RE: Thoughts on immunosuppresion for canine MPGN? 12 hours ago

What is LLC? If it is Lambda Light Chain then you need to consider Proliferative GN with monoclonal IgG deposits ------------------------------ ...

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RE: 9/11 and Nephrology 15 hours ago

An amazing combination of hilarious, insightful, imaginative, and fascinating. Thanks for sharing! ------------------------------ Sheldon Hirsch ...

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Thoughts on immunosuppresion for canine MPGN? 17 hours ago

Hi everyone, I'd love to get some thoughts on potential drug options for a patient of ours. This is a 3 and 1/2 year old French Bulldog who ha...

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9/11 and Nephrology 18 hours ago

As I always have flashbacks on 9/11, I thought I would share with you a report and an essay on the nephrologic aspects of that day in New York City...

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RE: Transplant Case 18 hours ago

A biopsy is needed. A late PTLPD is usually EBV negative and behaves more like a lymphoma that early PTLPD that often goes away when immunosuppresi...

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RE: Lupus Case 19 hours ago

I agree with you Dr. Dastoor. But the BLISS trial may have included too few patients with this severe crescentic GN to draw any firm conclusion abo...

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RE: Lupus Case 1 day ago

I would take the contrarian view. Your patient has severe renal and extra renal involvement , and would benefit more from a Belimumab based regimen...

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RE: Lupus Case 1 day ago

Thanks everyone after 6 pulses of cyclophosphamide Then start mmf ? Thanks --------------------------------- Muhammad Soobadar MBChB UK -----...

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RE: Transplant Case 1 day ago

Sorry my bad. I thought it was large bowel due to a careless reading of the post. In that case a CT guided lymph node biopsy would be best. ----...

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RE: Transplant Case 1 day ago

Dr. Balan tissue is needed for PTLD diagnosis but in this case the CT scan shows small bowel involvement.. would you still perform random biopsy in...

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RE: Recurrent ascites in ESRD pt 1 day ago

Very interesting discussion. I have a patient currently with severe recurrent ascites requiring frequent LVPs where cardiac source has been ruled o...

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RE: Transplant Case 1 day ago

I think your original suggestion of colonoscopy is great. Everything depends on the tissue diagnosis. If we are able to get a biopsy then the other...

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RE: Transplant Case 1 day ago

Agree with everything said and we usually involve oncology to help guide PET scan use and treatment. Get Outlook for iOS

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RE: 52 year old male with class V LN 2 days ago

Thank you all. I will provide a table of recent results which Will make things a bit more clearer ------------------------------ M Kaisar Neph...

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RE: 52 year old male with class V LN 2 days ago

Mycophenolate sodium 720 mg three times daily (2160 mg/d) is pretty much a maximum dose. I would not push it any further., especially with declinin...

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RE: 52 year old male with class V LN 2 days ago

Could you please post the deidentified report of the most recent kidney biopsy - this should help with the decisions about treatment modalities . I...

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RE: 52 year old male with class V LN 2 days ago

With these doses , the patient is receiving Mycophenolate sodium not Mycophenolate mofetil. ------------------------------ Richard Glassock MD, ...

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RE: 52 year old male with class V LN 2 days ago

I would not consider Rituximab again... Unless biopsy shows high Acuity scores and serology shows high activity . Would probably consider MMF + CN...

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RE: Qb and myocardia stunning 2 days ago

I too do not know whither there us any good data. No doubt the extracorporeal blood flow in the dialysis circuit is not affected unless the flow ex...

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RE: Recurrent ascites in ESRD pt 2 days ago

Dr Glassock. The word uremic is too broadly used. Some substance retained in the state of ESRD which has an effect in a particular target system is...

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RE: Recurrent ascites in ESRD pt 2 days ago

I agree tou Fr Rodby. How do measure adequate dialysis. After more than 49 years of Kt/V I am convinced that the latter does not do justice to "wha...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 2 days ago

When I had the ARR determines I was off ARB for a week but took the rest of the medical, of course mt BP did go up -----------------------------...

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RE: Recurrent ascites in ESRD pt 2 days ago

Odd because a "uremic" factor should be acting systemically, yet the serositis is localized exclusively to the peritoneal membrane in cases of "dia...

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RE: 52 year old male with class V LN 2 days ago

Dr. Kaisar: I am confused about the trends of urine protein, urine albumin and serum albumin levels. If the UPr and UAlb are unchanged but the seru...

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RE: Recurrent ascites in ESRD pt 2 days ago

Im not sure what you mean by odd, but to me, if I am correct that this is uremia, it just tells us how unhealthy you still are despite being consid...

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RE: 52 year old male with class V LN 2 days ago

His current dose is 720mg TDS which was his dose pre-reduction to twice a day. On the.TDS dose the urine protein level was 8.3 g though the serum a...

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RE: Recurrent ascites in ESRD pt 2 days ago

So the terminology is all wrong - it is "Uremic Ascites" in a patient with uremia treated with HD (and cured by Kidney Transplant) - all rather odd...

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RE: Recurrent ascites in ESRD pt 2 days ago

The only thing I have seen work is transplant I will be curious as HDF gets more common if we see it less ------------------------------ Roge...

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RE: Recurrent ascites in ESRD pt 2 days ago

Dr. Rodby very intriguing hypothesis Any personal experience of improvement with HD intensification , MCO membranes or PBUT removal? --------...

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RE: Recurrent ascites in ESRD pt 2 days ago

"when you say nephrogenic-what would the mechanism be (assuming that if pts has been on dialysis for some time residual kidney function is nil or q...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 2 days ago

I agree- but measuring ARR while a patient is receiving an ARB is usually not recommended. ------------------------------ Richard Glassock MD, F...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 2 days ago

The low (assuming it's below the lnl) renin concentration with ARB really points towards primary hyperaldosteronism. ---------------------------...

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RE: Transplant Case 2 days ago

Agree with Dr. Glassock biopsy/tissue diagnosis is needed. She is 7 years out from transplant. Early post-transplant lymphomas are more commonly EB...

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RE: Transplant Case 2 days ago

GI involved PTLD seems likely. Is the patient EB+ or -.?Can you get a CT guided biopsy of LN to see if it is CD20+ or not? Reduced IS is always the...

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RE: 52 year old male with class V LN 2 days ago

What is his current MMF , hydroxychloroquine and steroid dosage? What his current eGFR? Serum Sickness should not occur with OBI- the arthritis is ...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 2 days ago

Cannot interpret ARR while receiving an ARB. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...

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RE: 52 year old male with class V LN 2 days ago

Thank you Professor Aledan I have just received his latest labs. The UACR is down to 400+ from a peak of 900+. Interim level was around 600 2 wee...

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RE: 52 year old male with class V LN 2 days ago

Thank you Professor Glassock. He had OBI after Rtx and developed serum sickness type reaction. I have just received his latest labs. The UACR is do...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 2 days ago

@Emilio Venturelli What we measure in our lab is direct renin concentrations in ng/l and she was on ARB on board. --------------------------------...

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Transplant Case 2 days ago

Dear Colleagues, I would appreciate input/MDT for this case 38 Female DCD en bloc transplant 2018 Historical anti DP on dual agent( Tac and Aza...

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RE: Recurrent ascites in ESRD pt 3 days ago

I suppose that it is worth remembering that Eleanor Roosevelt. , the former First Lady of the USA , died of unrecognized Miliary Tuberculosis. -...

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RE: Recurrent ascites in ESRD pt 3 days ago

1 case in 500ver 40 years of practice and it was early in my care. The patient had a positive PPD and evidence of "healed" lesions on his chest x-r...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 3 days ago

I am intrigued by the concept of aldosterone being a vascular toxin. At the age of 40 I WAS noticed to be hypertensive. Thiazides precipitate hypok...

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RE: Recurrent ascites in ESRD pt 3 days ago

Tuberculous peritonitis as a cause of refractory ascites in Hemodialysis patients Must have a very geography specific association. After several de...

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RE: Anticoagulation in Nephrotic Syndrome 3 days ago

Sorry for the mis-citation. The Chapter on Hypercoagulability in Nephrotic Syndrome in the latest version of UpToDate is also an excellent resource...

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RE: Qb and myocardia stunning 3 days ago

Interesting question. A quick search of the literature revealed no good answer, because this issue is understudied. But Blood flow during dialysis ...

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Qb and myocardia stunning 3 days ago

Dear colleagues, The most effective strategies to reduce myocardial stunning are minimizing hourly ultrafiltration and avoiding intradialytic hy...

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RE: Case Of AKI And Nephrotic syndrome 3 days ago

This patient needs a kidney biopsy ASAP. Statistically the most likely lesion is de novo FSGS, possibly due to CNI, but as Dr. Rodby states many ca...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 3 days ago

"Tip lesion" FSGS can closely resemble MCD in many respects, including a tendency for periodic remission and relapse. (Sometimes spontaneously ) ...

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RE: Is kinetic eGFR valid for use in oligoanuric patient? 3 days ago

Or even concomitant diseases, e.g concerning the example above metastatic cancer might alter CysC concentration. These critically ill patients with...

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