RE: Fit To Fly In Ckd 5 Patient 3 hours ago

What is the hemoglobin level ? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: Lupus nephritis 3 hours ago

I'm not sure thatI would have recommended PLEx in this case -any opinions on indications for this procedure in cases like this with massive intrava...

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RE: Lupus nephritis 4 hours ago

Drug toxicity can definitely cause this picture and should be excluded, especially calcineurin inhibitor toxicity. This looks more consistent with...

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Fit To Fly In Ckd 5 Patient 5 hours ago

Pt with eGFR 7 for past year ( will have pd tube at some point ) Wants to fly out of uk to Thailand Feels well. Still working. No Uraemic sympto...

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RE: Lupus nephritis 7 hours ago

The one case that I saw with this grade of hemoglobinemia and the plasma removed by PLEX was literally black was a man in his 70s that turned out t...

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RE: Lupus nephritis 10 hours ago

Thanks Dr. Rodby, serum haptoglobin was not done in house so had to be outsourced the turnaround time was high so not sent. Also other signs like r...

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RE: Lupus nephritis 10 hours ago

"Thanks Dr. Rodby. The plasma (attached as image)removed by PLEX was dark brown, shall look for heme pigment as advised. She is on dialysis for the...

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RE: Lupus nephritis 12 hours ago

Thanks Dr. Glassock, She had schistocytes in peripheral smear with raised LDH, so was thinking in the lines of Lupus induced TMA, hence decided to ...

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RE: Lupus nephritis 13 hours ago

Curious findings of marked liver and pancreatic enzyme elevation with a lactic acid level of 15 mmol/L suggests shock, possibly transient, R/O medi...

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RE: Lupus nephritis 13 hours ago

Just curious- why are you using PLEX for this patient ? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School...

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RE: Lupus nephritis 15 hours ago

Thanks Dr. Glassock. LDH iso enzyme testing is not available at the hospital, however I shall check if it can be done as an outsourced test. ----...

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RE: Lupus nephritis 15 hours ago

Thanks Dr. Rodby. The plasma (attached as image)removed by PLEX was dark brown, shall look for heme pigment as advised. She is on dialysis for the ...

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RE: Lupus nephritis 15 hours ago

Thanks Dr. Hormaz. ------------------------------ Jaison George MD, MBBS Kollam, India ------------------------------

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RE: Lupus nephritis 15 hours ago

Thanks Dr. Glassock. I shall test the plasma for hemoglobin today.Direct Coomb's tests is negative. Complement levels are low (just got the reports...

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RE: Lupus nephritis 16 hours ago

Update: Her direct Coombs tests is negative, Her LDH dropped to 6840 (from 13969) after 1 session of PLEX. C3 is 44 (range is 90-180), C4 is 6.9 (r...

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RE: Lupus nephritis 23 hours ago

Can you measure iso -enzymes of LDH. LDH 1and 2 woukd be exclusively elevated in Hemolysix, not in Hepatic Necrosis ----------------------------...

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RE: IgA Nephropathy 23 hours ago

The data on efficacy of RTX in IgAV , which is wholly observational , is very impressive. I would give moderate doses of oral steroids (short term ...

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RE: Lupus nephritis 1 day ago

I wonder if the enzymatic assay levels are "false" positives due to the overwhelmingly severe intravascular hemolysis (and hemoglobinemia) . What w...

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RE: Lupus nephritis 1 day ago

Physical state of the patient : The patient is conscious, oriented and has high BP requiring NTG infusion. No fever. ---------------------------...

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RE: Lupus nephritis 1 day ago

With AST and ALT 3-5000, and a severe lactic acidosis, this (and the high LDH) appears like acute hepatic necrosis from an exposure or possibly sho...

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RE: IgA Nephropathy 1 day ago

I'm not convinced that IgAN and IgA vasculitis are completely separate entities, but more of a spectrum. Is there evidence that IgA vasculitis do...

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RE: IgA Nephropathy 1 day ago

Thank you. Do I need to use Prednisone with MMF? Or Tarpeyo with MMF? ------------------------------ Ibrahim Katerji MD Elmira NY -------------...

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RE: Lupus nephritis 1 day ago

This kind of hemolysis can ocurr in HD patients from a variety of issues- chloramine contamination , improper dialysate preparation, crimped vascul...

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RE: Lupus nephritis 1 day ago

I would get a hematology consult first --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheikh ...

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

in my opinion, although this article does not specifically say that it should not be done. It also does not recommend that it be done. As we see wi...

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

I gather from these guidelines that routine genetic testing of an unrelated (altruistic) live donor without any family history of kidney disease wo...

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RE: Lupus nephritis 1 day ago

My guess is that this is mainly severe intravascular hemolysis with false positive Lipase, amylase and troponin due to measurement positive interfe...

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Lupus nephritis 1 day ago

A 53 year old lady on twice weekly maintenance hemodialysis presented with chest discomfort to the casuaity. ECG shows non specific ST-T changes. A...

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RE: Immunosuppression in Lupus/APLA 1 day ago

I agree with Dr. Rubin that if you want to make a definitive diagnosis of hemodynamically significant RAS and establish the nature, site and extent...

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

this a practice guideline from AST ON GENETIC ANALYSIS for kidney transplant recipients and living donors. https://www.amjtransplant.org/action/s...

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RE: Immunosuppression in Lupus/APLA 2 days ago

I think that the Cleveland Clinic work by Novick and Pohl speaks in favor of stopping dancing around a clear-cut question which needs to be answere...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Dear Dr. Glassock, I agree tat the findings of the CORAL study may not necessarily apply to this patient. However, I have some concerns about t...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Whether RAS is related to APLS or atherosclerosis, given single functioning kidney (if the stenosis is severe enough and the right kidney is not to...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Why not do an anatomical study of the right renal artery (e.g. C02 selective renal angiogram or MRA) and if a stenosis is found, the second step wi...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Excellent point Dr. Campese. The CORAL study enrolled only patients with atherosclerotic RAS. Since we suspect (but have not proven angiographicall...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Thanks Dr. Dastoor - Please read the paper by Caps MD , et al Kidney Int, 1998 ;53: 735-742, which addresses the frequency of ocurrence of renal ...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Please see the CORAL Study N Engl J Med. 2014;370;13-22 ------------------------------ Vito M Campese Professor Emeritus of Medicine Keck Schoo...

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RE: Immunosuppression in Lupus/APLA 2 days ago

I doubt that in the absence of high BP , with a single functional kidney, this patient has high grade stenosis . Revascularization carries the risk...

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RE: Immunosuppression in Lupus/APLA 2 days ago

I agree with Dr. Venkat. If a high grade stenotic lesion is found in the right renal artery I would be very tempted to suggest revascularization in...

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RE: Immunosuppression in Lupus/APLA 2 days ago

I agree with Dr. Campese that revascularizing the right kidney with angioplasty/stenting is unlikely to significantly improve GFR. However, given l...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Let us assume a Doppler US shows RAS, how this is going to change the management? indications for a stent or angioplasty in RAS are uncontrolled ...

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RE: Bivalirudin for CRRT 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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 3 days 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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