RE: Clinical Practice Questions 1 hour ago

Peak SCr of 3.6 mg decreasing to 2.1 mg dL makes partially resolved AKI from diarrhea-induced volume depletion and/or increased tacrolimus level mo...

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RE: Anti Gbm Case 3 hours ago

You are going to have to reduce or stop the CYC. Did he ever have a kidney biopsy. ? What happened to the low C4 and elevated anti-PR3? Are you con...

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RE: Anti Gbm Case 3 hours ago

Dear all, After 14 sessions the anti gym levels remain stuck at around 23 ( previous 18/38/21) ( 0-7 U/ml) normal Out team have opted to stop pl...

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RE: Clinical Practice Questions 3 hours ago

Thanks prof Venkat and prof mark In Nepal creatinine went up to 3.6 and has been improving . Tac level when came to UK 12.5 dose reduced now 6.5 ...

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RE: Clinical Practice Questions 3 hours ago

If you already performed a transplant, kidney biopsy then please post the de- identified report as soon as available. This certainly could be ATN F...

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RE: Crescentic IgA 5 hours ago

I'd confirm no coexisting ANCA Ab if you haven't. I have a similar case and I'm transitioning to iptacopan now over cytoxan and agree the threshold...

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RE: Management In ADTKD 6 hours ago

Hi Shahzad, sorry for the delay to this posting. We follow a large cohort of patients with ADTKD. Early on, it was felt that allopurinol could be b...

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RE: Crescentic IgA 6 hours ago

If biopsy showed foam cells in in presence of heavy proteinuria could all be related to Iga not due to Alport syndrome -------------------------...

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RE: Elevated of B2-microglobulin in dialysis patients 13 hours ago

Yes - we don't measure ß2 as a measure of adequacy. We don't measure routinely. Some year ago we measured it regularly in our long hours home patie...

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RE: Crescentic IgA 14 hours ago

The only promising data with RTX is in IgA Vasculitis which is defined clinically, not pathologically . RTX is ineffective in IgAN, in my opinion. ...

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RE: Elevated of B2-microglobulin in dialysis patients 14 hours ago

Dr- Polkinghorne- many thanks for you input for this dialogue. . I would presume you do not use serial serum B2 microglobulin levels levels in your...

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RE: Elevated of B2-microglobulin in dialysis patients 16 hours ago

Hi All, My 2 cents worth. All the previous HDF trials have important issues and I totally agree that CONVINCE doesn't actually offer a way forwa...

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RE: Elevated of B2-microglobulin in dialysis patients 18 hours ago

The CONVINCE trial was conducted during the COVID pandemic. It showed lowered all cause mortality with On lines compared to standard high-flux HD a...

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RE: Clinical Practice Questions 18 hours ago

What was the peak SCr before the it plateaued at the current level of 2.1 mg/dL. If the peak level was significantly higher and it then came down t...

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RE: Clinical Practice Questions 20 hours ago

Colonoscopy results not back yet. Bw --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Clinical Practice Questions 20 hours ago

Thanks Prof Glassock. He had colonoscopy with biopsy . I thought the yield was low ? What do mean by non invasive molecular diagnostic ? Bw ----...

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RE: Clinical Practice Questions 20 hours ago

Blood CMV is insufficient for Diagnosis of CMV colitis. Needs colonoscopy with biopsy, given the abrupt change in SCr and reduction of IS I think a...

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RE: Elevated of B2-microglobulin in dialysis patients 20 hours ago

@Swapnil Hiremath Swap, your links above do not work for me, can you test them yourself? I get the impression that Dr Glassock is not counting...

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RE: Looking for Plasmapheresis Resources! 20 hours ago

The America Society for Apheresis (ASFA) is an excellent resource. Apheresis.org. It has a Certifying exam for Apheresis specialists,. --------...

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Clinical Practice Questions 20 hours ago

Hi , 1/ does anyone have Experience in dealing with patient who get vasovagal episode when giving local anaesthetic with spinal needle ? 2/ renal...

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RE: Crescentic IgA 21 hours ago

Creatinine 7 is awful and I doubt I would treat. but "only" (all relative) 15% crescents, 60% glomerulosclerosis and 50% fibrosis, creatinine see...

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RE: Looking for Plasmapheresis Resources! 21 hours ago

I will attach some articles: ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chic...

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Looking for Plasmapheresis Resources! 22 hours ago

Hi everyone, I'm an early-career nephrologist looking to enhance my knowledge and skills in plasmapheresis (therapeutic plasma exchange). If you've...

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RE: Crescentic IgA 1 day ago

Forgot to add that her serum creatinine is ~7 and the only previous creatinine available is from 3 years ago, which was 0.8 mg/dL. --------------...

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RE: Crescentic IgA 1 day ago

I have a similar case, 23 year old woman, IgA nephropathy, 15% crescents though but 60% glomerulosclerosis and 50% fibrosis. Would that change the ...

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RE: Elevated of B2-microglobulin in dialysis patients 1 day ago

B2m is a marker of proliferation not specific to plasma cells. It can be elevated in other tumors and inflammation. -----------------------------...

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RE: Membranous nephropathy 1 day ago

She has just received hepatitis B vaccine first dose on 11/20/24 ( scheduled for 4 doses at 0, 1, 2, 4 month intervals ). Will hepatitis B vaccine ...

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RE: drop in bicarb level more after starting emoagliflozin 1 day ago

Agree hyperclhloremic acidosis of CKD. No further work up needed for acidosis. Use of NaHOO3 up to you Dr Wesson would treat. -------------...

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RE: Steroids dependent nephrotic syndrom 1 day ago

IF was all negative. I agree it is strange that he noticed this very tiny incresed in albuminuria. I will see him in 2 days and I have his blo...

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RE: Membranous nephropathy 1 day ago

Her serum creatinine remains high at 5.82 ( 11/20/24 ) and albumin is low at 2.3 ( 11/20/24 ) with oliguria and she is still undergoing intermitten...

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RE: Membranous nephropathy 1 day ago

I want to update on this case with the biopsy results. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (8...

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RE: Elevated of B2-microglobulin in dialysis patients 1 day ago

Dr. Hiremath.-thanks for joining the " Debate"on this Fascinating but difficult topic. The CONVINCE trial showed no benefits of HDF compared to hig...

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RE: Elevated of B2-microglobulin in dialysis patients 1 day ago

Very interesting discussion as always and thanks for the nudge @Roger Rodby. The Chilean data is very interesting - thanks for the discussion and t...

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RE: drop in bicarb level more after starting emoagliflozin 1 day ago

Just plain-vanilla metabolic acidosis (mild ) secondary to CKD as far as I can tell. No indication for supplemental oral sodium bicarbonate. Would ...

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RE: Steroids dependent nephrotic syndrom 1 day ago

I agree 100% with Dr. Rodby- the NSAID exposure was likely co-incidental. Was any "dusting " of Podocytes with IgG seen in the IF. I'f so, this is ...

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RE: Steroids dependent nephrotic syndrom 1 day ago

I question if "he noticed more foamy urine, slight edema. His ACR was 200mg/" only 200 mg/g of albuminuria would give you foamy urine . I w...

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RE: PGNMID 1 day ago

Thanks so much for your advice! ------------------------------ Madeline Kirby MD Newport News VA (336) 543-5227 ------------------------------

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RE: drop in bicarb level more after starting emoagliflozin 1 day ago

One possibility for the proteinuria: A much cheaper and better alternative than finerenone --given the already low HCO3-- would be adding chlorthal...

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RE: drop in bicarb level more after starting emoagliflozin 2 days ago

Collection time: Nov 26, 2024@12:54 Test Name Result Units Range --------- ------ ----- ----- SODIUM 62 mmol/L POTASSIUM 21.6 mmol/L CH...

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RE: drop in bicarb level more after starting emoagliflozin 2 days ago

Because of worsened Albuminuria,, Albumin to creatinine ratio rising to 1112 and Urine protein to Creatinine ratio 1. 59 despite being on Empaglifl...

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RE: drop in bicarb level more after starting emoagliflozin 2 days ago

Type 4 RTA Is another possibility but potassium level has never been elevated and has been 3.7 to 4.7 for years and he is on Lisinopril 15 mg daily...

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RE: drop in bicarb level more after starting emoagliflozin 2 days ago

Edited from above correcting errors -----White gentleman age 47 with presumed type 2 diabetes that has always been insulin requiring so it is not c...

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drop in bicarb level more after starting emoagliflozin 2 days ago

White gentleman age 47 with presumed type 2 diabetes that has always been insulin requiring so it is not completely sure whether it is type II, sta...

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Steroids dependent nephrotic syndrom 2 days ago

Dear colleagues, I have been following a 50-year-old patient with no past medical history of revelance, with nephrotic syndrome minimal change d...

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RE: Steroid dependent FSGS with "tip lesion" 2 days ago

I would absolutely continue Rituximab, now and probably in 6 months again too! I would also follow his CD 19 cells and if they reconstitute befo...

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RE: symptomatic methemoglobinemia 2 days ago

I would contact https://www.extrip-workgroup.org extrip.info@gmail.com Even if they cannot help, I am certain they would like to know about ...

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RE: Re: kidney biopsy findings in a young lady 2 days ago

Good point. I missed the supplemental post. It is not clear (at least to me) if the Paraffin IF with Pronase included staining for kappa and lambda...

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RE: Re: kidney biopsy findings in a young lady 2 days ago

Dr Fogo has spoken and I would go with her opinion. I do believe therapy can extend the functional life of her kidneys. As for pronase, it seems ...

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RE: symptomatic methemoglobinemia 2 days ago

Addendum- you are quite correct thar Hydrogen Peroxide contamination can produce a similar effect as chloramine . Have you tested water for total C...

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RE: symptomatic methemoglobinemia 2 days ago

Your description is most likely methemoglobinemua from chloramine exposure in improperly prepared dialysate . Search for the origin of chloramine i...

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