RE: hemodialysis 1 hour ago

12.5-25 G mannitol IV given through hd port before start of HD.We used to do it not infrequently back in the day at UVA to prevent disequilibrium s...

View Discussion

RE: Hypercalcemia in a Critically Ill Patient with MAC Infection 1 hour ago

These findings are more suggestive of immobilization hypercalcemia , but the absence of 1,25 dihydroxy vitamin D suppression is a bit atypical. Do ...

View Discussion

RE: EPS 1 hour ago

Thanks Dr. Bargman. Very helpful advice. My enthusiasm for steroids and Tamoxifen was misguided, probably because of my paucity of "hands-on ";expe...

View Discussion

Hypercalcemia in a Critically Ill Patient with MAC Infection 2 hours ago

We would appreciate insights from colleagues regarding the following challenging case of hypercalcemia in an ICU patient. Case Summary: A 76-year-...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 4 hours ago

@Azam Mughni In addition to ECMO and as previously suggested, your patient may have a superinfection (PJP, fungus) and requires, if not already d...

View Discussion

RE: EPS 4 hours ago

Thank you Dr. Bargman for your customary valuable input. The unpredictable role of Tamoxifen in ESP reminds me of the one of Thyosulfate in calciph...

View Discussion

RE: EPS 5 hours ago

I agree with Dr. Rubin that it sounds like she is in the fibrosing phase of EPS and there is little indication for corticosteroids (unlike in the i...

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 5 hours ago

Dr Fein For cryo do we know cryocrit Are cryo class 1,2 or 3 What is Rheumatoid Factor and HepC status It seems pt already received Rituximab T...

View Discussion

RE: EPS 7 hours ago

Dr. Rubin is quite correct in his suggestion for avoiding high dose steroids in the management of the late, predominantly non-inflammatory fibrosin...

View Discussion

RE: EPS 15 hours ago

If not done already, I will have IR place a percutaneous cholecystostomy ASAP. Personally I would avoid steroids at this stage (he is well beyond t...

View Discussion

RE: EPS 15 hours ago

With this history , clinical findings and imaging this is very likely EPS progressing in the absence of PD. This is not an uncommon occurrence. I w...

View Discussion

EPS 16 hours ago

I have a 60 year-old Latin American female with a history of hypertension and ESRD for which she was on peritoneal dialysis for six years. The peri...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 16 hours ago

A relatively large observational cohort study of solid organ transplant with severe COVID showed no beneficial effects on outcome using Tocilizumab...

View Discussion

RE: Another lithium patient 16 hours ago

I was not suggesting that you should biopsy him but my intention was to add to the differential diagnosis of the glomerular component of his protei...

View Discussion

RE: Another lithium patient 16 hours ago

Thank you for that. He does not have nephrotic syndrome at this point. UPCR fairly stable on empagloflozin and valsartan. He is very resistant , fo...

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 17 hours ago

I did see it mentioned as a safer option. I have no experience with the procedure but could ask our IR team. On Wed, Mar 25, 2026 at 8:51 PM Debora...

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 17 hours ago

I really appreciate your comments and wisdom

View Discussion

RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 18 hours ago

Thanks prof glassock and prof sprague --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 18 hours ago

Dr. Whittier- what are your current views on transjugular kidney biopsy in patients with severe Thrombopenia contraindicating percutaneous or open ...

View Discussion

RE: hemodialysis 18 hours ago

@ prof rodby cool stuff. Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 20 hours ago

If serology is negative and biopsy would potentially change management any thought about transjugular kidney biopsy ? ---------------------------...

View Discussion

RE: hemodialysis 20 hours ago

Thanks for update What is mannitol prime? Can you explain this regime to me? Kind regards --------------------------------- Muhammad Soobadar M...

View Discussion

RE: hemodialysis 20 hours ago

Hi, we had palliative->wants to continue. To be honest I find this academically stimulating. I am hoping we can find a happy dialysis regimen for...

View Discussion

RE: hemodialysis 22 hours ago

Dr Junejo Is your Pt able to consent? Does he/she really want dialysis support? Given overall pathology supportive care may be a good choice. If I ...

View Discussion

RE: hemodialysis 23 hours ago

could also look for carotid disease. while not exactly the same symptoms, https://pmc.ncbi.nlm.nih.gov/articles/PMC12103909/#:~:text=This%20w...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 23 hours ago

I'm sorry to hear about this case from Transplant perspective. We have seen an increase number of invasive fungal infections and PJP in patients on...

View Discussion

RE: hemodialysis 23 hours ago

Update: mannitol prime 12.5 g,BFR 200->250.No UF, Na145->140 no heparin.EEG and tele ongoing. Running smoothly so far. -----------------------...

View Discussion

RE: Lupus Nephritis 23 hours ago

From Dr Glassock: "See this "Position Paper" by De Vriese, Fervenza and Sethi (KI 2025;107:198-211. ) It is very convincing, to me at least, t...

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 23 hours ago

I had to leave for an emergency in Dialysis so not with her chart now. I'm in the habit doing both ACR and UPCR to determine whether MGUS/ myeloma ...

View Discussion

RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

What a treatment nightmare for this patient. I have this pet peeve of mine, calling something ITP in the setting of other autoimmune disease (I s...

View Discussion

RE: Another lithium patient 1 day ago

Lithium is listed in the literature as a cause of MCG and FSGS (see the references listed below from UpToDate). So that is why the ratio of ACR/PCR...

View Discussion

RE: Another lithium patient 1 day ago

valsartan and Empa always a good idea. ACR 1.4 with PCR 2.0 is 70% albuminuria so this seems more like glomerular proteinuria (Li should be 20-3...

View Discussion

RE: Another lithium patient 1 day ago

Only reason I raise IGAN as far less likely is that anyone with proteinuria could have and not there are so many treatment options if found. So he ...

View Discussion

RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

As per Professor Glassock, Cinacalcet should not be used to lower PTH when using Denosumab. Denosumab MOA lowers calcium by decreasing bone resorpt...

View Discussion

Biopsy dilemma in setting of severe refractory ITP 1 day ago

A 73 yo female with remote breast CA, RA, Sjogrens, MGUS (BMB several years ago), MDS and very severe refractory ITP. Splenectomy at Memorial many ...

View Discussion

RE: Another lithium patient 1 day ago

Not sure why IgAN comes up but Diabetic nephropathy is certainly more common than Li nephropathy, Still this patient DID have a long history of Li ...

View Discussion

Another lithium patient 1 day ago

I have a 70 yo male with poorly controlled DM, on lithium for >20 years. In the past he has reports been institutionalized and "falling apart' when...

View Discussion

RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Dear Dr. Glassock and Dr. Ud Din, Thank you again for your insightful suggestions. Hemoglobin electrophoresis was not repeated during the current...

View Discussion

RE: hemodialysis 1 day ago

You are right,I will try it today.Also planning for mannitol prime.Still has U.O ar 400ml/d with lasix. ------------------------------ Nazia June...

View Discussion

RE: hemodialysis 1 day ago

Thanks.Neuro do not think its TIA or seizure.Tele unchanged ------------------------------ Nazia Junejo MD Las Vegas NV (801) 542-7115 ----------...

View Discussion

RE: hemodialysis 1 day ago

Clearly a tough situation. I would try a 250 to 500 ml bolus at the start of dialysis at a low blood flow. This is without details of cardiac reser...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

There are anecdotal reports of efficacy and safety of tociluzumab in kidney transplant recipients with COVID-19 infection: https://www.cureus.com...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

My understanding is that Fungitel also is helpful for the detection of fungal ailments (candida, aspergillus, etc.). Was a bronchoscopy with BAL do...

View Discussion

RE: Lupus Nephritis 1 day ago

Thank you Dr. Glassock for sharing this outstanding "proposal". Much like the published editorial by Dr. Jayne which I posted yesterday, which unde...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

Thank you for your inputs. We are considering transferring him to a center that has ECMO. In the meantime, his Fungitell test came back strongly po...

View Discussion

RE: ANCA vasculitis with AIN 1 day ago

Plateauing of SCr for a few days usually precedes kidney function recovery in AKI. Is daily urine output progressively increasing? --------------...

View Discussion

RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

What is CRP, LDH, ferritin and IL-6 levels ? Was your patient vaccinated if so when and which anti COVID vaccine ? Given advanced baseline CKD WOUL...

View Discussion

RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

The combination of Denosumab and Cinacalcet for therapy of osteoporosis in CKD is not advised as serious hypocalcemia can be the result. Vitamin D ...

View Discussion

RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

Thanks everyone for input. @ prof sprague denusomab increasing pth is that clinically significant ? And is it because anti resorptive agent cause ...

View Discussion

RE: Lupus Nephritis 1 day ago

Thanks for great case. Also worth pointing out lupus is often associated with joint symptoms , rash and other non Kidney organ involvement . So d...

View Discussion