RE: transplant cases 9 hours ago

I can't say for sure in kidney transplant recurrence, but in IgA V involving the native kidney often has a prominent tubulo-interstitial inflammati...

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RE: transplant cases 10 hours ago

Thanks - look forward to his comments- we also need to appreciate clinical picture which includes a noncompliant patient with immunosuppression and...

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Diamox causing kidney stones 10 hours ago

I just saw a 53 you woman who was started on diamox 500 tid for pseudotumor cerebri. The improvement in her headaches and vision has been life chan...

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RE: Crescentic ig a in transplant case 11 hours ago

Serum creatinine actual levels and trend? Is it increasing rapidly? Urine Alb/Cr and/or Pr/Cr? Urine sediment/hematuria? Agree with Dr. Lerman th...

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RE: transplant cases 11 hours ago

Yes, I do think that with severe crescentic recurrent IgAV it will not be possible to discern an underlying ABMR or ACMR, based on histology alone....

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RE: transplant cases 13 hours ago

Dear Dr.Glassock are you suggesting biopsy only shows IgAV without ACR 1B ?+\- ABMR? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP...

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RE: transplant cases 15 hours ago

I think this is mainly recurrent IgAV in an allograft. I would consider treating with Iptacopan or RTX in addition to short course of pulse IV MP./...

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RE: transplant cases 15 hours ago

Any MVI? Sound like mixed rejection and IgAN, I would increase the dose of MMF to 2 gram/day, add PLEX and IVIG. -------------------------------...

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transplant cases 18 hours ago

i am posting from Transplant Forum 18M, Issues: 1) Declining kidney function - Suspected rejection: Admits to poor compliance with...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 18 hours ago

Metabolic alkalosis has both generation and maintenance phases. In ectopic ACTH syndrome (EAS), generation phase is due to excess cortisol stimul...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 18 hours ago

these cases are rare but so interesting I have see only one IUhave attached my publication from it. the VERY high ACTH levels associated wit...

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RE: Crescentic ig a in transplant case 18 hours ago

Would treat ACR 1B with thymoglobulin 1mg/kg daily x 7-10 doses , convert Azrhioprine to MMF 2-3 gms/day. Get dd-cfDNA , rebiopsy after above treat...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 18 hours ago

This pathology report illustrates the continuum of chronic lesions that can be seen in a biopsy. Ci =3 but ci =1, ct= 1, cg =1 and affects only 2...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 19 hours ago

------------------------------ Vijayakumar Paramasivam MD Nephrologist Renal and Transplant Associates of the North East Springfield MA (484) 362-3...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 19 hours ago

Extremely high doses of spironolactone will likely be required, with much anticipated (and unwanted ) anti-androgenic effects. Amiloride or Triamte...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 19 hours ago

Send stat serum ACTH and a random/late-afternoon serum cortisol plus 24-hour urine free cortisol add aldactone or other MRA continue to replet...

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RE: Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 20 hours ago

I suggest looking at this biopsy before throwing in the towel cg1b could e just 5% of capillary loops affected in the worst glomeruli cv3 could...

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RE: Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 20 hours ago

This case cries out for the use of Metyrapone, Ketoconozole, Paseriotide, or Osilodrostat to inhibit the presumed ectopic ACTH driven hypercortisol...

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Chronic active AMR plus IgA nephropathy with a focal necrotizing lesion in a re-transplant - treat, or protect what's left? 20 hours ago

54/male, second deceased-donor kidney, ~7 years out. First living-related graft (2003–2010) lost to transplant glomerulopathy/secondary FSGS, allog...

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RE: Steroid-refractory seronegative demyelinating encephalitis in a kidney transplant recipient 20 hours ago

we chose to do the low dose tacro with goal of 3-5- neuro deficits resolved. latest mri - radiology read- 8/4/26- Significant improvement compared ...

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Metabolic alkalosis, high urine Chloride, new diagnosis of metastatic lung cancer 20 hours ago

A 71 yr old female with a heavy 30+ yr smoking history is admitted for a month of progressively increasing weakness. On presentation, her K was 2...

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RE: ig a case is it alcohol/liver disease related. 20 hours ago

C3 co-deposition in IgAN is so common in > 90% is some cohorts and not indicate alternative pathway activation. Some studies link this to future CK...

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RE: ICI induced IgAV 1 day ago

I thought of it LDH 388 slightly elevated Ferritin 1450 significantly elevated Triglyceride 1.7 normal Platelets 129 LFTs normal We do...

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RE: MPO VASCULITIS 1 day ago

Thank you Dr Aledan. The patient you referred had autoimmune hepatitis and might have been the reason for positve MPO titers ------------------...

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RE: ig a case is it alcohol/liver disease related. 1 day ago

My answer to your 2 Questions is No. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCL...

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RE: nephrotic syndrome with 1 day ago

Not necessarily. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA Laguna Woods CA (9...

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Crescentic ig a in transplant case 1 day ago

18M, Issues: 1) Declining kidney function - Suspected rejection: Admits to poor compliance with tacrolimus Previous negative DSAs July 202...

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RE: ig a case is it alcohol/liver disease related. 1 day ago

C3 and C4 levels, HBV status -ve cant find ANCA is diagnosis of abdominal pain in Ig a on kidney biopsy enought to label Ig a v . no documentatio...

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RE: nephrotic syndrome with 1 day ago

What is seum albumin? 17.6 , C3 and C4, HCV and HBV status.? all negative RF /BM/Cryo Not done @prog glassock would you not need to gi...

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RE: ICI induced IgAV 1 day ago

"I'm wondering if the levofloxacin caused a flare up! There are reports that fluoroquinolones may accentuate the immune response to Immune checkpoi...

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RE: ICI induced IgAV 1 day ago

Can you provide/do HLH-related studies, eg ferritin? --------------------------------- Oded Friedman ---------------------------------

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RE: Anti-gap positive metabolic acidosis 1 day ago

Thank you, Dr. Grimm. I was well aware of several things that artifactually reduced the serum HCO3 and thereby raised the AG, such as hyperlipidemi...

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RE: Anti-gap positive metabolic acidosis 1 day ago

The pseudo hypo bicarbonate would a potential explanation however mother said the used small tubes and they were fairly full. Sent from my iPhone O...

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RE: Anti-gap positive metabolic acidosis 1 day ago

The PCO2 was 37 and the calculated bicarb was 21.7 on the venous blood gas, which had a pH of 7.35. The blood gas was done four days after the orig...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Thanks - would this explain venous PH 7.35 @James Hasbargen MD what was PCO2 and calculated HCO3 on VBG and when in reference to original lab was i...

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RE: ICI induced IgAV 1 day ago

Thanks Dr Rodby! you're right! Its uncommon in IgA vasculitis, but I came across reports on IgA vascultitis induced by immune checkpoint inhibitors...

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RE: Anti-gap positive metabolic acidosis 1 day ago

Good morning. My diagnosis is that this is a classic case of pseudo-hypo-bicarbonatemia. We are literally getting consults like this every week o...

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RE: ICI induced IgAV 1 day ago

Fever in not that common in IgAV. I would reinitiate the ceftriaxone and increase steroids a bit (cover both bases) until PET is done. just an o...

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RE: ICI induced IgAV 1 day ago

Thanks Dr Glassock, update on this patient, his fever spikes to 39 and 40 degrees so I admitted him for extensive infectious work up (before rituxi...

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RE: Nephrotic syndrome with massive bilateral PE 1 day ago

DOCA is better in morbidly Obese but warfarin better in severe NS. So LMWH maybe better until proteinuria and albumin inproved it can be dosed and,...

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RE: Nephrotic syndrome with massive bilateral PE 1 day ago

Dr. Glassock. Thanks for the vital question. As I mentioned, to my knowlage no study test this hypothesis and all studies were on primary prophylax...

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RE: Nephrotic syndrome with massive bilateral PE 1 day ago

Dr. Aledan- thanks- do you mean that Apixaban is a better choice than Warfarin in secondary prevention of VTE in severe NS- if so , why? --------...

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RE: MPO VASCULITIS 1 day ago

A rare case reports showed a possible association . The classic reference is a Japanese autopsy case of MPO-ANCA vasculitis with autoimmune hepat...

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RE: Nephrotic syndrome with massive bilateral PE 2 days ago

The comparative data of VTE in nephrotic syndrome is small and retrospective and most on primary prophylaxis rather than secondary prevention of li...

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RE: Nephrotic syndrome with massive bilateral PE 2 days ago

Do DOAC work as well (efficacy) as Warfarin ,in preventing a recurrence of a life-threatening VTE in a morbidly obese patient with presumably treat...

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RE: Nephrotic syndrome with massive bilateral PE 2 days ago

not to be picky but "Warfarin here, wouldn't trust NOAC) " DOAC may be safer in ACUTE PE unless CKD( CREAT CL < 30ML/MIN ), LIVER DZ, APLS, prostat...

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RE: MPO VASCULITIS 2 days ago

Gastroentrelogist . Thanks Dr Glassock I looked at the literature and I could not find any association. ------------------------------ Dwa...

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RE: MPO VASCULITIS 2 days ago

Where did the suggestion of "paraneoplastic association of elevated anti-MPO antibodies" come from. The anti-MPO antibody is most likely an associa...

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RE: Anti-gap positive metabolic acidosis 2 days ago

was this the venous BG taken when AG WAS 18 or later ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medi...

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RE: MPO VASCULITIS 2 days ago

Thanks Drs Glassock and Dr Rodby. Alpha fetoprotein is not elevated. Started on empirical therapy despite a suggestion whether raised MPO tite...

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