RE: Relapsing MCD 6 hours ago

Peripheral B cell depletion doesn't necessarily reflect adequate therapy as you may still have apparent B cells at the tissue level. However, I thi...

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RE: Relapsing MCD 6 hours ago

Peripheral B cell depletion doesn't necessarily reflect adequate therapy as you may still have apparent B cells at the tissue level. However, I thi...

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RE: Relapsing MCD 6 hours ago

Any thoughts on persistence of proteinuria and hypoalbuminemia despite adequate B- cells depletion (with CD19 monitoring) and 2 gram RTX after 1-2 ...

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RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 6 hours ago

To my knowledge, Taurolidine is available in Europe and now in the US. Perhaps worth trying it. References: 1. DefenCath® (taurolidine and hepari...

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RE: Free water deficit formula derivation 7 hours ago

Thanks for the detailed and thoughtful responses. It is so helpful! The textbook that presents the FWD calculation without use of the correction fa...

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RE: to pulse or not to pulse?? 8 hours ago

And pexivas protocol steroids --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: to pulse or not to pulse?? 8 hours ago

Thanks everyone . Crp coming down nicely with methylpred Had biopsy Friday but did not get provisional report . I thought to start 2 pulse iv cycl...

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RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 8 hours ago

Thanks prof Bersarab for input. He has a temporary left sided jugular line . It has three lumens ( one used for antibiotics and blood of required ...

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RE: Relapsing MCD 10 hours ago

Excellent insight in area with no trials comparing different treatment options. I also like the steroid avoidance CNI approach as the biggest compl...

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RE: Relapsing MCD 11 hours ago

I can often buy 1–2 years off therapy in at least half of the patients I treat. The key is consistent weekly home monitoring of albuminuria. I do...

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RE: Free water deficit formula derivation 13 hours ago

Dr. Nielson Thank you for your attached article. It brough memories back for me. I overlapped with Dr Feig as a fellow in 1972 in Dr Epstein Prog...

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RE: Relapsing MCD 13 hours ago

@Jai Radhakrishnan Do you use CD19 at all in monitoring your rituximab dosing for MCD or do you redone strictly on proteinuria? I dont know ho...

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RE: Relapsing MCD 20 hours ago

I use both approaches with my frequent relapsing steroid-sensitive nephrotic syndrome. Regarding RTX therapy, some cases showed brisk response, so...

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RE: Relapsing MCD 1 day ago

I fully agree with Dr. Radhakrishnan that steroid free regimens are highly desirable in such multi-relapsing steroid sensitive MCD patients . A RTX...

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RE: Relapsing MCD 1 day ago

My approach in such patients is to avoid corticosteroids entirely. At relapse, I initiate tacrolimus to control proteinuria -typically low dose 2...

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RE: Free water deficit formula derivation 1 day ago

JD, Thanks for starting this interesting discussion. I agree with the general sentiment here from you and others that a high level of precision in...

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RE: Relapsing MCD 1 day ago

I think RTX would be my choice, due to good efficacy and acceptable safety. But repeated courses (Q 4-6 months) of RTX will likely be needed for ma...

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Relapsing MCD 1 day ago

67 woman kidney biopsy in March 2021 - MCD. Rapid response to steroids. Multiple relapses in 10/2022, 1/2024, 9/2024 and 7/2025. All steroid sensit...

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RE: IgA nephropathy with FSGS and significant IFTA 1 day ago

Has the efficacy and safety of Finerenone ever been tested in this scenario?. Thus drug is not approved for use in IgAN (without T2DM) in the USA b...

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RE: Steroid-Induced Metabolic Alkalosis with Dexamethasone – Experience or Evidence? 1 day ago

The short answer is yes, dexamethasone, when used at a high dose and for a long term, can cause a mild metabolic alkalosis. Based on several basic ...

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

Clearance in CVVHDF is the addition of both the diffusive clearance through dialysate and the convective clearance through hemofiltration. The HF g...

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RE: IgA nephropathy with FSGS and significant IFTA 1 day ago

Understood, we need to know the magnitude of the microscopic hematuria (in RBC/hpf or dipstick hemoglobinuria) . A Lesion of M1, E0, C0 is faintly ...

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RE: IgA nephropathy with FSGS and significant IFTA 1 day ago

Have you considered adding Finerinone to the existing prescription given its potential for cardio renal protection in such a scenario. ---------...

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

Thank you Dr @Roger Rodby and @Graham Abra @Graham Abra Dr Rodby uses the ratio of Qb to Qd of 2.5 to determine the full saturation of dialysate,...

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RE: IgA nephropathy with FSGS and significant IFTA 1 day ago

my point is that the patient is still showing an active disease with mesangial expansion and mesangial cells proliferation, persistent hematuria an...

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RE: remote history of Wegener's, PR3 positive, minimal urinary findings 1 day ago

Wonder whether doing a biopsy is an option here. ------------------------------ M.N. Alhosaini ------------------------------

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RE: Blood flow to dialysate flow ratio for full saturation 2 days ago

Interesting technical questions. The maximum combined dialysate and replacement fluid rate for Prismaflex is 8L/hr which you can combine any way y...

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RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 2 days ago

I see , he needs a way of administering his Antibiotics. What Vascular Access for HD does he have now? ------------------------------ Anatole Bes...

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RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 2 days ago

Thanks . Diabetic type 1/ prolonged admission with complication of diabetes . I mean peripheral veins using ultrasound is difficult Therefore nee...

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RE: Steroid-Induced Metabolic Alkalosis with Dexamethasone – Experience or Evidence? 2 days ago

I would be seriously looking for an alternate explanation but your thought of indirect tubular effects is interesting --------------------...

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RE: Free water deficit formula derivation 2 days ago

Looking at the final derived equations; Rose formula: FWD = 50kg * 0.6 * (160/145 - 1) or 3.1L Second formula: FWD = 50kg * [(160/145) – 1] or ...

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RE: remote history of Wegener's, PR3 positive, minimal urinary findings 2 days ago

PR3 positivity in the pt with h/o Wegners, as Dr Glassock said, should be taken with great degree of seriousness with high risk of relapses even fa...

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Steroid-Induced Metabolic Alkalosis with Dexamethasone – Experience or Evidence? 2 days ago

Hello Everyone, I wanted to reach out to see if anyone in the community has encountered and how frequent or found literature on metabolic alkalosi...

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RE: Case Of Tunnelled Line Bactaeremia With Osteomyelitis And Endocarditid 2 days ago

How did thus patient get to the point of having no peripheral access available? Was he always on a catheter; did he previous attempt to construct n...

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RE: remote history of Wegener's, PR3 positive, minimal urinary findings 2 days ago

At the present time, the patient 's UA showed UA shows 3-5 RBCs and urine alb/creat ratio of 0.2 Do we have previous random UA's while he was in ...

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RE: remote history of Wegener's, PR3 positive, minimal urinary findings 2 days ago

"How likely is a recurrence? " not unlikely and with PR3 vasculitis a lot more likely than MPO vasculitis and can occur at any time so close ...

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RE: Free water deficit formula derivation 2 days ago

One other thought, the formula in question, as Dr Rodby indicates, is better used with serum Na. This formula was arbitrarily derived by Feig and M...

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RE: Free water deficit formula derivation 2 days ago

Welcome Dr. Neilson. Thanks so much for your contribution. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-888...

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RE: remote history of Wegener's, PR3 positive, minimal urinary findings 2 days ago

Non-vasculitic positive ANCA are typically anti-MPO, not anti-PR3. I would regard this value of anti-PR3, while low, of serious clinical significan...

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RE: Free water deficit formula derivation 2 days ago

The considerations for adjusting total body water for gender, age, etc, are well discussed by Jay Bhave in the attached paper. I think they probabl...

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RE: Blood flow to dialysate flow ratio for full saturation 2 days ago

filtration fraction applies only to the hemofiltration component. If you are providing 2000 ml/hour of dialysate that normally would be enough cl...

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RE: Free water deficit formula derivation 2 days ago

I think the problem of the second formula is assuming TBW = 60% of BW in both sides. If it is truely water loss, the percentage of water cannot be ...

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Blood flow to dialysate flow ratio for full saturation 2 days ago

In a hospital which i work, the hospotalized non ICU patients need dialysis (AKI or ESR) receive sessions using prismaflex machine even hemodynamic...

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RE: to pulse or not to pulse?? 2 days ago

I like the idea of up front Avacopan, this seems like BAD vasculitis and while Avacopan was really studied as a steroid sparing option, I suspect...

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RE: Advanced Crescentic Lupus Nephritis 2 days ago

Tough case. Agree with others. An underlying high risk APOL1 gene mutation may also be in play given the African ancestry, aggressive lupus nephri...

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RE: Advanced Crescentic Lupus Nephritis 2 days ago

Thank you Dr. Glassock and Dr. Aledan --------------------------------- Gary Singer MD, FASN Partner Midwest Nephrology Associates Saint Peters M...

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RE: TOLVAPTAN-RESISTANT HYPONATREMIA 2 days ago

Just curious, can we try Conivaptan for short-term correction of hyponatremia and possible overcome resistant to Tolvaptan (no comparative studies,...

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RE: to pulse or not to pulse?? 2 days ago

I would treat with PEXIVAS protocol of RTX with rapid steroid tapering, perhaps with addition of Avacopan , if liver function tests are normal. ...

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RE: Advanced Crescentic Lupus Nephritis 2 days ago

In a patient with these characteristics I would agree with Dr, Aledan. Some might favor RTX because of the predominance of crescentic disease. All ...

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RE: to pulse or not to pulse?? 2 days ago

Look like medium vessel vasculitis such as PAN with neuritis. Any cutaneous manifestations? Results of viral hepatitis, ANA, complements, RF, cryo...

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