RE: AAV ? 42 minutes ago

Dr. Taam was a lung diffusion test (DLCO) performed? thanks ------------------------------ Emilio Venturelli MD Scuola di specializzazione i...

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RE: AAV ? 50 minutes ago

As pointed out by Dr. Glassock, lung involvement dominates in anti-synthetase syndrome. Also, unlike SLE, nephritis and malar rash are uncommon in ...

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RE: Follow up 1 hour ago

Many private hospital renal docs have interventional radiology doing renal biopsies There seems to be many more complications Most of us don’t have...

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RE: Follow up 2 hours ago

Interventional radiology biopsied the left kidney!??? 3 days later, went into shock. Lacerated spleen. They tried to convince me splenic laceration...

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RE: AAV ? 2 hours ago

Hematuria persists. CRP is 10 mg/L. Complement levels (C3 and C4) are within the normal range (not consumed), and anti–dsDNA antibodies are negati...

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RE: AAV ? 3 hours ago

Without any signs of pulmonary inolvement it would be very difficult to diagnosis an "antisynthtase syndrome" in this case, in my opinion ------...

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RE: AAV ? 7 hours ago

Is hematuria persisting? Sedimentation rate/CRP? C3/C4 and anti-ds-DNAab trend?Has ANCA become negative? Since SCr has improved only from 3.1 mg....

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RE: Follow up 7 hours ago

Thanks for sharing biopsy- what was reason for splenectomy ? Not optimistic for recovery of function . Would not continue IS especially if tolerati...

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RE: AAV ? 8 hours ago

Follow-up We would like to provide an update on the patient's clinical course. The patient received rituximab (1 g at Day 0 and Day 14), along w...

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RE: Follow up 21 hours ago

80 and remains on dialysis? I would taper everything off except perhaps follow up dose of rituximab. I would check CD 19 first and if suppressed ...

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RE: Is Hypertonic Saline appropriate here 23 hours ago

I would first treat the Hyponatremia with Hypertonic saline and delay treatment of Hyperglycemia by 24 hours to avoid over correction of Hyponatrem...

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RE: Follow up 1 day ago

I would treat this patient as a case of combined ANCA and anti-GBM disease. Some sort of maintenance therapy (RTX) may be required to prevent a rel...

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RE: Distal RTA , COLA and Sibnayal 1 day ago

Dr Dastoor – very interesting patient. There is a case report from Japan (attached) that describes a patient with lysinuric protein intolerance w...

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RE: Follow up 1 day ago

28 glomeruli in specimen 11 globally sclerotic 13 of 17 showed segmental fibrinoid necrosis with cellular crescents. several crescents contained...

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RE: Canine amyloidosis treatment options 1 day ago

Dr. Foster could you share your email address off-line to me? My email is MJL 972@aol.com I would like to ask you a question off-line. ----------...

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RE: Follow up 1 day ago

Can you reshare biopsy report unidentified? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Directo...

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RE: Canine amyloidosis treatment options 1 day ago

The pathology sounds like AA with the nonspecific trapping of IgG. Immunohistochemistry is very accurate for AA so I would try that first. I actual...

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RE: Membranous Nephropathy with Rapid Progression 1 day ago

We can have ANCA vasculitis GN without microscopic hematuria. We had a patient with AKI , p ANCA and cANCA negative , anti proteinase 3 positive , ...

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RE: Follow up 2 days ago

Is she is a cigarette smoker? If no, risk of pulmonary hemorrhage from anti-GBM antibody will be low. ANCA is already negative. Given her age and m...

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Follow up 2 days ago

Last month I presented a case that continues to present difficult choices. I summarize 80 year old female presented with 1 gram of proteinuria, h...

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RE: Distal RTA , COLA and Sibnayal 2 days ago

Distal RTA was diagnosed based on clinical findings of hypokalemia , urine pH , failure to acidify urine with furosemide , non anion gap acidosis ,...

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RE: Distal RTA , COLA and Sibnayal 2 days ago

What is the significance of Lysine and Arginine excretion in the urine with normal Po4, glucose, Cystine and ornithine . Would it suggest the possi...

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RE: Novel COL4A3 Variant and Kidney Transplantation 2 days ago

What you have is a missense variant which is not X linked and is not even a definitely pathogenic variant. So I would think the risk of post transp...

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RE: Novel COL4A3 Variant and Kidney Transplantation 2 days ago

Regarding risk of anti-GBM antibody RPGN after kidney transplantation - from Google AI: " The risk of developing anti-GBM RPGN (rapidly progres...

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Distal RTA , COLA and Sibnayal 2 days ago

This is a case of a 35 year old female 1.distal RTA 2. medullary calcifications 3. Hypokalemia ( on ARB and MRA) 4. urine PH >=7 ( off K citrate...

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RE: Novel COL4A3 Variant and Kidney Transplantation 2 days ago

Our main concern is the potential risk of anti-GBM antibody development in the recipient, which could impact post-transplant outcomes. What do you...

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RE: A patient presented with signs of infection, including chills, no signs of septic shock and no obvious source of infection. A blood culture taken following a hemodialysis session tested positive for BGN, 2 days ago

I agree with Dr Rodby. I would treat and till consults. ------------------------------ Awais Nauman HMC Doha ------------------------------

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RE: Case of FSGS with IgM and C3 post transplant 2 days ago

Thank you for posting this case For my own education , for non US nephrologists Rena sight : WES or WGS ? i mean they do sequencing of both mitoc...

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RE: A patient presented with signs of infection, including chills, no signs of septic shock and no obvious source of infection. A blood culture taken following a hemodialysis session tested positive for BGN, 3 days ago

Citrobacter is an uncommon contaminant in venous blood cultures. It is most commonly an opportunistic infection in an immunocompromised patient. Wh...

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RE: arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 2 days ago

Thanks for case .Does he have any clinical sign/symptoms that could be explained by other reasons of high blood pressure apart from ig a ? Endocrin...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 2 days ago

I do not use STS in PD pts, it is too difficult to administer and if they need it, they frequently need more efficient and frequent dialysis for ca...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

STS on PD (forgot her was on PD) is a bit more difficult bc you have to give it IV although there are IP protocols (set attached) @Stuart Spragu...

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RE: arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 3 days ago

Hi, thanks for your reply. The dialysis is isonatrial. Pre-dialysis Na is 138 mmol/L and post-dialysis Na is 136mmol/l Best regards. . ------...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

I sincerely appreciate everyone's input on this difficult case. The thoughtful insights and shared experiences were extremely helpful. Discussions ...

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RE: Canine amyloidosis treatment options 3 days ago

Hi Dr Foster if your clinical suspicion of AA amyloidosis is high, I wonder if IHC for SAA might be a reasonable and cheaper first line alternat...

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RE: arterial Hypertension in an intra dialysis patient since two months due to an IgA Nephropathy. 3 days ago

Hi Dr Tirolen what is the patient pre dialysis serum sodium and the dialysate sodium concentration? You might try to lower the dialysate sodiu...

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RE: Canine amyloidosis treatment options 3 days ago

please report back when the nature of the amyloid is found! And if AA, if any inflammatory condition is identified. keep posting your cases, ...

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RE: Canine amyloidosis treatment options 3 days ago

I can certainly offer Tocilizumab to the clients to see if they are interested in giving it a shot. I'd probably use the pediatric dosing as a guid...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

Dr.Rodby- great summary of the uncertainties in this case. I agree. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

Dr Glassock, See my post above about my experience with Exphoza's gi tolerance. IF diarrhea is his issue this may not be the best approach. A...

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RE: A patient presented with signs of infection, including chills, no signs of septic shock and no obvious source of infection. A blood culture taken following a hemodialysis session tested positive for BGN, 3 days ago

I dont know how you can assume this is not real, and may be endocarditis like (infection of his endoprothesis) I would treat pending ID and vasc...

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RE: Canine amyloidosis treatment options 3 days ago

"Unfortunately, serum AA protein levels can occur in AA Amyloidosis, but this finding is diagnostically non-specific as many, many acute abd chroni...

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RE: A patient presented with signs of infection, including chills, no signs of septic shock and no obvious source of infection. A blood culture taken following a hemodialysis session tested positive for BGN, 3 days ago

How many sets of cultures drawn initially, and are all of them positive or only one? I assume repeat blood cultures were drawn when he came back ne...

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A patient presented with signs of infection, including chills, no signs of septic shock and no obvious source of infection. A blood culture taken following a hemodialysis session tested positive for BGN, 3 days ago

Fever and chills overcome during dialysis with no signs of septic shock and no obvious source of infection in an 80-year-old patient who underwent ...

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RE: Canine amyloidosis treatment options 3 days ago

Chlorambucil is not an unreasonable approach, if this is AA Amyloidosis . The elevated SAA implies a poor prognosis, but exactly how rapidly the do...

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RE: Canine amyloidosis treatment options 3 days ago

We have requested proteomics on the biopsy tissue to confirm the fibrils to be SAA, but I imagine this may take a few weeks. Clinically, we would s...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

Dr Glassock I think patient has diarrhea Aluminum binders may be better tolerated but agree that more effective dialysis best Just theoretically wo...

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RE: Canine amyloidosis treatment options 3 days ago

Unfortunately, serum AA protein levels can occur in AA Amyloidosis, but this finding is diagnostically non-specific as many, many acute abd chronic...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

Probably very good advice Dr. Rodby. How hard would you push for aC switch to 4-5 X week HD , instead of PD. Would you not try XPhoza? ----------...

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RE: treatment options for intramuscular calcifications and severe left hip pain in PD patient with hyperphosphatemia 3 days ago

I would treat this as calciphylaxis, get pt into a negative Ca balance. stop Ca based binders lower Ca in dialysate no Vit D No coumadin ...

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