RE: Lupus nephritis 6 hours ago

Can you measure iso -enzymes of LDH. LDH 1and 2 woukd be exclusively elevated in Hemolysix, not in Hepatic Necrosis ----------------------------...

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RE: IgA Nephropathy 7 hours ago

The data on efficacy of RTX in IgAV , which is wholly observational , is very impressive. I would give moderate doses of oral steroids (short term ...

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RE: Lupus nephritis 7 hours ago

I wonder if the enzymatic assay levels are "false" positives due to the overwhelmingly severe intravascular hemolysis (and hemoglobinemia) . What w...

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RE: Lupus nephritis 8 hours ago

Physical state of the patient : The patient is conscious, oriented and has high BP requiring NTG infusion. No fever. ---------------------------...

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RE: Lupus nephritis 8 hours ago

With AST and ALT 3-5000, and a severe lactic acidosis, this (and the high LDH) appears like acute hepatic necrosis from an exposure or possibly sho...

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RE: IgA Nephropathy 8 hours ago

I'm not convinced that IgAN and IgA vasculitis are completely separate entities, but more of a spectrum. Is there evidence that IgA vasculitis do...

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RE: IgA Nephropathy 9 hours ago

Thank you. Do I need to use Prednisone with MMF? Or Tarpeyo with MMF? ------------------------------ Ibrahim Katerji MD Elmira NY -------------...

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RE: Lupus nephritis 11 hours ago

This kind of hemolysis can ocurr in HD patients from a variety of issues- chloramine contamination , improper dialysate preparation, crimped vascul...

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RE: Lupus nephritis 14 hours ago

I would get a hematology consult first --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh ...

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RE: Potential donor with mutation in NR3C2 Gene 15 hours ago

in my opinion, although this article does not specifically say that it should not be done. It also does not recommend that it be done. As we see wi...

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RE: Potential donor with mutation in NR3C2 Gene 16 hours ago

I gather from these guidelines that routine genetic testing of an unrelated (altruistic) live donor without any family history of kidney disease wo...

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RE: Lupus nephritis 17 hours ago

My guess is that this is mainly severe intravascular hemolysis with false positive Lipase, amylase and troponin due to measurement positive interfe...

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Lupus nephritis 18 hours ago

A 53 year old lady on twice weekly maintenance hemodialysis presented with chest discomfort to the casuaity. ECG shows non specific ST-T changes. A...

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RE: Immunosuppression in Lupus/APLA 18 hours ago

I agree with Dr. Rubin that if you want to make a definitive diagnosis of hemodynamically significant RAS and establish the nature, site and extent...

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RE: Potential donor with mutation in NR3C2 Gene 19 hours ago

this a practice guideline from AST ON GENETIC ANALYSIS for kidney transplant recipients and living donors. https://www.amjtransplant.org/action/s...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I think that the Cleveland Clinic work by Novick and Pohl speaks in favor of stopping dancing around a clear-cut question which needs to be answere...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Dear Dr. Glassock, I agree tat the findings of the CORAL study may not necessarily apply to this patient. However, I have some concerns about t...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Whether RAS is related to APLS or atherosclerosis, given single functioning kidney (if the stenosis is severe enough and the right kidney is not to...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Why not do an anatomical study of the right renal artery (e.g. C02 selective renal angiogram or MRA) and if a stenosis is found, the second step wi...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Excellent point Dr. Campese. The CORAL study enrolled only patients with atherosclerotic RAS. Since we suspect (but have not proven angiographicall...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Thanks Dr. Dastoor - Please read the paper by Caps MD , et al Kidney Int, 1998 ;53: 735-742, which addresses the frequency of ocurrence of renal ...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Please see the CORAL Study N Engl J Med. 2014;370;13-22 ------------------------------ Vito M Campese Professor Emeritus of Medicine Keck Schoo...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I doubt that in the absence of high BP , with a single functional kidney, this patient has high grade stenosis . Revascularization carries the risk...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I agree with Dr. Venkat. If a high grade stenotic lesion is found in the right renal artery I would be very tempted to suggest revascularization in...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I agree with Dr. Campese that revascularizing the right kidney with angioplasty/stenting is unlikely to significantly improve GFR. However, given l...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Let us assume a Doppler US shows RAS, how this is going to change the management? indications for a stent or angioplasty in RAS are uncontrolled ...

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RE: Bivalirudin for CRRT 2 days ago

Thanks. We make do without anticoagulation much of the time. Mostly CVVHD. We are having some issues with BSI in these patients. I think mostly jus...

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RE: Bivalirudin for CRRT 2 days ago

We also do not anticoaulate CRRT/PIRRT unless there is a real clotting issue, We use the NxStage machine that lacks a blood air interface (though...

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RE: Bivalirudin for CRRT 2 days ago

Thanks. We routinely use anticoagulant-free CRRT with blood flows of 300 ml/min ------------------------------ Jeffrey Berns MD, FASN Philadelphi...

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RE: Bivalirudin for CRRT 2 days ago

Dr Berns, Have you tried high blood flows (ie 250-300) with pre-and post-infusions? In our experience, that markedly decreased (though did not elim...

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RE: Bivalirudin for CRRT 2 days ago

Additionally, frequent filter clotting needs managing of other potential underlying reasons. ------------------------------ Ahmed Yasin, MD,FASN ...

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RE: Immunosuppression in Lupus/APLA 2 days ago

The vascular changes are suggestive of APLA-associated nephropathy, particularly in the absence of another clear explanation for the progressive de...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

Dr Venkat: Very interesting suggestion to this fascinating topic of discussion...in practical terms to get down to a 10 mmol/day Na diet (I did not...

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RE: Immunosuppression in Lupus/APLA 2 days ago

That's correct. Right kidney is of normal size and left is atrophic. The renal biopsy is from right kidney. ------------------------------ Sanje...

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RE: Immunosuppression in Lupus/APLA 2 days ago

As far as I know, the Right kidney (the one that was biopsied) is not "atrophic". Only the Lefu kidney is "atrophic ". Kidney sizes have not been r...

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RE: Immunosuppression in Lupus/APLA 2 days ago

The left kidney is also atrophic, regarding discordance of biopsy of right kidney and global kidney function. ------------------------------ Argy...

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RE: Immunosuppression in Lupus/APLA 2 days ago

In my opinion. The discordance of glomerulosclerosis and IFTA with eGFR suggests glomerular hypoperfusion.. ------------------------------ Richa...

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RE: Immunosuppression in Lupus/APLA 3 days ago

Regardless of the cause of ckd , a eGFR of 24 ml/min, does not correlat with IFTA of 20% . There is a discrepency here , but even if it was RAS or ...

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RE: Immunosuppression in Lupus/APLA 3 days ago

What I am suggesting is that the progressive CKD is due to "Ischemic Nephropathy" from major vascular disease, Not progressive "Lupus nephritis"- I...

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RE: Immunosuppression in Lupus/APLA 3 days ago

Thank you for your inputs. I shall update once EM is available and will also get a repeat Renal A doppler. ------------------------------ Sanjee...

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RE: Immunosuppression in Lupus/APLA 3 days ago

Only 20 % global sclerosis and 20% IFTA does indicate "advanced CKD". The APLA syndrome likely accounts for L kidneys RAS and loss of kidney functi...

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RE: Immunosuppression in Lupus/APLA 3 days ago

Extensive subendothelial deposits on EM might indicate need for immunosuppression. Regarding anticoagulation: No recent thromboembolic events, remo...

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RE: Anti GBM with Fibrillary GN 3 days ago

Yes. Negative for paraprotein. --------------------------------- Narothama Reddy Aeddula MD, FASN Newburgh IN (774) 641-1444 -----------------...

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RE: Bivalirudin for CRRT 3 days ago

We have some reluctance to go down the citrate path due to complexity with multiple ICUs, nursing turnover, etc. We also use NxStage machines so wo...

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RE: Immunosuppression in Lupus/APLA 3 days ago

Thanks Dr. Venkat- anything that the EM might show that would change your mind? Would you anti-coagulate ( because of the vascular changes and the ...

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RE: Bivalirudin for CRRT 3 days ago

Hi Dr. Burns, Leo here. Why not citrate, given that it is the recommended anticoagulation strategy per KDIGO? In our experience, when citrate a...

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RE: Anti GBM with Fibrillary GN 3 days ago

Many thanks. Very interesting case report. I wonder if this is not IgG-4 related disease. It is definitely not Fibrillary GN --------------------...

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RE: Anti GBM with Fibrillary GN 3 days ago

Dr Glassock thanks I just read knowing it is rare Dual Anti-Neutrophil Cytoplasmic Antibody and Anti-Glomerular Basement Membrane Antibody-Posit...

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RE: Immunosuppression in Lupus/APLA 3 days ago

I agree with Dr. Dastoor that the pathological changes in the right kidney are too chronic/inactive to justify immunosuppression. I think Doppler U...

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RE: Anti GBM with Fibrillary GN 3 days ago

Dr. Safdar - can you provide a citation that supports this contention. Paraproteinemias are very rare caused of Fibrillary GN or anti-GBM disease, ...

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