Iptacopan In High Risk Patients With IgA .... not Again !! 33 minutes ago

Recently at the ERA 2025 in Vienna , we once again had a look at the APPLAUSE trial with Iptacopan in IgA Nephropathy. My conclusion, we spend $500...

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RE: Coronary angiogram in AKI 52 minutes ago

Thanks Dr. Rodby. Very helpful comments . If I understand you correctly you are"diagnosing " CI -AKI based on the presence of risk factors, rather ...

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RE: Suspected ANCA vasculitis ( Should I biopsy her? ) 1 hour ago

Good suggestion about Avacopan instead of steroids, but I have no idea if Avacopan is effective in Drug+induced ANCA Vasculitis and it has a propen...

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RE: Suspected ANCA vasculitis ( Should I biopsy her? ) 3 hours ago

If she has high titers of ANCA , renal failure , active urine sediment , and negative serologies - could it be anything else . Also was anti-GBM ...

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RE: Suspected ANCA vasculitis ( Should I biopsy her? ) 3 hours ago

Complicated case. Amiodarone will increase serum creatinine by about 10-15% from BL, but this us usually non-progressive. Of greater concern Is the...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 4 hours ago

The literature says that many patients with MN do respond to treatment with antiviral therapy alone. Unfortunately those with anti PLA2R positivity...

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RE: Coronary angiogram in AKI 4 hours ago

Dr Glassock, This has not been updated, I CANNOT believe it is even 1/2 that old (5 years ago) already. We had a number of Radiologists and Ne...

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RE: Coronary angiogram in AKI 4 hours ago

Could this be cholesterol embolisation? Or tin from anti platelet I encountered a case OOH cardiac arrest and needing stent Aki that became dialys...

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RE: Coronary angiogram in AKI 5 hours ago

Dr. Rodby- thanks very much for posting this excellent position paper. It provides a Lot of clarifying data and viewpoints. Has the statement been ...

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RE: Concomitant use of Patiromer and Sod. Zirconium 5 hours ago

Want to add my 2 cents in. A K of 5.4 is not lethal. has it been stavle. A HCO# of 12 is lower than desired. HCO3 Supplements will increase ...

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RE: Coronary angiogram in AKI 5 hours ago

Cardiologist do not have more wisdom than others. Patient is a 32-year-old Kenyan male with a 5-year Hx of known DM baseline creatinine of 130 u...

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RE: Coronary angiogram in AKI 6 hours ago

Dr Glassock says: "The evidence that contrast media exposure is the direct cause of AKI in this setting is controversial and weak." The c...

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RE: Concomitant use of Patiromer and Sod. Zirconium 6 hours ago

Since this patient seems to be fluid overloaded and is being pumped with NaBicarbonate and 10 g lokelma bid ( 1600 mg Na ) , i think it may be a wi...

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RE: Coronary angiogram in AKI 7 hours ago

I will try to answer both the responders questions . Yes he was adequately hydrated before the contrast procedure as it was not an emergent proce...

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RE: Concomitant use of Patiromer and Sod. Zirconium 7 hours ago

OK, RR, I want my own box of Lasix 500 mg tabs. I have a list of people to give that to. I guess you could argue that the amount of K in the bowel ...

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RE: leucocytoclastic vasculitis with overlap syndrome 8 hours ago

Thanks Dr Glassock and Dr Zuckerman. Going with either rituxan or eculizumab, do you have any suggestions for the duration of therapy and lab par...

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Suspected ANCA vasculitis ( Should I biopsy her? ) 8 hours ago

I have a 77-year-old female who was initially seen by me in 2021 for CKD evaluation and at that time she had presented with creatinine level of 1.3...

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RE: leucocytoclastic vasculitis with overlap syndrome 8 hours ago

Thanks Dr Venkat. I was planning on checking the Ualb/cr and Upr/cr prior to initiation of therapy. I will check ferritin and CRP also. Hypoalbumin...

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RE: Proteinuria of unclear etiology in a pediatric patient. 8 hours ago

RG re: platelets -- 350k. Not clear if the deposits on the leukocytes would require an additional ask of the lab but there was nothing commented on...

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RE: Coronary angiogram in AKI 8 hours ago

These are the kind of questions that are very difficult for a platform like Open Forum to address. So many clinical variables must be taken into co...

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RE: heart transplant candidate with membranous nephropathy 8 hours ago

Agree with Dr.Rodby that LVAD either as a bridge to heart transplant or destination therapy should be considered. Severe hypoalbuminemia, regardles...

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RE: Concomitant use of Patiromer and Sod. Zirconium 8 hours ago

I like the idea of pushing the diuretics, volume removal may help both K and HCO3 . but I see no problem giving both lokelma and Paritomer. Persona...

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RE: Coronary angiogram in AKI 9 hours ago

I will be honest, I have no idea but I will opine anyway. This comes up a lot. It seems logical to wait, Also one could argue that his GFR is ...

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Coronary angiogram in AKI 13 hours ago

Hello I have a young 32-year-old male from Kenya. Hx of DM x 5 years and baseline creatinine of 130 umol/l (1.6 mg/dl, I think) He underwent co...

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RE: APLS Nephropathy 14 hours ago

Quick update - Cr 124 umol/L (DC around 170umol/L) after 48h, Hb 86g/L but Plt is normal (as outpatient). Will follow closely with all above mark...

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RE: Concomitant use of Patiromer and Sod. Zirconium 18 hours ago

Urine volume? If not very oliguric, high dose loop diuretic +/-metoalozone may help with hyperkalemia. ------------------------------ K.K. Venkat...

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RE: leucocytoclastic vasculitis with overlap syndrome 19 hours ago

Dr. Anand Khurana: "Visceral epithelial cell podocytes: 30% effacement" Given above finding on EM, you may want to perform UAlb/Cr and UPr/Cr o...

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RE: Mpo Vasculitis Case 21 hours ago

Thanks prof glassock . Will keep you updated with case Bw --------------------------------- Muhammad Soobadar MBChB UK -------------------------...

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RE: Mpo Vasculitis Case 22 hours ago

IgG4 related disease is a very wise inclusion in the Differential Diagnosis of this confusing case. If proven, a rapid response to RTX would be exp...

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RE: Mpo Vasculitis Case 22 hours ago

Lupus serology negative , c3/c4 normal, myeloma negative , --------------------------------- Muhammad Soobadar MBChB UK -----------------------...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 22 hours ago

These are common findings in HBV-related MN. See Xie Q, et albAm J Nephrol 2015; 41:345 - 353 ------------------------------ Richard Glassock MD,...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

Just to clarify, the kidney biopsy confirmed primary membranous nephropathy with characteristic antler-like PLA2R staining. Serum PLA2R antibody le...

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RE: Anti-GBM negative IF in suspected RPGN 1 day ago

I doubt that access to a Western blot assay for anti-GBM antibody is availabke, but if it were and tested negative, then the ELISA is a false posit...

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RE: Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

What is the cause of the MN? Is it PLA2R + or negative. How can you be sure that this is not HBV related MN . The Use of steroids will likely incre...

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RE: leucocytoclastic vasculitis with overlap syndrome 1 day ago

This is a unique case in my experience. I have no idea how to treat it. Maybe RTX. Maybe Eculizumab. Any suggestions. I am at a loss to opine on an...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

I do not believe that dosing Patiromer above 25.2gms/ d is strictly forbidden, but it is true that dosing above thus level us usually not recommend...

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Hepatitis B and Immunosuppression in Primary Membranous Nephropath 1 day ago

I’m treating a 35-year-old woman with primary membranous nephropathy. She has 9 grams of proteinuria in 24 hours, low serum albumin, and normal kid...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

That's what Lexicomp said , but would be great if higher dose can be given . Fernando ------------------------------ Fernando Ariza MD Gen...

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RE: leucocytoclastic vasculitis with overlap syndrome 1 day ago

Also worth noting that a small percentage of ANCA vasculitis cases have isolated arteritis without glomerulonephritis. ~7% of cases with vasculitis...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

Is there really a "maximum dose" of Patiromer.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---------...

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RE: leucocytoclastic vasculitis with overlap syndrome 1 day ago

The main ddx here for the vasculitic lesions would be some sort of ANCA negative pauci-immune GN (un-sampled given limited gloms) with associated n...

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RE: Concomitant use of Patiromer and Sod. Zirconium 1 day ago

wow, horrible problem, but....short lived, since she will either be on dialysis or gone in the near future, esp if her pericardial effusion or lung...

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Concomitant use of Patiromer and Sod. Zirconium 1 day ago

Hi to All: Have a pt in her full mental capacity , BUN=130, Cr= 14, K=5.4 on Patiromer 25.2g daily (max dose) Corr. Ca = 6.1 , TCO2 =12 , pleuro...

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RE: heart transplant candidate with membranous nephropathy 1 day ago

I thought of using an LVAD in this patient. My experience is N=2 .One patient had developed ESRD and was on OP HD thrice weekly. Maybe use of LVAD ...

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RE: Anti-GBM negative IF in suspected RPGN 1 day ago

If Dr Glassock cannot explain the lack of linear IF staining I won't embarrass him by explaining why this is occurring :) Young man with that ant...

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RE: heart transplant candidate with membranous nephropathy 1 day ago

His severe hypoalbuminemia is preventing transplant , he certainly would be a AWFUL candidate for nephrectomy with that albumin, Is a catch 22. I...

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RE: heart transplant candidate with membranous nephropathy 1 day ago

Tough decision. Let us know what you and the patient decide to do. Are you considering a simultaneous kidney - heart transplant ? If so there might...

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RE: Anti-GBM negative IF in suspected RPGN 1 day ago

Sorry for delayed It is by ELISA --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 51377736 ----------------...

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RE: Anti-GBM negative IF in suspected RPGN 1 day ago

FALSE positive commercial tests for anti-GBM using ELISA are there when not using purified Goodpasture antigen.We can use antigens either native or...

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RE: leucocytoclastic vasculitis with overlap syndrome 1 day ago

Very odd. All extra-glomerukar fibrinoid necrosis and no signs of glomerular Vasculitis involvement -only chronic MPGN pattern of injury without ou...

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