RE: Recurrent ascites in ESRD pt 19 minutes ago

I always try to determine the cause of ascites in these patients. With a SAAG of 1.1 the fluid is likely accumulating from the liver, but why? My...

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RE: Recurrent ascites in ESRD pt 4 hours ago

That's a great suggestion. She was resistant to the idea of going back to PD to help manage the ascites but a weekly drain in HD unit seems like a ...

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RE: Recurrent ascites in ESRD pt 5 hours ago

Dr. Rodby- Somehow, I was under the impression that "dialysis associated (Nephrogenic) ascites" was becoming much less common (for reasons that I d...

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RE: Recurrent ascites in ESRD pt 8 hours ago

I see nephrogenic ascites (I prefer the term dialysis associated ascites) in the hospital every month, lots of it out there, while a diagnosis of e...

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RE: Recurrent ascites in ESRD pt 9 hours ago

Dr. Glassock, she has had right upper quadrant ultrasounds which have consistently showed normal flow in portal vein, and spleen size is normal. ...

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RE: Recurrent ascites in ESRD pt 10 hours ago

Abdominal pain is uncommon in Nephrogenic (Dialysis associated ) Refractory ascites . Has the imaging satisfactorily excluded Portal Vein thrombosi...

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RE: primary membranous nephropathy 10 hours ago

An IFA anti-PLA2R antibody test is available in many commercial laboratories. The IFA is very useful in detecting false positive ELISA for anti-PLA...

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RE: Recurrent ascites in ESRD pt 11 hours ago

If the common causes of ascites are excluded, given the imaging findings this could be a very rare case of Meigs or pseudo Meigs syndrome. -----...

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RE: Recurrent ascites in ESRD pt 12 hours ago

Yes, to be complete I would suggest a RHC and hepatic vein wedge pressure measurement. ------------------------------ John Mellas MD Nephrology a...

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RE: primary membranous nephropathy 12 hours ago

Thanks for great case 1/Is ifa more sensitive /specific that elisa ? And why so? Is it done in most labs ? 2 why do we think the ELISA is false...

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RE: Recurrent ascites in ESRD pt 13 hours ago

Thank you all for your replies. She has no evidence of cirrhosis on CT or ultrasound of the abdomen, and the flow in portal vein was normal. She al...

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RE: Recurrent ascites in ESRD pt 13 hours ago

Dr, Mellas: how would you go about "ruling out " portal hypertension in a case like this? Would a hepatic vein wedge pressure be of value? Just cur...

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RE: Recurrent ascites in ESRD pt 13 hours ago

Encapsulating peritoneal sclerosis would be rare (still possible, but rare) in a patient who was on PD for just 1 year. https://journals.sagepub....

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RE: Recurrent ascites in ESRD pt 15 hours ago

Would make sure there is no evidence of right heart failure with pulmonary hypertension by ECHO, possible RHC. Also need to R/O cirrhosis with po...

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RE: primary membranous nephropathy 16 hours ago

I am not convinced that the level of anti-PLA2R antibody detected by ELISA in a diabetic patient can be used to separate a true from a false positi...

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RE: primary membranous nephropathy 17 hours ago

IMO, since Rituxan was initiated, wait 3-4 month for serologic and clinical response and if not satisfactory, I would biopsy to evaluate if there a...

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RE: Recurrent ascites in ESRD pt 17 hours ago

Hi there. Does this patient have a fistula or a graft. If so, are there flow volume measurements. High flow accesses can cause right heart strain. ...

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RE: primary membranous nephropathy 17 hours ago

My understanding is that if diabetes is present and biopsy is feasible, it should be undertaken. It 's rare but there are report of patient with no...

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RE: primary membranous nephropathy 19 hours ago

Thanks all for your insightful comments. In fact, this patient was consulted our center and all workup was done outside out country and I asked Dr...

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RE: Case Of Progressive ckd / HTN 1 day ago

I took the height in cm rgat you sent, divided that by 2,54 cm per inch, to het the total height in inches. The I took the total height in inches a...

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RE: Recurrent ascites in ESRD pt 1 day ago

This sounds like Nephrogenic refractory Ascites. The only successful therapy for this condition is kidney transplantation. Other opinions very welc...

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RE: Tocilizumab in renal AA amyloidosis 1 day ago

Are the infections completely under control? Both IL-1 and IL-6 blockade should only be used when there is no infection. In fact, I instruct all of...

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Recurrent ascites in ESRD pt 1 day ago

Hello everyone, I have a 58 y/o F pt with ESRD on HD, with recurrent ascites for the past 6 months that requires paracentesis every 10 days. The...

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RE: to pulse or not to pulse?? 1 day ago

Thanks dr emilio. I agree about dah and plasma exchange The question that pexivas does not Addresss in multisystem vasculitis and with cardiac i...

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RE: Case Of Progressive ckd / HTN 1 day ago

How do you calculate this ? Prof bersarab? --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Atrasentan experience and first thoughts 1 day ago

I do not share the enthusiasm for drugs approved "quickly" by the FDA because of decrease in proteinuria. We have gone from considering IgA Nephroa...

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Nephrology Quiz and Questionnaire 1 day ago

Calling all nephrology fellows and program directors—we need your help with the Nephrology Quiz and Questionnaire. Take the quiz today! Each year...

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Nephrology Quiz and Questionnaire 1 day ago

Calling all nephrology fellows and program directors—we need your help with the Nephrology Quiz and Questionnaire. Fellows, try to outsmart the Nep...

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RE: Atrasentan experience and first thoughts 1 day ago

The main problem with the ALIGN presentation at ERA, 2025 is that it did not include eGFR. It is entirely post hoc and based in magnitude of declin...

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RE: Atrasentan experience and first thoughts 1 day ago

Dr. Dastor, this year at the ERA-EDTA congress, the ALIGN investigators presented a post - hoc analysis (in the poster session) entitled "ALIGN ...

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RE: Atrasentan experience and first thoughts 1 day ago

Your comments are the absolute truth! Is there anything we physicians can do about it. In the area of genetic disorders, gnomics can idntify thepat...

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RE: The patient who keeps on giving 1 day ago

Any chance the second biopsy was milabeled as to patient? Nothing makes sense. ------------------------------ Anatole Besarab MD ABesarab Consult...

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RE: Atrasentan experience and first thoughts 2 days ago

Dr. Dastoor- thank you for posting these two cases. While this experience may or may not be generalizable , it does point towards a possible non-st...

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RE: Atrasentan experience and first thoughts 2 days ago

The "cost" of these medications is a real issue. Not so much as actual "out of pocket " costs to the patients with commercial insurance , as most P...

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RE: primary membranous nephropathy 2 days ago

I like to know what works and what does not. Using Rituxan and CYC will confound the picture. Rituxan will be a good start and follow serology. Mig...

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RE: The patient who keeps on giving 2 days ago

The presence of organized deposits in the first kidney biopsy makes an infectious cause (other than Chronic HCV infection) unlikely, in my opinion....

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FREE HOME DIALYSIS WEBINARS ANNUAL DIALYSIS CONFERENCE 2 days ago

Dear fellows, The Annual Dialysis Conference is offering FREE webinars focusing on critical home dialysis topics. These webinars will provide val...

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FREE HOME DIALYSIS WEBINARS ANNUAL DIALYSIS CONFERENCE 2 days ago

Dear fellow educators, The Annual Dialysis Conference is offering FREE webinars focusing on critical home dialysis topics. These webinars will pr...

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RE: Tocilizumab in renal AA amyloidosis 2 days ago

The literature supporting use of Tocilizumab or Anakinra for renal AA Amyloidosis is mainly case reports and small observational studies This le...

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RE: The patient who keeps on giving 2 days ago

What was the IF finding in the second biopsy? Seems an incredible turnaround in the renal biopsy findings. In view of the varied findings do we nee...

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RE: Atrasentan experience and first thoughts 2 days ago

I am glad that you bring up the issue of cost of when taking care of such patients. Maybe that is why "Insurance" turn down treatment. Agree why we...

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Tocilizumab in renal AA amyloidosis 2 days ago

This is a 83 year old woman w/ clinical records of bronchiectasis and respiratory superinfections. She presented progressive proteinuria in 6 month...

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RE: Atrasentan experience and first thoughts 3 days ago

Sorry in my initial description I meant both high risk patients were approved for IPTACOPAN, not AVACOPAN. As their insurance refused to pay $450,0...

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RE: The patient who keeps on giving 3 days ago

Very interesting . Biopsy #1 showed unequivocal Fibrillary deposits by EM. No Pronase digestion or paraffin IF was done. What was the EM magnificat...

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RE: The patient who keeps on giving 3 days ago

His repeat biopsy was negative for any fibril deposition on EM. SPEP , UPEP, IFE did not detect a monoclonal spikes -----------------------------...

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RE: Rituximab Contraindicated in ILD?? 3 days ago

On initial presentation with AKI, he had dyspnea . CXR and CT of the lungs showed ILD and COPD . The findings were similar to his previous CXR done...

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RE: Atrasentan experience and first thoughts 3 days ago

Dr. Rodby's response is both highly reasonable and pragmatic. It is going to take a long time to acquire the data he appropriately requests. Post H...

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RE: Atrasentan experience and first thoughts 3 days ago

Both patients had previously received oral steroids and MMF for 6 and 12 months respectively . Nefecon is still unavailable in our area. Our PTC in...

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RE: primary membranous nephropathy 3 days ago

Just a little over 50 years ago , Donadio J , et al (Kidney Int 1974; 6:431-439) from the Mayo Clinic reported a small (and likely underpowered) pr...

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RE: primary membranous nephropathy 3 days ago

My CNI suggestion is only a antiproteinuric bridge. In PLA2R+ MGN you are treating the PLA2R ab so yes if after 3 (maybe 4) months of CYC the PLA...

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