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

Very interesting thank you all for your valued input and fruitful discussion, will give you an update ------------------------------ Saja Mohammed...

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

Good morning Kidney biopsy in our institute usually done by IR and the indication is justified in her case Thank you ---------------...

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RE: Appreciate Input in this case ESP 8 hours ago

She has permacath. Complete Metabolic Panel - TP 6.1 and albumin 2.9 Ascites fluid albumin 1.6 Ascites fluid protein 3.2 Ascites fluid gluc...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 11 hours ago

Thank you, Dr Glassock . ------------------------------ Rochak Varma MD Oro Valley AZ (917) 459-0750 ------------------------------

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RE: Appreciate Input in this case ESP 13 hours ago

Can you provide ascitic fluid albumin + protein & serum albumin values? Odd though that reports show EPS ascites to be either low SAAG which is w...

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RE: Re: variation in GFR measurements 13 hours ago

This is good to know, thank you Dr Glassock ------------------------------ [Sriram] [Sriperumbuduri] [MBBS FASN] [Assistant Professor in Nephrolo...

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RE: Re: variation in GFR measurements 14 hours ago

yes, it is ------------------------------ [Sriram] [Sriperumbuduri] [MBBS FASN] [Assistant Professor in Nephrology] [Virginia Commonwealth Unive...

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RE: Re: variation in GFR measurements 14 hours ago

The Gates method for estimating GFR by nuclear scan can be associated with major errors in patients low or high BMi - not recommended. I would rele...

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RE: Re: variation in GFR measurements 14 hours ago

Was the DTPA GFR based on plasma disappearance ? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 --------...

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RE: Re: variation in GFR measurements 14 hours ago

Thank you Dr Glassock Nuclear scan was done approximately 3 months after starting Jardiance. Since Flozins decrease GFR, is it possible that her ...

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RE: Re: variation in GFR measurements 15 hours ago

CKD-EPI creat is known to seriously overestimate GFR in adolescents and young adults. The low BMI (low muscle mass) may be another factor. The DTPA...

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RE: Haemodialysis patient with high calcium and low Po4 15 hours ago

Dr. Aledan- Great suggestion!!!. Do we have an serum FLC and bone survey in this patient? ------------------------------ Richard Glassock MD, ...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 15 hours ago

Very good point. The transplacental transfer of IgG1 is negligible until about 13 weeks of gestation. Rituximab may be very safe in the first trime...

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RE: Haemodialysis patient with high calcium and low Po4 15 hours ago

Laboratory interference of monoclonal immunoglobulins with phosphomolybdate colorimteric measurements of serum phosphorus is another cause of pseud...

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Re: variation in GFR measurements 16 hours ago

Hi all, Good afternoon. I am sharing details about a patient that I have seen in clinic recently for CKD Female in high teens- transferred from...

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RE: Appreciate Input in this case ESP 16 hours ago

have the surgeon talked to pictures of the peritoneum my cases the peritoneum was NOT normal looking , very beefy, no sclerosis per se but we...

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RE: Appreciate Input in this case ESP 17 hours ago

Such a strange story. Just to clarify, the paracenteses were bloody taps, not necessarily that the PD fluid itself was bloody? (implied not by CT...

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RE: Haemodialysis patient with high calcium and low Po4 18 hours ago

I agree with Dr Rodby and am very curious about the 1,25 level. I do believe the low phosphate is from lack of absorption, though interesting to fi...

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RE: Appreciate Input in this case ESP 19 hours ago

Ovaries are unremarkable on CT Scan. I spoke with her surgeon who is willing to do peritonoscopy and peritoneal biopsy. PD fluid cultures are n...

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Encapsulating peritoneal sclerosis 20 hours ago

We have a young pt that has developed EPS. PD cath has been removed. On high dose steroids he is finally improving and able to stop TPN. We are swi...

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RE: Appreciate Input in this case ESP 20 hours ago

bloody PD fluid scares me. I have seen it a couple of times with early EPS. but EPS after only a year seems very unlikely. Culture for TB... ...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 20 hours ago

We had a case years ago where a young woman with vasculitis and a prior history of alveolar hemorrhage, but was in remission, who relapsed late in ...

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Appreciate Input in this case ESP 20 hours ago

59 years old female started HHD in 2017 then changed to In Center HD in 2022. PD catheter placed in 11/2022 and pt transitioned to PD. PD catheter ...

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RE: Haemodialysis patient with high calcium and low Po4 20 hours ago

without urine this pth or FGF 23 cannot be involved in low PO4, I did not see the "elevated ACE" level , thanks Dr Sprague. How high is it? eit...

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RE: Haemodialysis patient with high calcium and low Po4 20 hours ago

Hi Is it possible that he has pica to chalk? Consuming large amount of chalk may cause mile alkali syndrome, hypercalcemia as well as hypophos...

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RE: Haemodialysis patient with high calcium and low Po4 22 hours ago

Please check if the patient has been taking niacin as a supplement. This can cause hypophosphatemia. ------------------------------ [Basant Pawa...

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

Dear Siva, What are the values and trends? Low phosphate with little urine output is usually nutritional. Ideally easiest to see pattern with seria...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 1 day ago

Understand. Good luck. Let us know what happens with the pregnancy. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 1 day ago

Thank you We chose induction with rituximab over azathioprine as induction providing rituximab has been used based on limited evidence with the ...

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

Here is a "far out" - " off the wall " suggestion- spontaneous infarction of parathyroid glands in secondary hyperparathyroidism with hungry bone s...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 1 day ago

I agree with Dr. Aledan that AZA is " conventionally" regarded as a maintenance o( remission drug in ANCA Vasculitis - but its efficacy for inducti...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 1 day ago

In my opinion, the density and frequency of deposits by EM can be used to asses "activity" of disease in non-anti-PLA2R induced MN. ------------...

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

This is not adynamic bone disease. With increased ACE Do you have a 125 Vit D level? Also check monograms complicated case ------------------...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 1 day ago

In the absence of any immunological marker and background of considerable chronic disease , is there anything which can convey immunological diseas...

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RE: active PR3 -AAV with pulmorenal involvment during the first trimaster of pregnancy 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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 2 days 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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