Looking for Plasmapheresis Resources! 4 minutes 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 hour 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 hour 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 2 hours 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 4 hours 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 5 hours 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 5 hours 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 7 hours 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 7 hours 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 15 hours 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 18 hours 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 18 hours 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 18 hours 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 22 hours 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 23 hours 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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" 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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 1 day 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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RE: Hypomagnesemia 1 day ago

Both the CUBN and PTPRO mutations are present in heterozygous state and should be present in homozygous state/digenic variants to be pathogenic. Th...

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symptomatic methemoglobinemia 1 day ago

We have couple of adult patients who suffer from symptomatic methemoglobinemia and severe hemolytic anemia requiring blood transfusion . It starts ...

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RE: Hypomagnesemia 1 day ago

Hi Dr. Glassock, here is the deidentified Natera report. It also showed 2 other mutations, a carrier for CUBN and a VUS of an autosomal recessive m...

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RE: Steroid dependent FSGS with "tip lesion" 1 day ago

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

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RE: Hypomagnesemia 1 day ago

I thought that HNF4A mutations were associated with MODY. HNF 1B heterozygous mutations are associated with renal Magnesium wasting, resembling Git...

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RE: Hypomagnesemia 1 day ago

I've only gotten a patient up to 15 mg bid, but have heard of others who've done more. 100% agree on SGLT2 plan. Laura Maursetter showed this gre...

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RE: Hypomagnesemia 1 day ago

@Joshua Waitzman ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL (773) ...

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RE: Elevated of B2-microglobulin in dialysis patients 2 days ago

Dr. Rosales. Thanks for the additional information. As noted in comments in thus thread, on-line HDF is not widely available (yet) in the USA and i...

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RE: Hypomagnesemia 2 days ago

Thanks Dr. Rodby. I’ll see if I can convince him on sglt2i I remember Josh Waitzman say in the “Channel your enthusiasm” podcast that he uses high...

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RE: Elevated of B2-microglobulin in dialysis patients 2 days ago

Greetings to everyone. In response to Dr. Glassock and Dr. Rodby's comments about HDF... I think our clinical practice is not necessarily an ex...

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RE: Hypomagnesemia 2 days ago

I assume he never received venetoclax (lymphoma) or cetuximab (head and neck, prostate, and bowel cancer) PPIS do it but they are off and that w...

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RE: Elevated of B2-microglobulin in dialysis patients 2 days ago

This middle molecules are important v middle molecules (MM) are not important, HDF v HD argument has been going on for years. Franky I find it tire...

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Hypomagnesemia 2 days ago

A 67 yr old male with type 2 diabetes developed cramping of his muscles and was found to have a low serum Magnesium of 1.0. He has had several low ...

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

Proteinase K works as well as pronase. In the article on MPGN with masked monoclonal depositis. Mayo used pronase and Arkana (Nephropath at the tim...

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RE: Elevated of B2-microglobulin in dialysis patients 2 days ago

Thanks. I agree. The Rosales experience in Chile seems to be an outlier, at least in respect to conventional HD, but maybe it needs more validation...

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RE: primary Membranous nephropathy and HBV infection 2 days ago

In the absence of HBV infection I would treat such a patient without delay,, if Nephrotic Syndrome (NS) was present. With concomitant HBV, I do not...

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RE: Elevated of B2-microglobulin in dialysis patients 2 days ago

B2M level is rarely measured in our practice. Kidney is not the only organ that clears B2M. I think we will be chasing our tail if it is used in al...

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RE: primary Membranous nephropathy and HBV infection 2 days ago

Do you have any threshold of the PLA2R levels by ELISA above which you would recommend immunosuppressive therapy regardless of any other factor? fo...

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RE: Aspergillosis in resistant ANCA associated GN 2 days ago

I think the initial treatment was effective, perhaps a bit too aggressive if anything, which leads me to suspect that this entire 'relapse' could b...

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

Sparsentan has never been tested for this approach and is not approved by the FDA for this indication. The drug failed to meet its primary end poin...

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

Is it worth trying Sparsentan to maintain remission after giving Rituximab and tapering Prednisone ? --------------------------------- Rochak Var...

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RE: PIGN with Nephrotic Syndrome case 2 days ago

Prior serologies not available. But i did all of them recently and C3 and C4 not low anymore; SIFE with Faint free lambda light chain noted with no...

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