RE: Anti Gbm Case 54 minutes ago

Had a similar patient with 100% cellular crescents and 30 % IFTA . he had dual antibody positive , anti GBM and pANCA. Though he had biopsy proven...

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RE: simultaneous liver kidney transplant 8 hours ago

SCr of 2.1 mg most likely from incoomplete recovery of ATN. Need to exclude technical problems with Doppler ultrasound. Repeat serum oxalate level?...

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RE: Anti Gbm Case 8 hours ago

Cigarette smoker? Exposure to hydrocarbons? Prodromal respiratory infection symptoms? If these risk factors for pulmonary hemorrhage (PH) are absen...

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RE: lupus membranous nephropathy treatment 10 hours ago

i do not see any value in monitoring CD 19 levels with OBI if you plan to use a fixed dose ,fixed interval regimen. The onlyvbantigens in Class V L...

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RE: Anti Gbm Case 10 hours ago

Judgement call. Very low probability of recovery with therapy, , but not zero and still at risk for DAH. How much IFTA and fibrous crescents.? How ...

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RE: lupus membranous nephropathy treatment 11 hours ago

Cd19 --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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Anti Gbm Case 11 hours ago

20 year old anti gbm positive only . Creatinine 20 at presentation . Kidney biopsy linear ig g with 100 cellular crescent . Oligoanuria no pH Wou...

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RE: lupus membranous nephropathy treatment 11 hours ago

Prof glassock can we check c19 counts in this context and dose obi for 18 -24 month then watch with protieinuria/ albumin Is there any antigen th...

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RE: simultaneous liver kidney transplant 12 hours ago

Respected faculty further to our SLKT pt. POD 11- LFT. S creat stuck at 2.1 mg% UO about 2.5 lit daily graft biopsy- No evidence of rejection ,...

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RE: ocular disequilibrium syndrome in hemodialysis any clinical experience 13 hours ago

ocular dysequilibrium syndrome, sounds awful. I think I would try an amp of D50 right when the symptoms begin and see if this helps, It should be...

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RE: Proteinuric Patient With Normal Blood Pressure 13 hours ago

Thanks really helpful Kind regards prof rodby --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Proteinuric Patient With Normal Blood Pressure 13 hours ago

My experience is that if a patient has renal disease (even proteinuria alone) that their BP does not typically drop with RAASi used to lower protei...

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Proteinuric Patient With Normal Blood Pressure 14 hours ago

Would full dose of ACE and ARB cause low bp in young and middle aged patients ? What about elderly and frailer? Many thanks

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RE: anti gbm/mpo +ve in young female 14 hours ago

Thanks everyone . Really helpful @ prof rodby mcv 74(78-100) Cxr normal . Hb stable after blood transfusion . Would you do CT chest or CT TAP. Not...

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RE: ocular disequilibrium syndrome in hemodialysis any clinical experience 14 hours ago

If memory serves me well, Iremsmberca few patients who developed ocular pain and reduced vusion (ocular crusis) during standard hemodialysis. All o...

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RE: Radiation therapy - peritoneal dialysis membrane 16 hours ago

I agree with Prem Chandran. The "radiation fibrosis" is a long-term effect and probably not important here. It would be a big deal to change her to...

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ocular disequilibrium syndrome in hemodialysis any clinical experience 16 hours ago

I have a patient with recent glaucoma surgery ( ? if was even effective) who has severe ocular pain at hemodialysis up to a point hat she does not ...

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RE: Radiation therapy - peritoneal dialysis membrane 17 hours ago

It depends where the metastases or located, lymph nodes or bone (or both) . Muscle invasive bladder cancer is treated with chemotherapy or by check...

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RE: renal limited microangiopathy 18 hours ago

Just to clarify. I did not state that there is a lack of correlation between serological markers and histological markers in renal limited TMA. I j...

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RE: renal limited microangiopathy 18 hours ago

Hello Dr Rubin Completely agree with you about lack of correlation between histologic markers and serologic markets However I do not think that wor...

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RE: renal limited microangiopathy 19 hours ago

Thank you Dr. Guevara-Pineda for the reference (which I had seen in the recent past), which is thought provoking. Regretfully, it does not fully an...

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RE: Radiation therapy - peritoneal dialysis membrane 19 hours ago

I think this is local radiation therapy (?) not systemic radioactive agents as given for thyroid cancer. If that is the case there should be no con...

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RE: renal limited microangiopathy 19 hours ago

Dr Rubin there is an interesting paper about your question. The authors stained biosy samples with C4d and C5b-9 the conclusion was C4d is a common...

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RE: renal limited microangiopathy 20 hours ago

I had a heck of a time downloading the article so in case others did I attach it here ------------------------------ Roger Rodby MD, FASN Prof...

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RE: renal limited microangiopathy 20 hours ago

I found this paper quite revealing in terms of the relatively high incidence of Renal limited-TMA. This finding underscores the need for a biopsy t...

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RE: Radiation therapy - peritoneal dialysis membrane 21 hours ago

Changing her to HD will be problematic in terms of residual radiation in the open HD unit & disposal of potentially radio-active spent dialysate wa...

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RE: AI Is Refilling Prescriptions Without Real-Time Clinician Sign-Off: Why Nephrologists Should Pay Attention 1 day ago

When a physician writes a Prescription limited to no refills without a physicians authorization this limitation should be honored despite advice fr...

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RE: Radiation therapy - peritoneal dialysis membrane 1 day ago

I have no personal experience , but anecdotes have been reported describing peritoneal membrane failure after extensive abdominal radiation. Whethe...

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RE: AI Is Refilling Prescriptions Without Real-Time Clinician Sign-Off: Why Nephrologists Should Pay Attention 1 day ago

I agree some of the meds need more careful oversight and scrutiny when refilled, on the other hand I think there is little risk associated with ref...

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RE: renal limited microangiopathy 1 day ago

Dear Dr Glassock to my knowledge there is no RCT that evaluates Eculizimab for renal limited TMa . Based on small cohorts studies the response for ...

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RE: renal limited microangiopathy 1 day ago

Due to cost issues , we usually give 1 dose of Eculizimab in the hospital . Then we await Complement studies , which if they confirm aHUS , we proc...

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RE: renal limited microangiopathy 1 day ago

Dr. Guevara-Pineda- i do not know how to interpret this paper in terms of efficacy of Eculizumab or Ravulizumab for renal limited TMA. How wel...

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Radiation therapy - peritoneal dialysis membrane 1 day ago

Hi, Any previous experience with continuing peritoneal dialysis whilst undergoing abdominal radiation therapy? A patient in her 70s has just be...

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RE: renal limited microangiopathy 1 day ago

Patient did not have diarrhea. I have ordered stool studies but were not done. I will update on insurance coverage and treatment outcomes -------...

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RE: renal limited microangiopathy 1 day ago

thank you for your input. will update after treatment. Patient was previously on ADALIMUMUB with last dose more than 1 year ago. He has been on ...

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RE: renal limited microangiopathy 1 day ago

Absolutely: https://www.kidney-international.org/action/showPdf?pii=S0085-2538%2824%2900170-4 ------------------------------ Daniel Guevara-Pined...

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RE: renal limited microangiopathy 1 day ago

Could you give us the reference on that review? This is useful information. ------------------------------ Roger Rodby MD, FASN Professor of Med...

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RE: renal limited microangiopathy 1 day ago

Based on a recent French review 60% of renal likited TMA are associated to complement . in this particular case you need to review medications , h...

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RE: renal limited microangiopathy 1 day ago

It is fda approved for aHUS, even renal limited. Truly, it's harder to get eculizumab approved if a patient is not pregnant or failed outpatient ra...

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RE: renal limited microangiopathy 1 day ago

It is not clear to me that thve FDA approved label for Ravulizumab woul embrace this patient with "renal limited" TMA in the absence of any hemolys...

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RE: renal limited microangiopathy 1 day ago

Thank you Dr. Blonsky for the valuable information. I have started the prior auth for ravulizumab as you suggested. ----------------------------...

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RE: simultaneous liver kidney transplant 1 day ago

@Satish Balan Thank you for your concise clarification and the reference you provided which I will agree is more conjectural than proof of pri...

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RE: simultaneous liver kidney transplant 1 day ago

@Mario Rubin The effect of the transplanted liver in preventing renal rejection in SLKT is primarily believed to be due to the effect of HLA Clas...

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RE: simultaneous liver kidney transplant 1 day ago

Good idea but the issue is not that simple. This patient had a negative flow cytometry and CDC crossmatch which argues against the presence of Abs....

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RE: simultaneous liver kidney transplant 1 day ago

If we have pre-transplant Anti Donor antibodies intensity scored by MFI , then it may be repeated post transplant to explore the effectiveness of s...

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RE: renal limited microangiopathy 1 day ago

I agree with starting eculizumab. You will have better luck with starting ravulizumab outpatient as it is less expensive overall. It is q8 weeks ...

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RE: simultaneous liver kidney transplant 2 days ago

Sir both the donors were negative for PH1 ------------------------------ Sunil Prakash Vice Chairman and Head, Dept of Nephrology and Renal trans...

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RE: simultaneous liver kidney transplant 2 days ago

Respected Sir we could not repeat S ox. as it expensive and turn around time is about a week. So we blindly kept post SLKT HDF without fluid remo...

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RE: simultaneous liver kidney transplant 2 days ago

Sir The patient was not on lumisarin. It's not freely available. In fact, getting plasma oxalate is also expensive and time consuming here. In...

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RE: simultaneous liver kidney transplant 2 days ago

TAC LEVELS vacillated between 4.0 3.5 to ng/ml by CLIA method ------------------------------ Sunil Prakash Vice Chairman and Head, Dept of Nephro...

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