RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 3 hours ago

I will opt for RTX as induction remission drugs because AZA is a maintenance therapy. The data on use of RTX during pregnancy are somehow reassurin...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 7 hours ago

Hi Dr Saja, Did you do a kidney biopsy while she was pregnant? And did you do it with IR? How you counselled patient? Bw ------------------------...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 8 hours ago

Why are you not using AZA. With relatively mild disease , it could be quite effective and safe. Just an opinion ------------------------------...

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RE: Haemodialysis patient with high calcium and low Po4 8 hours ago

what about his ALP Level? VIT D level? Is he on Sevelamer? ------------------------------ Saja Mohammed MD, MBChB, MS Doctor SQUH Muscat ----...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 8 hours ago

Thank you, prof, actually, the patient clinically remained stable her creatinine was stable at around 90s from a baseline of 70, after the M...

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RE: Clinical Practice Questions 9 hours ago

Thanks . Will post the biopsy result this week --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Haemodialysis patient with high calcium and low Po4 9 hours ago

Thank you Dr Gassock, Dr Rodby, Dt Mellas The Bio intact PTH is betweem 1.2 to 2 pg/ml (12 - 18 pg/ml) which is in the lower end of normal. Th...

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RE: Haemodialysis patient with high calcium and low Po4 11 hours ago

How sedentary is the patient and the state of nutrition? ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St...

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RE: Haemodialysis patient with high calcium and low Po4 12 hours ago

Does the patient still make urine? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chic...

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RE: Treatment of Sclerotic glomerular disease 20 hours ago

Please post the EM findings on both cases when they become available . An Alport spectrum disorder may be the cause, ---------------------------...

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RE: Treatment of Sclerotic glomerular disease 23 hours ago

Dr. Glassock, He has no family history of kidney disease and consanguinity. His birth weight was normal. I also encountered another patient, aged ...

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RE: Haemodialysis patient with high calcium and low Po4 1 day ago

Does the patient abuse alcohol? What is the PTHrp level? What is the serum Mg and the serum Albumin/Globulin levels? ----------------------------...

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Haemodialysis patient with high calcium and low Po4 1 day ago

Dear experts Would be grateful for your inputs on following clinical scenario: 86yrs; ESKD secondary to primary membranous GN (pos anti PLA2R...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Thanks- let us know how things go. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----------------------...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

I appreciate the input and guidance from my colleagues. I have asked the patient to stop the allopurinol already. She has an appointment next week ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

This sample of photomicrographs suggests a glomerular disease, not a "hypertensive Nephropathy". I suggested an IgA/C3 ratio as studies from Japan ...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

We have all made our suggestions and now we await the results. What treatment dis you decide to offer this patient and what were the results of you...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Agree with Dr. Hirsch and I think we should not put more weight on serology similar to LN as ANCA may be non-pathogenic and we should correlate ser...

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RE: Treatment of Sclerotic glomerular disease 1 day ago

immunosuppressive therapy is not indicated, In my opinion, but genetic testing may reveal a cause. I assume that the global sclerotic lesions have ...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Respectfully, I do not think anyone is "ignoring" the ANCA anymore than anyone is ignoring the possibility that it is a false positive or due to Al...

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Treatment of Sclerotic glomerular disease 1 day ago

A 49 year-old male patient was admitted due to "frothy urine for over 2 years ". The patient first noticed frothy urine in 2022 but had no lower l...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

The discussion is also about an ANCA- induced medullary vasculitis secondary to Allopurinol. Is RTX needed to treat this condition ?. The key quest...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Doe the discussions were about the use of RTX for presumed AIN as primary therapy and to avoid the use of steroids? Am I missing something? ------...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Sorry i got only those photos that may be uploaded. ------------------------------ Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ------------...

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RE: Dialysis/Hemolysis 1 day ago

The labs came back hemolyzed. The lab was following the hemolysis index which was high. It cleared after 1-2 days and the f/u samples normalized af...

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RE: Dialysis/Hemolysis 1 day ago

so are you saying the hemolysis was longer than the ER visit? How did you know continued hemolysis if the Hgb wasnt dropping? And what was the e...

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RE: first inflow alarm in peritoneal dialysis 1 day ago

My experience is that PD catheters either work well or they dont and those that dont rarely can you make them work better, unless there is obvious ...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Dr Hirsch, we are on the same page in maybe less is more, but my less is less steroids and achieving that through rituximab, which I feel is infini...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Of course, this case raises questions about specificity, not sensitivity, of ELISA for anti-MPO -antibodies, Generally, such ELISA have very high s...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Interesting case My question to all is, how sensitive and specific is ANCA serology for diagnosing AAV? Many studies have shown considerable v...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

Too bad- although a "negative" ANA and a "positive " antidsDNA is uncommon, no test is 100% sensitive. A number of such patient are reported in the...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

ANA was negative , our lab will not run the Anti DNA Ab and Anti Smith Ab if ANA is negative. ------------------------------ Zubair Ahmad MD Tuls...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

Just curious -was the ANA and anti- DNA antibody negative in this patient?. "False Positive " antiMPO ANCA have been described when cationic MPO su...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

The specimen had 19 glomeruli and only one showed obsolescence. None of the glomeruli had any evidence of any lesion at all levels -------------...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

This case show significant Proteinuria and hematuria that goes with glomerulonephritis , kidney biopsy show mesangial proliferation and interstitia...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

Dr. Hirsch. Thanks for posting your very well reasoned suggestions for management of this case. The notation of a stable serum creatinine since Apr...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

The cr has been stable from April to now at 2.4. This is not a RPGN "emergency" in which we need to be maximally aggressive on day one, or need to ...

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RE: first inflow alarm in peritoneal dialysis 2 days ago

it is good option, will be considered defiantly thank you ------------------------------ Maryam Alahmed MBBS dr NGHA riffa 32338389 ----------...

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RE: first inflow alarm in peritoneal dialysis 2 days ago

hi dear, I positioned the patient to lie down in the same manner as he does at home, and successfully initiated automated peritoneal dialysis (AP...

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RE: first inflow alarm in peritoneal dialysis 2 days ago

hi Maryam . have you tried to use manual PD? the fact that the alarms are triggered when pt is bedside and not when you did in the PD unit, may be ...

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RE: first inflow alarm in peritoneal dialysis 2 days ago

Morning dr Maryam. Before shifting him to HD , what is the position of the patient while in bed? . If you connected him in the unit and it worked f...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

Is she is treated with steroids and Ritux, both bases will be covered. I wonder if steroid avoidance is sought then I think there is not much exper...

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first inflow alarm in peritoneal dialysis 2 days ago

good day all, I requesting your expert opinion on one PD case. 54 years old ESRD due to DKD, started on PD 2 month back which was smooth at the...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

The patient has a positive anti-MPO and has received Allopurinol. We all agree that Allopurinol must be stopped. Are you willing to ignore the ANCA...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

Dr. Jabur- would it be possible for you to post a (deidentified) image of the global glomeruloscleroisis seen in this patients biopsy? ----------...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

How does one tease out interstitial nephritis due to drugs from one due to ANCA. If it's the drug associated AIN, cessation of Allopurinol is cruci...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

Obsolescent glomerulosclerosis is compatible with aging and ischemia- solidified glomeruloscleroisis is more compatible with an intrinsic Glomerulo...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

Dr. Glassock, will you kindly elaborate on IgA/C3 and how its reliable in diagnosing IgA nephropathy? ------------------------------ Wael Jebur ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

Dr. Glassock. The global glomerulosclerosis was obsolescent type and immunoflorescent staining was performed on intact glomeruli. May I ask wha...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

Thank you for all your replies. He records showed normal renal function and minimal proteinuria before gastric reduction surgery. He lost almost ...

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