RE: Bivalirudin for CRRT 1 hour ago

Thanks. We make do without anticoagulation much of the time. Mostly CVVHD. We are having some issues with BSI in these patients. I think mostly jus...

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RE: Bivalirudin for CRRT 2 hours ago

We also do not anticoaulate CRRT/PIRRT unless there is a real clotting issue, We use the NxStage machine that lacks a blood air interface (though...

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RE: Bivalirudin for CRRT 5 hours ago

Thanks. We routinely use anticoagulant-free CRRT with blood flows of 300 ml/min ------------------------------ Jeffrey Berns MD, FASN Philadelphi...

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RE: Bivalirudin for CRRT 6 hours ago

Dr Berns, Have you tried high blood flows (ie 250-300) with pre-and post-infusions? In our experience, that markedly decreased (though did not elim...

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RE: Bivalirudin for CRRT 8 hours ago

Additionally, frequent filter clotting needs managing of other potential underlying reasons. ------------------------------ Ahmed Yasin, MD,FASN ...

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RE: Immunosuppression in Lupus/APLA 8 hours ago

The vascular changes are suggestive of APLA-associated nephropathy, particularly in the absence of another clear explanation for the progressive de...

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RE: Potential donor with mutation in NR3C2 Gene 10 hours ago

Dr Venkat: Very interesting suggestion to this fascinating topic of discussion...in practical terms to get down to a 10 mmol/day Na diet (I did not...

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RE: Immunosuppression in Lupus/APLA 11 hours ago

That's correct. Right kidney is of normal size and left is atrophic. The renal biopsy is from right kidney. ------------------------------ Sanje...

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RE: Immunosuppression in Lupus/APLA 11 hours ago

As far as I know, the Right kidney (the one that was biopsied) is not "atrophic". Only the Lefu kidney is "atrophic ". Kidney sizes have not been r...

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RE: Immunosuppression in Lupus/APLA 12 hours ago

The left kidney is also atrophic, regarding discordance of biopsy of right kidney and global kidney function. ------------------------------ Argy...

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RE: Immunosuppression in Lupus/APLA 12 hours ago

In my opinion. The discordance of glomerulosclerosis and IFTA with eGFR suggests glomerular hypoperfusion.. ------------------------------ Richa...

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RE: Immunosuppression in Lupus/APLA 14 hours ago

Regardless of the cause of ckd , a eGFR of 24 ml/min, does not correlat with IFTA of 20% . There is a discrepency here , but even if it was RAS or ...

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RE: Immunosuppression in Lupus/APLA 21 hours ago

What I am suggesting is that the progressive CKD is due to "Ischemic Nephropathy" from major vascular disease, Not progressive "Lupus nephritis"- I...

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RE: Immunosuppression in Lupus/APLA 22 hours ago

Thank you for your inputs. I shall update once EM is available and will also get a repeat Renal A doppler. ------------------------------ Sanjee...

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RE: Immunosuppression in Lupus/APLA 23 hours ago

Only 20 % global sclerosis and 20% IFTA does indicate "advanced CKD". The APLA syndrome likely accounts for L kidneys RAS and loss of kidney functi...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Extensive subendothelial deposits on EM might indicate need for immunosuppression. Regarding anticoagulation: No recent thromboembolic events, remo...

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RE: Anti GBM with Fibrillary GN 1 day ago

Yes. Negative for paraprotein. --------------------------------- Narothama Reddy Aeddula MD, FASN Newburgh IN (774) 641-1444 -----------------...

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RE: Bivalirudin for CRRT 1 day ago

We have some reluctance to go down the citrate path due to complexity with multiple ICUs, nursing turnover, etc. We also use NxStage machines so wo...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Thanks Dr. Venkat- anything that the EM might show that would change your mind? Would you anti-coagulate ( because of the vascular changes and the ...

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RE: Bivalirudin for CRRT 1 day ago

Hi Dr. Burns, Leo here. Why not citrate, given that it is the recommended anticoagulation strategy per KDIGO? In our experience, when citrate a...

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RE: Anti GBM with Fibrillary GN 1 day ago

Many thanks. Very interesting case report. I wonder if this is not IgG-4 related disease. It is definitely not Fibrillary GN --------------------...

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RE: Anti GBM with Fibrillary GN 1 day ago

Dr Glassock thanks I just read knowing it is rare Dual Anti-Neutrophil Cytoplasmic Antibody and Anti-Glomerular Basement Membrane Antibody-Posit...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I agree with Dr. Dastoor that the pathological changes in the right kidney are too chronic/inactive to justify immunosuppression. I think Doppler U...

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RE: Anti GBM with Fibrillary GN 1 day ago

Dr. Safdar - can you provide a citation that supports this contention. Paraproteinemias are very rare caused of Fibrillary GN or anti-GBM disease, ...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

Dr. Balan - thanks forvyour very erudite discussion of the dilemma posed by genetic testing of unrelated (altruistic)? Living organ donors .Are you...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

No personal experience with this problem. Will putting this donor on a strict salt-restricted diet, say 10 mmol/day and testing her ability to rema...

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RE: AKI/ANCA Vasculitis 1 day ago

Thanks. Are the Pulmonary Disease consults comfortable with using Cyclophosphamide in this case ? Just curious by. ------------------------------...

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RE: AKI/ANCA Vasculitis 1 day ago

The plan is to start cytoxan. We are reaching out to get it approved (sent friday, hopefully start monday or tuesday). He is back on avacopan as we...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

With a genetic report like this, I would definitely not take up the donor. The risks are theoretical but we do not want this to play out in practic...

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RE: Anti GBM with Fibrillary GN 1 day ago

Was pt checked for paraprotein even MGUS can cause antiGBM AND Fib GN --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology,...

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RE: AKI/ANCA Vasculitis 1 day ago

Many thanks for case August 25 diagnosis of Anca Vascultis Sept 25- rituximab 1g x2, prednisolone , avacopan and pcp and bone protection . U...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Drs. Venkat and Rodby -what would be your preferred management of this case? ------------------------------ Richard Glassock MD, FASN Emeritus P...

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RE: Anti GBM with Fibrillary GN 1 day ago

Immunological relapses of anti-GBM disease, after a complete immunological remission , is quite uncommon but it occur in about 10% or less of cases...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

Thank You Dr. Lerman and Dr. Rubin for your help with this case. I have already requested Plasma Aldosterone and Renin activity and will post when ...

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RE: AKI/ANCA Vasculitis 2 days ago

I don't see any clear need for repeat Kidney biopsy. Did you use combined CYC (IV or PO) + RTX . Do you known ehat happened to anti MPO titers? Did...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

@Katafan Achkar -a second response from AST Hub Thanks for that info. This is a mutation in the intronic segment of chromosome 6 where NR3C2 r...

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RE: Anti GBM with Fibrillary GN 2 days ago

Hello all, Wanted to provide an update and seek advice on the case I shared in March( Anti GBM and Fibrillary GN) The patient completed 24 sessio...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

@Simone Sanna-Cherchi Hi Simone. Please comment on the genetic results belonging to a potential living donor included below. As a geneticist, wou...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

My humble professional point of view, is that Dr. Tedla's opinion is logistically sound but, it lacks scientific data that backs up his elegant ass...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

@Katafan Achkar from 1 response so far on AST Hub If she has no evidence of subtle salt wasting (i.e. she has normal renin and aldosterone lev...

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RE: AKI/ANCA Vasculitis 2 days ago

he is breathing comfortably on room air. He's not on any specific treatments for his lungs. he does follow with a pulmonologist but it appears to b...

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RE: AKI/ANCA Vasculitis 2 days ago

His UA from yesterday had 1+ glucose, 3+ protein and 3+ blood. visually it was yellow. No gross hematuria. microscopical eval showed numerous no...

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RE: Bivalirudin for CRRT 2 days ago

Thank you!! Jeff Berns

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RE: Bivalirudin for CRRT 2 days ago

Dr. Berns, I attached an article from Yadava et al. from earlier this year that is the first study I have seen that directly compares reg...

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RE: Membranous Nephropathy 2 days ago

With ANA+ 1:40, other than holding hydralazine, would you recommend checking anti histone ab or ds dan ab+ in this case? By the time 6 months are...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

Thank you Dr. Lerman, please feel free to post this important question on AST hub. ------------------------------ Katafan Achkar MD, FASN Houston...

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RE: Potential donor with mutation in NR3C2 Gene 2 days ago

"this raises an important question: is it preferable to use broad panel testing-with the potential to uncover unexpected and difficult-to-interpret...

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RE: Immunosuppression in Lupus/APLA 2 days ago

"a doppler in 2024 showed increased peak systolic velocity proximal and mid right renal artery with small kidney" I assume there is a typo here a...

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RE: Generic FSGS 2 days ago

Hello Just as a follow up , all 10 siblings in this family tested positive for Homozygous LAMA5 genetic mutation. Have suggested Atrasentan or Sp...

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RE: Immunosuppression in Lupus/APLA 2 days ago

The left kidney is atrophic . The right kindey showing a lot of fibrosis and not much activity eGfR down to 24 ml/min Not sure how much of kidney ...

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