from Transplant perspective. We have seen an increase number of invasive fungal infections and PJP in patients on...

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