RE: Renal transplant with pan resistant Kelbsiella colonization 35 minutes ago

Glad to have a card-carrying Urologist reply. I agree with your comments. ------------------------------ Anatole Besarab MD ABesarab Consulting ...

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RE: Anuric ATN Without Any Obvious Cause 47 minutes ago

Thanks Dr Glasock Free light chains were not done CK was not checked Up to 47 glomeruli are available one is iobsolescent. The glomeruli appear...

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RE: Anuric ATN Without Any Obvious Cause 1 hour ago

How many glomeruli in the Kidney Biopsy? Any casts in tubules.? This is a lot of proteinuria for ATN, but UPCR can be very unreliable in AKI.b any ...

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RE: Renal transplant with pan resistant Kelbsiella colonization 2 hours ago

In my opinion, in a situation like this, an evaluation of the lower urinary tract is required, if it hasn't already been done. This would, at minim...

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Anuric ATN Without Any Obvious Cause 3 hours ago

74 year-old gentleman no smoking very little alcohol history of CAD seven stents in 2020 exercise induced asthma hypertension history of kidney st...

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RE: Renal transplant with pan resistant Kelbsiella colonization 3 hours ago

Sure, there is no telling. However, absent urine and urea following bilateral nephrectomy and anuria, it will reduce the ability of klebsiella to c...

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RE: Renal transplant with pan resistant Kelbsiella colonization 3 hours ago

I agree with the decision for nephrectomy of the remaining kidney along with transplant. We face a lot of issues with carbapenamase producing Enter...

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RE: Renal transplant with pan resistant Kelbsiella colonization 4 hours ago

You state it so much concisely than I. I am worried about a TX unless rgw source of the bacteriuria is eliminated. ------------------------------...

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RE: Renal transplant with pan resistant Kelbsiella colonization 4 hours ago

Transplant center where transplant is scheduled should make decisions related to risks with ID consultation. IMO placing new kidney with stent in a...

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RE: Renal transplant with pan resistant Kelbsiella colonization 5 hours ago

Agree But it would be of interest whether the kidney is the source for the low level bacteriuria. What if the site is colonization of the bladde...

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RE: Rituximab for Minimal Change GN - For how long ? 5 hours ago

Thank you Dr. Mellas. I agree with your assessment. We have traditionally stated that 60-65 Percent of the filtered load is reabsorbed by the PT...

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RE: Renal transplant with pan resistant Kelbsiella colonization 5 hours ago

Thanks for the valuable feedback. Concur with Dr Venkat about pre-transplant nephrectomy of the remaining polycystic kidney. Thanks again.

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RE: Rituximab for Minimal Change GN - For how long ? 6 hours ago

From the article provided by Dr Besarab; "Two-thirds of the filtered sodium is absorbed in the proximal tubule, primarily through the action of N...

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RE: Renal transplant with pan resistant Kelbsiella colonization 8 hours ago

Original post mentions "recurrent" positive urine cultures. Although the colony count is low, this cannot be ignored because he is going to be immu...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

Please see attachment Important to know the Hx surrounding the R nephrectomy. Do the low CC of 10 X 3 represent a balance between the or...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

Please see the attachment ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 -------------------...

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RE: Is this Immune complex GN or something else? 1 day ago

Yes Dr. Besarab. He is currently just on Prednisone 60 mg daily which was started 3 weeks ago pending results of the biopsy. I will be seeing him i...

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RE: Is this Immune complex GN or something else? 1 day ago

Thank you very much Dr. Zuckerman for your detailed review and expert assessment. As suggested before by Dr. Rodby as well, I have requested for th...

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RE: Is this Immune complex GN or something else? 1 day ago

Thanks Dr. Zuckerman for your very detailed interpretation, based on the written report only ( without a direct review of the slides and photos) I ...

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RE: Is this Immune complex GN or something else? 1 day ago

Images would be helpful. From reading the biopsy description above, a few observations accepting the descriptive text as is: As Dr. Glassock note...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

What about tigecycline and colistin? With so few organisms, I wonder if therapy is indicated at all. What do ID consultants opine? -------------...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

Like Dr Venkat I assume that bilateral Nephrectomy was done presumably for infection within a Cyst(s) and the risk from that . Any data on that? ...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

It seems only right nephrectomy was performed. The source could be bladder or possibly left kidney. Patient is in New Delhi so Bacteriophage is li...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

I assume "nephrectomy" refers bilateral native nephrectomy. This suggests bladder colonization. May discuss with urology with any antibiotic/chemic...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

What about sensitivity to Colistin and Fosfomycin? Any experience from the community about bacteriophages in this situation? --------------------...

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RE: Rituximab for Minimal Change GN - For how long ? 1 day ago

Concur that Genetic testing will not impact therapeutic decisions. Dr Buhary is in KSa where to my understanding some patients will have Genetic te...

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RE: Renal transplant with pan resistant Kelbsiella colonization 1 day ago

What is the source of the specimen showing such colonization? Has the test been repeated at least once? ------------------------------ Richard Gl...

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Renal transplant with pan resistant Kelbsiella colonization 1 day ago

This is about an ESKD sec to PKD. He underwent nephrectomy a few months ago and has recurrent growth of Pan resistant (even Carbopenam) Klebsiella ...

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RE: Rituximab for Minimal Change GN - For how long ? 2 days ago

What genetic association have been shown in MCD? . Several candidate circulating factors and their effects on podocytes have been proposed but are ...

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RE: Rituximab for Minimal Change GN - For how long ? 2 days ago

Dr Buhary have you considered doing Genetic testing. ------------------------------ Awais Nauman HMC Doha ------------------------------

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RE: Is this Immune complex GN or something else? 2 days ago

So you favor 2 diseases rather than one. Per Dr Glasscock's interpretation previously, :"Dr, Hickam would be very pleased but Reverend Occam would ...

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RE: Is this Immune complex GN or something else? 2 days ago

"IgAN nephropathy (atypical) may present with MCD like picture and it's responded to steroids." MCD and IgAN may be two independent disorders wit...

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RE: Is this Immune complex GN or something else? 2 days ago

I see your poiint. Well taken. Theses studies have one potential drawback. Pronase digestion and paraffin IF were not performed So the possibility ...

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RE: Is this Immune complex GN or something else? 2 days ago

My reading of the study is that IgA dominant IRGN and IgA dominant MPGN were classified separately in the cited study. --------------------------...

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RE: IgA nephropathy 2 days ago

I do not understand the origin of your statement " that those (patients with IgaN) with clones in the intestines may be better served (with Tarpeyo...

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RE: IgA nephropathy 2 days ago

Looking from different angle: What the ethnicity of this patient, her birth weight, was she premature at birth, any maternal exposure (tobacco and ...

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RE: Immunotactoid GN treatment 3 days ago

Dr. Glassock thanks for your question. I am not aware of any trial of use of combination of RTX (or Obinutuzumab) plus Daratumumab for ITG. My advi...

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RE: Is this Immune complex GN or something else? 3 days ago

Agree that NSAIDs-induced MCD doesn’t occur after their discontinuation and the remission of MCD occurs after treatment discontinuation. IgAN neph...

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RE: Is this Immune complex GN or something else? 3 days ago

Although the localisation of immune deposits is quite odd.. I agree with the experts here that the picture fits the most with IgAN or IgAVN. Does h...

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RE: Immunotactoid GN treatment 3 days ago

Thanks to everyone who responded Regarding the chronic urticaria - she has it for almost 10 years now. But the idea of a possible CLL tying every...

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RE: Is this Immune complex GN or something else? 3 days ago

Where is the infection provoking a proposed IgA dominant IRGN? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388...

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RE: Is this Immune complex GN or something else? 3 days ago

KM55 staining might help in teasing out IgA vs IgA dominant MPGN KM55 staining in evaluation of IgA ------------------------------ Awais Nauman...

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RE: Is this Immune complex GN or something else? 3 days ago

I agree with your explanations. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------------...

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RE: Is this Immune complex GN or something else? 3 days ago

This was one of my initial thoughts for this case. What doesn't fit is that he used NSAIDS 4 months ago for about a month and then stopped. NO NSAI...

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RE: Is this Immune complex GN or something else? 3 days ago

Thanks for your input. Patient has no clinical features of scleroderma, no evidence of microangiopathic hemolytic anemia (MAHA) on his labs and ren...

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RE: Immunotactoid GN treatment 3 days ago

Dr Aleday "As Daratumumab act on CD38 positive plasma cells and B cells and not on CD19 and CD20 memory B cells" doesnt this figure imply other...

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RE: Immunotactoid GN treatment 3 days ago

Interesting idea Dr. Aledan. Thanks . Do you know of any actual trial data describing the effects of combination of RTX + Daratumumab or Obinutuzum...

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RE: Is this Immune complex GN or something else? 3 days ago

Interesting suggestion Dr. Aledan. Two diseases rather than one. Dr, Hickam would be very pleased but Reverend Occam would not. How would you treat...

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RE: Is this Immune complex GN or something else? 3 days ago

I assume you rule out scleroderma renal crisis. NSAIDs may explain severe nephrotic syndrome and possible AIN (some intestinal inflammatory cells)...

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RE: Immunotactoid GN treatment 3 days ago

Or combination of Daratumumab and RTX or preferable off-label use of Obinutuzumab to target both hidden B and plasma cell clones. As Daratumumab ac...

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