RE: O K dialysate 45 minutes ago

Even when the potassium is 7 or 8, I will use the 4K bath to prevent rapid lowering of potassium. If I get it to 5.5 from severe high K, I think th...

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Board review courses 1 hour ago

As a general nephrologist most of my time is spent taking care of patients . I update myself by KSAP and Nephsap although neither are meant to be r...

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RE: O K dialysate 1 hour ago

I agree with the concept that if rapid lowering of K is needed, of course, HD is superior. However, I definitely have used CRRT to treat life-threa...

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RE: ABMR In Kidney After Liver TX 2 hours ago

This is an interesting case which provides an opportunity to observe that ABMR should not be considered as a Yes/No phenomenon. It is an entire spe...

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RE: ABMR In Kidney After Liver TX 2 hours ago

Did the patient received antibiotics or NSAIDs before the observed increase in serum creatinine. Tubulointerstitial nephritis may be misinterpreted...

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RE: ABMR In Kidney After Liver TX 4 hours ago

Given absence of C4d PTC positive and low level (? Pathological ) DSA and clinical improvement with out PLEX/IVIG , is this ABMR? You might conside...

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TCM in dialysis 5 hours ago

Hello forum members, This forum has been a great resource to address questions. I learn something new each day ! Had a question about billing...

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RE: O K dialysate 7 hours ago

Has anyone ever seen or heard of a hyperkalemic patient die of hyperkalemia AFTER starting dialysis (at least after the first couple minutes, which...

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RE: O K dialysate 8 hours ago

Questions. Do we know the risk of arrythmias when CRRT with a zero K concentration in fluid replacement is used for treatment of hyperkalemia? Wouk...

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RE: O K dialysate 9 hours ago

I generally agree with the previous comments. Having said that, I have used a 0 K bath in life threatening hyperkalemia (K 9 or even greater) durin...

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RE: O K dialysate 9 hours ago

Agree with Dr. Rodby that rapid K lowering with a risk of arrhythmia occurs in 4 hr HD, while in CRRT the removal is slow and depend mainly on effl...

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RE: persistent post infectious GN 15 hours ago

This us not an easy question to answer, as many bacterial and viral infections can exacerbate an acute relapse of pre-existing Primary IgA N, whils...

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RE: persistent post infectious GN 20 hours ago

Staphylococcal infection is most common but streptococcus pyogenes is the offending organism is up to about 15-20% of cases, so it is not rare. ...

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RE: persistent post infectious GN 21 hours ago

How common is IgA dominant post infectious GN associated with Strep? It must be uncommon? ------------------------------ Roger Rodby MD, FASN Pr...

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RE: O K dialysate 21 hours ago

NxStage (and likely all the other companies) makes a CVVHD 0K dialysate for CRRT. The risk of 0K is too rapid reduction of serum K , and is assoc...

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RE: m-Tor In Premalignant Skin Cancer 21 hours ago

Thanks for bringing up Kaposi sarcoma. Yes, reduction/discontinuation of CNI should occur first and mycophenolate subsequently in Kaposi. For other...

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RE: O K dialysate 1 day ago

Agree with Dr. Glassock that 0 K bath is associated with high risk of arrhythmia and SCD and the risk is escalated with higher predialysis plasma K...

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RE: ABMR In Kidney After Liver TX 1 day ago

Surprising that an ABMR responded to just adjustment in maintenance immunosuppression. What was the cyclosporine level before it was changed to tac...

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RE: O K dialysate 1 day ago

I agree. The risks of inducing arrhythmias from sudden K shifts is too great.. I have used low K , but not Zero K , dialysate in patients with late...

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RE: persistent post infectious GN 1 day ago

The IF showed 1-2+ IgG, 2+ IgA, 3+ C3 and a slight predominance of lambda LC . Ciq and IgM were negative. The EM showed ED deposits in many locatio...

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O K dialysate 1 day ago

O K dialysate is no longer used by most or all nephrologists as far as I know. I was asked by an intensivist in another hospial about using using...

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RE: persistent post infectious GN 1 day ago

Dr. Glassock, I would like to learn from your thought process, how did you conclude from path report "a diagnosis of IgA dominant infection relate...

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RE: 17q12 deletion syndrome 1 day ago

this appears to be part of the HFNB1 autosomal dominant tubuointerstital disease with variable MODY, renal cysts, CKD, hypoMg syndrome. You co...

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RE: AKI and low C3 1 day ago

Most hypocomplementemia related renal disease has much more pronounced hypocomplemetemia. What does the urine look like? Blood, Protein, RBCs, W...

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AKI and low C3 1 day ago

45 yo Female with history of ulcerative colitis diagnosed 1.5 years ago and started on Mesalamine.One year after that she developed acute kidney in...

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17q12 deletion syndrome 1 day ago

Could you share any experience on how to manage this case of 45 yo male with history of recurrent severe hypomagnesemia, started or diagnosed about...

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RE: membranous nephropathy 1 day ago

This will sort itself out with time I would not biopsy unless he develops repeatedly nephrotic range proteinuria I would still follow serum PLA...

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RE: ABMR In Kidney After Liver TX 1 day ago

MFI was 2000 No access to cf-DNA --------------------------------- Ahmed Emara MD, MBChB, FASN Ain shams University Cairo 00201006721401 -------...

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RE: membranous nephropathy 1 day ago

Dr. Hirsch- all good questions- very insightful and challenging , as expected. I will try to answer them, and I hope tgat others will add their own...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

This patient has albuminuria and proteinuria which seems quite significant. There are no glomerular lesions in the biopsy to explain the protein lo...

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RE: membranous nephropathy 1 day ago

Dr Glassock I have accepted and followed the guideline that increases in proteinuria down the line in initially PLA2R positive membranous should ...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

The following reference is relevant to the patient I posted. The authors report an obstetric ATN case with significant albuminuria. Interestingly, ...

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RE: ABMR In Kidney After Liver TX 1 day ago

What was MFI for DSA? Do you have access to cf- DNA ? If so would get to assess any of allograft injury. Depending on MFI and cf-DNA would decide r...

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RE: membranous nephropathy 1 day ago

The points about auto-antibody affinity , the "immunological sink" hypothesis " and very low but detectable levels of anti-PLA2R antibody by ELISA ...

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RE: membranous nephropathy 1 day ago

It depends from the affinity of the APLA2R Ab I think. Especially in a relapse of MN, if the APLA2 Ab are measured only with ELISA but rarely also ...

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RE: membranous nephropathy 1 day ago

I think it is uncommon for serum PLA2R Ab positive MN to have clinical relapse in the absence of riding titer of serum PLA2R Ab, if present does th...

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Women in Nephrology (WIN) Leadership Conference 1 day ago

Women in Nephrology (WIN) is celebrating its 40th anniversary this year!! The anniversary and our annual leadership conference will be on August 9-...

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ABMR In Kidney After Liver TX 1 day ago

50 y one year post kidney after liver Tx, developed acute allograft dysfunction ( Creat rise from 1.1 to 2.3 mg/dl), Bx showd borderline TCMR with ...

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RE: m-Tor In Premalignant Skin Cancer 1 day ago

@K.K. Venkat Thank you for your comment Just to make sure we are on the same page, in malignancies other than skin, you tend to reduce/stop MMF 1s...

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RE: membranous nephropathy 1 day ago

Dr. Glassock, in case of negative anti-PLA2R Ab but with lower albumin and elevated protein to creatinine ratio, would still consider a relapse of ...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

Thanks- understood and agree. Still a mystery. I wonder if anyone has studied proteinuria indexed to iGFR during episodes of AKI- does it remain a ...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

Dr. Glassock: I believe that the patient I posted had significant elevations in UAlb and UPr excretion. Without relying on the UCr which may be cha...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

Even allowing for variations in the contributions of individual nephrons to albumin, protein and creatinine, if the total nephron population is now...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

You analysis will only be correct if the individual nephron contribution to protein excretion is uniform and roughly comparable from nephron to nep...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

Dr. Glassock: In the hypothetical patient posted by you: UPr/Cr 400 mg/g at baseline, now in AKI and excreting only 100 mg/day of creatinine. Since...

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RE: persistent post infectious GN 1 day ago

Let us know the RF and TTE results when you can. If both normal/negative ,I place my bets n IgA dominant Infection Related GN. Conservative, non-IS...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 1 day ago

Hypothetical. Patient with chronic mild proteinuria (400mg/gm creatinine) . Develops oliguric AKI. Urine output 200ml/d. Urine ptiein excretion rem...

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RE: Reversible nephrotic range proteinuria during AKI due to biopsy-proven ATN 2 days ago

Yes @John Mellas while not confirmed, I think the same exact thing. the urine creatinine is the filtered creatinine increased by water reabsorp...

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RE: Solitary kidney and biopsy 2 days ago

let me get the official answer: @William Whittier ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Me...

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RE: Solitary kidney and biopsy 2 days ago

Yes I would treat this as ANCA vasculitis w. RTX & PSN, as I stated before. I also thought the patient was reticent re a Bx in the first place. T...

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