RE: Patient with VASCULITIS ANCA PR3 43 minutes ago

If RTX is not available , CYC can be used instead. I expect that the biopsy will show necrotizing and crescentic GN, pribably of the pauci immune v...

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RE: Patient with VASCULITIS ANCA PR3 1 hour ago

Thank u for the updates on Plex... Always learning more everyday --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consult...

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RE: Patient with VASCULITIS ANCA PR3 1 hour ago

Thank you all for your contributions. Here are some additional details about the clinical case: - Anti-GBM still pending Serolo...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 1 hour ago

Everyone has made excellent management suggestions here. The thing that strikes me with management of rhabdo is that we have gotten used to check...

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RE: delay prog CkD in PKD 1 hour ago

I acknowledge that is not very strong clinical evidence but if I can, I try not to use DHP-CCB for blood pressure control in patients with ADPKD fo...

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RE: Patient with VASCULITIS ANCA PR3 2 hours ago

Dr. Dastoor for my understanding the data for an additional role of Plasma Exchange in ANCA associated vasculitis with diffuse alveolar hemorrhage ...

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RE: Patient with VASCULITIS ANCA PR3 2 hours ago

Dr. Chimoy: SCr 0.8 ---> 4.0 mg (in 1 week) -----> 2.0 mg (and stable). What treatment resulted in improvement in SCr - volume repletion, steroid ...

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RE: Patient with VASCULITIS ANCA PR3 2 hours ago

EULAR fell short of a strong recommendation for use of PLEX in ANCA Vasculitis- stating that "it may be considered" in cases of RPGN with serum cre...

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RE: delay prog CkD in PKD 9 hours ago

As far as I can tell from published literature a beneficial effect of Tolvaptan or SGLT2i on the very slowly progressive course of IFT140 variants ...

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RE: Patient with VASCULITIS ANCA PR3 9 hours ago

The issue of PLEX seems to be a trans Atlantic rift ... With UK colleagues at Cambridge having published data in favour , especially with an acute ...

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RE: Patient with VASCULITIS ANCA PR3 9 hours ago

Interesting thought. -has this purported "benefit" of prophylactic IVIg administration in PLEX treated patients been confirmed by a well designed R...

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RE: Patient with VASCULITIS ANCA PR3 10 hours ago

Yes I agree , there is a risk of infections with PLEX .. can that be mitigated with the use of prophylactic IgG in high risk patients ( such as eld...

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RE: delay prog CkD in PKD 10 hours ago

Not sure if Tolvaptan would benefit at this age or this variant . Perhaps just drinking water and keeping Uosm less than 300, would have same effe...

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RE: Patient with VASCULITIS ANCA PR3 10 hours ago

The "indications " for PLEX in ANCA +, aGBM - Vasculitis are quite controversial. Published guidelines differ on this point. I personally fall on t...

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RE: Patient with VASCULITIS ANCA PR3 11 hours ago

A rapidly rising creatinine to a value greater than 350 umol/l or 4 mg/dl , is an indication for PLEX ... In addition to pulmonary hemmorage with h...

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RE: Patient with VASCULITIS ANCA PR3 11 hours ago

Any signs of infection.? heart murmurs, oslers nodes, positive BC, elevated RF, low C3/C4, IV Drug abuse, Results of HBV serology. If not , would t...

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Patient with VASCULITIS ANCA PR3 11 hours ago

Hello everyone! Could someone help me with this case, a 48-year-old male patient with a history of scleritis, negative serological tests, who was...

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RE: Friday : Unexplained metabolic acidosis 12 hours ago

looks like the patient with sever malnourished state at baseline, presented with starvation ketosis and AKI (sever pre-renal high BUN/Cr even thoug...

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delay prog CkD in PKD 13 hours ago

Looking for any additional intervention to delay prog CKD in a retired youthful healthy 74 y/o M Pathologist w PCKD (not PKD 1 or 3 but rather IFT1...

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RE: Friday : Unexplained metabolic acidosis 17 hours ago

Concur with discussants. The main issue is that of an AGMA likely due to KA production. Correction of this disorder is inversely related to kidney ...

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RE: Friday : Unexplained metabolic acidosis 19 hours ago

Dr. Rubin, Thank you for attaching this NEJM 1982 landmark paper on the presence of high anion gap acidosis as well as the development of non-gap...

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RE: white male with collapsing FSGS 19 hours ago

Thank you everyone for your expertise! Great suggestions and tips! Very grateful to have great minds come together. ----------------------------...

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RE: white male with collapsing FSGS 20 hours ago

Also to be noted: "There is mild epithelial foot process effacement." This also argues against typical collapsing glomerulopathy, a podocytopathi...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 21 hours ago

Dr Rodby, you are correct. Release of creatinine from muscle woyld increase the plasma levels without a change in true FFR as measured by inulin or...

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RE: Friday : Unexplained metabolic acidosis 21 hours ago

Yeap. See attached. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------ Files Attached Docu...

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RE: Friday : Unexplained metabolic acidosis 21 hours ago

ketoacidosis (diabetic or starvation) will develop a NAGMA as you excrete the ketoanions in the urine in fact the loss of the salt of those anion...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 21 hours ago

I always thought the under appreciated thing about Rhabdo is that creatinine production increases and that will raise your serum creatinine without...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 22 hours ago

Thank you Dr. Teixeira. Very helpful. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 22 hours ago

Good question. This graph has been reproduced a bunch in reviews (even UpToDate), but I think the primary data are super old, and many of the revie...

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RE: Friday : Unexplained metabolic acidosis 23 hours ago

I would and could be wrong but I think what this patient has , has been well described in this case report https://academic.oup.com/qjmed/artic...

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RE: Metabolic alkalosis interpretation 23 hours ago

Thanks Dr. Teixeira for your very helpful post . It is my impression that Alcoholic, Starvation and DKA are all characterized by relative hypo-insu...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 23 hours ago

Thank you for the graph. I always taught that it might take up to week for CPK to normalize assuming no new insults to the muscles --------------...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 23 hours ago

Great educational figure. Do you happen to know the reference for this work? Thank you ------------------------------ Mario Rubin, M.D. Houston T...

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RE: Metabolic alkalosis interpretation 23 hours ago

Great case. I may use this for fellow case conference. Agree with not giving insulin. At least classically, starvation / alcoholic ketoacidosis s...

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RE: white male with collapsing FSGS 23 hours ago

Thanks Dr. Zuckerman for your very welcome post and citation as well as thanks to Dr. Makhyoun for posting the case in the first place. We have all...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 23 hours ago

Agree with all of the above, but have 1 more point. Not only is it important to realize that myoglobin rather than CPK is the kidney toxin, they ha...

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RE: Friday : Unexplained metabolic acidosis 23 hours ago

The more you look, the more you find!! The serum bicarb was 20 with a gap of 20 on admission. The serum bicarb goes down to 3 mmole in 2 days (a dr...

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RE: white male with collapsing FSGS 1 day ago

Collapsing glomerulopathy has been associated with ischemia (as you noted) (TMA, atheroembolic disease, and severe arteriosclerosis) in older adult...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

Was D-Lactate levels measured in this patient with GI problems? ------------------------------ Manoocher Soleimani MD Professor University of New...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

I would invite more answers before I release what I think is the answer ... But 8 think the answer is well evident in the table presented . -----...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 1 day ago

I agree with Dr. Glassock. It is the myoglobin and not the released cellular enzymes from damaged muscle cell that produce renal damage. His Cr if ...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

The unfortunate patient was admitted with aspiration pneumonia . She was unable to consume calories and the family had a DNR in place , which inclu...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

@Manoocher Soleimani In the setting of significant ketonuria (a non-reabsorbable anion) shouldn't we expect to see some degree of hypokalemia. Wh...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

The rising chloride, along with the persistent low HCO3-, may be due to a change from high-anion-gap to non-gap acidosis precipitated by a large vo...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

Starvation ketosis most likely, give some d5w and thiamine and I bet it goes away fairly rapidly . Ketones+++ is that blood or urine? Doubt it matt...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

I noticed that the serum lactate is normal, which is probably against a pyruvate dehydrogenase deficiency alone. In that case, an starvation ketosi...

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RE: Friday : Unexplained metabolic acidosis 1 day ago

Excellent and fascinating case. This is a case of severe metabolic acidosis as a primary disorder, since no respiratory alkalosis can lower the ser...

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Friday : Unexplained metabolic acidosis 1 day ago

Question : We were asked to investigate cause of unexplained low Bicarbonate in this patient . The questions were what was the cause of the me...

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RE: Duration of IV Fluid Therapy in Severe Rhabdomyolysis–Associated AKI 1 day ago

With heme negative urine and a declining Scr I see no reason to continue a forced saline diuresis. Just an opinion. ----------------------------...

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RE: MPGN Input Appereciated 1 day ago

Further evaluation of the paraffin blocks might reveal a likely diagnosis. . I fully agree that IgAN is most likely, especially if the serum IgA/C3...

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