RE: Post infectious MPGN 31 minutes ago

Patient noticed swelling about 2 months ago, the process started before that. He's certainly nephrotic. 24 hours urine protein? If serum creatine ...

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RE: to pulse or not to pulse?? 6 hours ago

I'd like to take the chance to ask the community the following question: How often, in this type of patients, do you start induction therapy wit...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 11 hours ago

@Cristian Pedreros ------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: Post infectious MPGN 16 hours ago

I think you need to dig more searching for occult infections such as WBC scan as bone, joint and spine infection can be missed. What are the levels...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 19 hours ago

isn't the answer simpler than all that? you have a dialysis bath that is lower in HCo3 to account for the citrate becoming HCO3 and thus you dial...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 20 hours ago

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 21 hours ago

Hi everyone: There are two ways to explain the acidosis in citrate accumulation: Explanation according to Stewart's physicochemical model In Stew...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 21 hours ago

Excellent discussions. Question to Dr Goldfarb in regard to lactic alkalosis, the elevated AG and no metabolic acidosis. If one infuses HCO3 the ...

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RE: Post infectious MPGN 21 hours ago

I agree with Dr. Zuckermans well considered interpretation. There is no MPGN pattern of injury. There is no need to consider a "superimposed " MCD....

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RE: to pulse or not to pulse?? 22 hours ago

Given the clinical circumstances in this case, I doubt that PLEX is needed for therapy. ------------------------------ Richard Glassock MD, FASN ...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 22 hours ago

Pedro, very much appreciate you citing and attaching our article about citrate. ACD, or acid citrate dextrose, used to anticoagulate RBCs, includes...

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RE: Post infectious MPGN 22 hours ago

Thank you for the input. To clarify, the patient has not had previous urine/renal studies because he has been "healthy". In hindsight he believes t...

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RE: to pulse or not to pulse?? 23 hours ago

Dr. Soobadar the colleagues' recommendation against PLEX is based on the fact that there are no data from large randomized study (PEXIVAS) that dem...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I agree this is confusing. My thoughts are that if you have an anion gap, you by definition have an acidosis (HAGMA). However, I agree that it...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I think this one is due to correlation between a common clinical outcome (patient with liver disease and AKI or ESKD put on CRRT with citrate antic...

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RE: Post infectious MPGN 1 day ago

Based on the provided path report this is not MPGN pattern injury (unless I am mis-reading something). This is a diffuse exudative GN (prominent ne...

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RE: how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

That is an interesting question. If citrate, as HCO3 equivalent, is not metabolized and accumulates, then the anion gap will rise. If the [Na] rema...

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RE: Post infectious MPGN 1 day ago

Dr. Gunnell that doesn't seem to me a clear MPGN rather a diffuse proliferative GN (C3 dominant type). If I'm not mistaken, pronase digestion, m...

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how citrate used in regional citrate anticoagulation in CRRT can cause metabolic acidosis if not metabolized 1 day ago

I prepare presentation about CRRT. while i read about regional citrate anticoagulation, i can not explain how the sodium citrate can cause metaboli...

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RE: Post infectious MPGN 1 day ago

Dr. Glassock: I suggested the possibility of a superimposed new podocytopathy on preexisting glomerulopathy for the following reasons: 1. Such seve...

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RE: Post infectious MPGN 1 day ago

Dr. Venkat - interesting suggestion, but I do not know how one can distinguish between a superimposed Primary diffuse Podocytopathy and a secondary...

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RE: Post infectious MPGN 1 day ago

With such massive proteinuria a diffuse effacement of the foot processes would be expected as a reaction to severe capillary wall injury in MPGN . ...

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RE: Post infectious MPGN 1 day ago

What was the baseline SCr before current SCr of 1.7 mg was documented? Do you have any past urine studies showing abnormalities? How much weight ha...

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RE: Post infectious MPGN 1 day ago

Does the LM show a clear MPGN pattern of injury (with double contour capillary walls)? ------------------------------ Richard Glassock MD, FASN L...

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RE: Post infectious MPGN 1 day ago

If the Pathologist will not do a Paraffin IF, at least have the biopsy studied for IgG subclass distribution. If the heavy chain is monoclonal this...

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RE: Post infectious MPGN 1 day ago

what are your thoughts on the 21gm of protein and diffuse foot process effacement? There is no evidence of infection. Pathology insists no value to...

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RE: Post infectious MPGN 1 day ago

I have not seen this much proteinuria with diffuse foot process effacement. with no evidence of infection is there any role for steroid. Pathology ...

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RE: Post infectious MPGN 1 day ago

Any time I am told of a PIGN, and especially if C3 is predominant, I consider C3 GN. This may have too much other Igs to consider C3GN , but I ALWA...

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RE: rituxan and Obinutuzumab 1 day ago

As proteinuria is a marker for poor cardiokidney outcome and tend to admit that those patients with nephrotic-range proteinuria without nephrotic s...

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RE: Post infectious MPGN 1 day ago

Occasionally the Frozen IF IgG can show weak but positive IgG deposition in patients with concealed PGMID. C3 deposition by frozen IF is typically ...

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RE: Blood flow to dialysate flow ratio for full saturation 1 day ago

Hey Dr. Omar and team -- I agree almost entirely with everything that is said. Like Dr. Rodby initially said, keeping blood flow at least...

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RE: Post infectious MPGN 1 day ago

I requested the pronase digestion but the pathologist told me they only do it when the staining is negative on IF and did not think it would be hel...

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RE: Post infectious MPGN 1 day ago

The SPEP, ANA and RF are normal. Blood and urine cultures are negative. No murmurs. --------------------------------- J Gunnell, MD Attending...

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RE: Post infectious MPGN 1 day ago

I think I would also ask the kidney pathologist to perform a Pronase digestion of a paraffin embedded specimen to test for concealed monoclonality ...

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RE: Post infectious MPGN 1 day ago

Can you post the de-identified kidney biopsy report. Did the serologic investigation include ANCA, Rheumatoid factor,, serum FLC and ANA? . Any new...

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

We are looking at Indian subcontinent population. Hopefully we will have data to share early next year --------------------------------- Bajinder...

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

Agrred - ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: IgA nephropathy with FSGS and significant IFTA 2 days ago

Valiga study also supports value of sub-classifying S lesions in IgA and there cohart was mostly European --------------------------------- Baji...

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Post infectious MPGN 2 days ago

I have a 76yo male patient with no other medical problems admitted with anasarca which started about 3 weeks prior. His serum Cr 1.7. There have be...

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RE: rituxan and Obinutuzumab 2 days ago

He had partial remission to 2 grams from 7. Renal function normal. Biopsy shows minimal sclerosis or fibrosis. Now up to 5.5 grams by ration and 7 ...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Sorry for delayNot will rule out infection, but it also tells me to treat this patient like vasculitis even if there is a dual pattern of injury on...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I think this us correct, but the likelihood of an infection cause of crescentic GN was already very low in this patient. Nevertheless, anti MPO sta...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I think the idea of the dr reen is that if ANCA is positive by immunohistochemistry, this rules out infection-related --------------------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Ok -thanks- I just do not understand how the results (MPO + or - ) will help management in this case- please clarify. Important issue! -------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Kidney biopsy does some deposits If immune staining is done in those deposits may help --------------------------------- Bajinder Reen MD Etobico...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Thanks Dr. Reen. Interesting paper. I just don't see how a study of MPO in the deposits in this case would help refine the diagnosis (and therapy )...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

I think arkana and Myo clinic do. If i remember this issue was brought up at last Rush rounds Sent from my iPhoneSpelling mistakes are regretted w...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

Dr. Reen. Interesting suggestion. How would one go about looking for ANCA by immunocytochemistry on a kidney biopsy?" ---------------------------...

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RE: ? overlapping MPO vasculitis + idiopathic MPGN 2 days ago

You could look for ANCa by immunohistochemistry on kidney biopsy if negative most likey infection If postive anca vasculitis or anca related to dru...

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RE: rituxan and Obinutuzumab 2 days ago

Treatment decisions can be very uncertain in thus patient (and others like this). The benefits if RTX or other AntiCD20 MoAB in the presence of "ne...

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