RE: hemodialysis 4 hours ago

@ prof rodby cool stuff. Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Biopsy dilemma in setting of severe refractory ITP 6 hours ago

If serology is negative and biopsy would potentially change management any thought about transjugular kidney biopsy ? ---------------------------...

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RE: hemodialysis 6 hours ago

Thanks for update What is mannitol prime? Can you explain this regime to me? Kind regards --------------------------------- Muhammad Soobadar M...

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RE: hemodialysis 6 hours ago

Hi, we had palliative->wants to continue. To be honest I find this academically stimulating. I am hoping we can find a happy dialysis regimen for...

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RE: hemodialysis 8 hours ago

Dr Junejo Is your Pt able to consent? Does he/she really want dialysis support? Given overall pathology supportive care may be a good choice. If I ...

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RE: hemodialysis 8 hours ago

could also look for carotid disease. while not exactly the same symptoms, https://pmc.ncbi.nlm.nih.gov/articles/PMC12103909/#:~:text=This%20w...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 8 hours ago

I'm sorry to hear about this case from Transplant perspective. We have seen an increase number of invasive fungal infections and PJP in patients on...

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RE: hemodialysis 8 hours ago

Update: mannitol prime 12.5 g,BFR 200->250.No UF, Na145->140 no heparin.EEG and tele ongoing. Running smoothly so far. -----------------------...

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RE: Lupus Nephritis 8 hours ago

From Dr Glassock: "See this "Position Paper" by De Vriese, Fervenza and Sethi (KI 2025;107:198-211. ) It is very convincing, to me at least, t...

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RE: Biopsy dilemma in setting of severe refractory ITP 9 hours ago

I had to leave for an emergency in Dialysis so not with her chart now. I'm in the habit doing both ACR and UPCR to determine whether MGUS/ myeloma ...

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RE: Biopsy dilemma in setting of severe refractory ITP 10 hours ago

What a treatment nightmare for this patient. I have this pet peeve of mine, calling something ITP in the setting of other autoimmune disease (I s...

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RE: Another lithium patient 10 hours ago

Lithium is listed in the literature as a cause of MCG and FSGS (see the references listed below from UpToDate). So that is why the ratio of ACR/PCR...

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RE: Another lithium patient 10 hours ago

valsartan and Empa always a good idea. ACR 1.4 with PCR 2.0 is 70% albuminuria so this seems more like glomerular proteinuria (Li should be 20-3...

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RE: Another lithium patient 10 hours ago

Only reason I raise IGAN as far less likely is that anyone with proteinuria could have and not there are so many treatment options if found. So he ...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 10 hours ago

As per Professor Glassock, Cinacalcet should not be used to lower PTH when using Denosumab. Denosumab MOA lowers calcium by decreasing bone resorpt...

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Biopsy dilemma in setting of severe refractory ITP 10 hours ago

A 73 yo female with remote breast CA, RA, Sjogrens, MGUS (BMB several years ago), MDS and very severe refractory ITP. Splenectomy at Memorial many ...

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RE: Another lithium patient 10 hours ago

Not sure why IgAN comes up but Diabetic nephropathy is certainly more common than Li nephropathy, Still this patient DID have a long history of Li ...

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Another lithium patient 11 hours ago

I have a 70 yo male with poorly controlled DM, on lithium for >20 years. In the past he has reports been institutionalized and "falling apart' when...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 11 hours ago

Dear Dr. Glassock and Dr. Ud Din, Thank you again for your insightful suggestions. Hemoglobin electrophoresis was not repeated during the current...

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RE: hemodialysis 12 hours ago

You are right,I will try it today.Also planning for mannitol prime.Still has U.O ar 400ml/d with lasix. ------------------------------ Nazia June...

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RE: hemodialysis 12 hours ago

Thanks.Neuro do not think its TIA or seizure.Tele unchanged ------------------------------ Nazia Junejo MD Las Vegas NV (801) 542-7115 ----------...

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RE: hemodialysis 12 hours ago

Clearly a tough situation. I would try a 250 to 500 ml bolus at the start of dialysis at a low blood flow. This is without details of cardiac reser...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 13 hours ago

There are anecdotal reports of efficacy and safety of tociluzumab in kidney transplant recipients with COVID-19 infection: https://www.cureus.com...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 14 hours ago

My understanding is that Fungitel also is helpful for the detection of fungal ailments (candida, aspergillus, etc.). Was a bronchoscopy with BAL do...

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RE: Lupus Nephritis 14 hours ago

Thank you Dr. Glassock for sharing this outstanding "proposal". Much like the published editorial by Dr. Jayne which I posted yesterday, which unde...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 14 hours ago

Thank you for your inputs. We are considering transferring him to a center that has ECMO. In the meantime, his Fungitell test came back strongly po...

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RE: ANCA vasculitis with AIN 14 hours ago

Plateauing of SCr for a few days usually precedes kidney function recovery in AKI. Is daily urine output progressively increasing? --------------...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 15 hours ago

What is CRP, LDH, ferritin and IL-6 levels ? Was your patient vaccinated if so when and which anti COVID vaccine ? Given advanced baseline CKD WOUL...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 20 hours ago

The combination of Denosumab and Cinacalcet for therapy of osteoporosis in CKD is not advised as serious hypocalcemia can be the result. Vitamin D ...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 20 hours ago

Thanks everyone for input. @ prof sprague denusomab increasing pth is that clinically significant ? And is it because anti resorptive agent cause ...

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RE: Lupus Nephritis 21 hours ago

Thanks for great case. Also worth pointing out lupus is often associated with joint symptoms , rash and other non Kidney organ involvement . So d...

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RE: hemodialysis 21 hours ago

Thanks . What about Continuous replacement therapy in ITU? And also Troponin ,ECG? Maybe think of neurolgy input too for consideration of pseudo se...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago

With DNAJBN Congo Red organized monoclonal deposits this is Immunotactoid GN (MGRS) and therapy with Daratumumab or CART-T Cells may be indicated. ...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Interesting Idea. A diagnosis of PNH can be easily confirmed by high sensitive flow cytometry for absence of CD55 and CD59 on red cells. Therapy wi...

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RE: IgG kappa MGRS x3: recrudescence and worse response to cybord- time for rebiopsy? 1 day ago

I wanted to give an update to this case. Hematology had held off on a BM bx though have been considering it. Over the last year there has been no c...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

This all may be explained by one diseas process i.e Paroxysmal nocturnal hamoglobinuria ,it has association with ig A nephropathy , H/o early mor...

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RE: hemodialysis 1 day ago

Peritoneal dialysis, despite blindness, would be preferable to intermittent HD in a patient like this. Just an opinion. -------------------------...

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RE: Lupus Nephritis 1 day ago

Azathioprine is a concern about malignancy as it is chemical that is integrated into the DNA genome, MMF does not have the same risk as it is not i...

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RE: Lupus Nephritis 1 day ago

Thank you to all who have responded and all the articles attached. From the patient’s perspective, she has done very well for over 5 years and gon...

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hemodialysis 1 day ago

61 y/o DM,HTN,ESKD,AMI 2 weeks ago LVEF 22%.Any time put on dialysis becomes unresponsive, hemodynamically stable but rolls over eyes and passes ou...

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RE: Lupus Nephritis 1 day ago

See this "Position Paper" by De Vriese, Fervenza and Sethi (KI 2025;107:198-211. ) It is very convincing, to me at least, that serological, not his...

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RE: Lupus Nephritis 1 day ago

The hybrid report (Buenos Aires-Ohio) is thought provoking and may well become the way to go but it requires validation (see attached editorial by ...

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RE: Lupus Nephritis 1 day ago

That is a reasonable "camp", and a logical conclusion, I just know if there data is there that improving serologic activity in a patient without pr...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Has the patient been transfused with normal RBC? this might obscure the meaning of a normal MCV. What does the peripheral smear show? What is the L...

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RE: Lupus Nephritis 1 day ago

I am in the Mayo Clinic camp in this debate. So long as immunological activity is present (increased levels of anti-DNA antibody, low C3/C4 levels ...

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RE: Lupus Nephritis 1 day ago

this is an excellent point, that when patietns thought to be in remission are biopsied (lupus protocol biopsies) there is often histologic activity...

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RE: Lupus Nephritis 1 day ago

Assessing actvity on a repeat biopsy might be helpful. In a study in 2022, 21 percent patients had activity index more than 2 even with clinical re...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Dear Dr. Garrick, Dr. Thomas, and Dr. Guevara-Pineda, Thank you for these insightful considerations and your help to solve the case. The patient ...

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RE: Lupus Nephritis 1 day ago

the million dollar question actually 2 questions 1) Do you continue maintenance therapy "forever" 2) Do you treat abnormal serology alone (ot...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

Tocilizumab is not very effective and may be harmful in organ transplant patients with severe COVID (see Pereira MR, et al Am J Transplant 2022; 20...

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