RE: Rapidly progressive glomerulonephritis 1 hour ago

Thank you all for the contribution. EM was difficult to interpret since it contained few glomeruli with predominantly ischaemic changes. However, ...

View Discussion

RE: Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 2 hours ago

From the post, I see that his antibody screen is negative but a HLA DSA has not been done. In this case, I would definitely need a HLA DSA. If that...

View Discussion

RE: Transplantation case 2 hours ago

Yes it is worth screening if vigourous excercise is related to AKI especially if serum uric acid is low or low normal during episode -@Zineb Taaam ...

View Discussion

RE: Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 4 hours ago

Thank you very much for your invaluable comments and expert advice. We are truly grateful for your time and guidance. To answer Dr. Soobadar's que...

View Discussion

RE: + MPO ANCA RLV case 17 hours ago

We will have to agree to disagree on this point. My AI consultant and colleague (Claude ) agrees with me that the urinary albumin-creatinine ratio ...

View Discussion

RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 17 hours ago

Epitope spreading as a prognostic indicator in Primary MN, independent of the total anti-PLzA2R antibody , is controversial and predominantly a res...

View Discussion

RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 18 hours ago

In mn relapsers there is concept of epitope spreaders vs non spreaders and impact as result can you explain ? --------------------------------- M...

View Discussion

RE: Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 18 hours ago

Many thanks for case and input from Prof lerman Haploidentical means 50% genetic match. Therefore as alluded doing flow on top sab with cdc for com...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 18 hours ago

the anion gap can fool you. If the baseline is low a normal anion gap may be lelvated. I like the above idea of checking lactate and B-oH butyrat...

View Discussion

RE: + MPO ANCA RLV case 18 hours ago

@Richard Glassock says "I think that Dr. Rodby's more conservative suggestions are very reasonable (as expected) but proteinuria is likely to be ...

View Discussion

RE: Transplantation case 20 hours ago

I know that it is a rare cause of recurrent AKI, but exercise induced AKI , with spontaneous reversibility has been observed in patients with genet...

View Discussion

RE: + MPO ANCA RLV case 20 hours ago

I will admit that the persistence of + anti-MPO serology has influenced my opinions in this case. I fully recognize, the possibility that the persi...

View Discussion

RE: + MPO ANCA RLV case 23 hours ago

I will have those results back early next week. Thank you. Sent from my iPhone

View Discussion

RE: Transplantation case 1 day ago

it would be interesting especially if serum uric acid levels were unusually high or low but since each episode recovered with IV 0.9 NS not sure ho...

View Discussion

RE: Transplantation case 1 day ago

Got it thanks. Would it be worthwhile to study fractional excretion of uric acid after the patient has recovered from AKI. What about genetic studi...

View Discussion

RE: Transplantation case 1 day ago

Dr. Lerman -what is the date of the post and the topic title so I can find the discussion of this case in es in the Transplantation Community posts...

View Discussion

RE: + MPO ANCA RLV case 1 day ago

What are the values for ESR and CRPas Biomarkers for "active inflammation"? ------------------------------ Richard Glassock MD, FASN Emeritus Pro...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

HI John, I also wondered about SGLT2 and Metformin contributing but AG 6 ( though HCO3 was taken from BG ) would seem to exclude euglycemic DKA and...

View Discussion

RE: Transplantation case 1 day ago

this same case has been discussed in more detail under KIDNEY TRANSPLANTATION community ------------------------------ [Mark] [Lerman] [MD,FASN,F...

View Discussion

RE: Transplantation case 1 day ago

Do the episodes of have any relationship to vigorous exercise or gross hematurua/hemoglbinuria ? .. is the donor perfectly healthy? How firm is the...

View Discussion

RE: Transplantation case 1 day ago

Denovo Iga diagnosis was confirmed by IF staining ? any hematuria along with protienuria What's his HB AIC < his sugar under control Th...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

I also wondered about SGLT2i euglycemic ketoacidosis and Metformin lactic acidosis playing a role, but the normal anion gap discouraged those two t...

View Discussion

RE: + MPO ANCA RLV case 1 day ago

I suppose this is one of the issues that has bothered me… With the presence of an active urine sediment, and no evidence of increased albuminuria,...

View Discussion

RE: + MPO ANCA RLV case 1 day ago

I think that Dr. Rodby's more conservative suggestions are very reasonable (as expected) but proteinuria is likely to be a poorly reliable biomarke...

View Discussion

RE: + MPO ANCA RLV case 1 day ago

Thank you Dr. Rodby. Sent from my iPhone

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Thank you Dr. Emmett for your customary thoughtful comments and therapeutic suggestions. ------------------------------ Mario Rubin, M.D. Housto...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Very interesting discussion. Couple of things to point out. First re mechanism – there is one abstract describing 2 patients with One thing I h...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

@Joseph Crivelli Excellent points. Thank you ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -----------------------...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Agree with trying to replace at least some of the sodium bicarbonate with potassium citrate, with caution because of lisinopril. His serum K looks ...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Dr. Rubin you are correct to question the sensitivity of ultrasound in measuring residual urinary volume in an orthotopic ileal Bladder as Trans...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

@Michael Emmett @Biff Palmer Stasis of urine within the pouch (as already mentioned) leads to enhanced activity of the Cl-/HC03- intestin...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Good idea- if Claude agrees. Open AI and Anthropic are not on friendly terms right now. ------------------------------ Richard Glassock MD, FAS...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 1 day ago

Maybe we should let our AI friends meet and settle this matter among themselves. ------------------------------ Christian Kuhn MD Kantonsspital S...

View Discussion

RE: Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 1 day ago

just heard from my HLA LAB DIRECTOR “totally agree with you. We ignore any positive crossmatch, T or B cells with no DSA as those are considered ...

View Discussion

RE: Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 1 day ago

Thanks for presenting this very interesting case on our kidney transplantation site. negative T cell cross matches with indeterminant B cell cross ...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

My AI colleague (Claude) was more optimistic and nuanced, Why not tru a low dose of Nicotinic Acid (100 mg TID) and monitor Glucose and bicarbonate...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

I just asked OpenEvidence about the role of chlorpromazine or nicotinic acid in this setting. The summary was that "both agents have a plausible ...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

Dr Rodby's points are described quite well. From a quantitive perspective he is receiving around 100 mmole HCO3 to neutralize the addition of the e...

View Discussion

RE: + MPO ANCA RLV case 2 days ago

Im a bit more conservative on this, I think you can watch her for now, but if MPO increases and proteinuria develops then I would restart Rituximab...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

Thank you for the interesting suggestion regarding nicotinic acid or chlorpromazine! According to the urologist: there is no relevant residual uri...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

The urine pH of 8.5 is tell;ing you that the pouch is excreting a lot of HCO3. I have not seen the high requirements that you are describing and I ...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

Agree with Dr. Glassock's suggestions - would also consider adding kcitrate and consider measuring residual volume in neoblader ( ultrasound post v...

View Discussion

RE: Persistant metabolic acidosis after cystectomy 2 days ago

This problem is most likely due to excessive bicarbonate secretion and chloride reabsorption by the orthopic ileal pouch, especially if it is exces...

View Discussion

Persistent Indeterminate B-cell Crossmatch Before Living Donor Kidney Transplantation 2 days ago

Hello everyone. Thank you for the opportunity to present this case. I would greatly appreciate your thoughts and recommendations. We are evaluatin...

View Discussion

RE: + MPO ANCA RLV case 2 days ago

Thank you Dr. Glassock. Sent from my iPhone

View Discussion

Persistant metabolic acidosis after cystectomy 2 days ago

59-year-old patient who underwent radical cystoprostatovesiculectomy in 2020 with creation of an orthotopic ileal neobladder. We are consulted beca...

View Discussion

RE: Membranous Patient 2 days ago

I agree, MTX is contra-indicated in this patient! in my limited experience, Treating the Sarcoidosisv usually relieves the MN as well. ----------...

View Discussion

RE: + MPO ANCA RLV case 2 days ago

With 54+ Glomeruli in the cortical sample is is unlikely (but remotely possible) that you have mussed an area of focal glomerular active Vasculitis...

View Discussion

RE: Membranous Nephropathy with PLA2R positive & crescents in 8/37 glomeruli with negative ANCA,ANA & ANTI GBM. 2 days ago

Yes, planning to start prophylactic anticoagulation 4 to 5 days post biopsy. Is using Apixaban okay or stick with Warfarin? Thank you. --------...

View Discussion

RE: Treatment of MVI 2 days ago

Thanks prof Lerman --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion