RE: Renal biopsy in Jehovah witness with low Hb/AKI 3 minutes ago

I guess that PLEX is not in the cards in this patient due to religious objections. If ADAMST13 is very low, and schistocytes are seen in the periph...

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RE: peritonial dialysis sugar control 1 hour ago

The absorption of IP insulin is about 30% after a 5 hrs CAPD dwell and higher after a longer dwell duration ( Wideroe T-E et al. Kidney Int 1983). ...

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RE: peritonial dialysis sugar control 3 hours ago

Would IP insulin n CAPD be pro-atherogenic? Just wondering? ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geff...

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RE: peritonial dialysis sugar control 4 hours ago

Insulin i.p. is fine in a CAPD setting with long dwells, because its absorption is slow due to its molecular weight ( ~5500 D). Therefore a much hi...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 6 hours ago

Not a bad idea. The magnitude of the RF titer will give a clue.  My point is that anti-viral therapy alone will have little beneficial effect  in t...

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RE: peritonial dialysis sugar control 9 hours ago

IP insulin gets absorbed through the portal system which I believe is what insulin from the pancreas does? I haven't thought about this for years b...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 9 hours ago

If those Igm deposits resemble cryo thrombi aND the pt has AKI, I woukd plex a few times before the rituxan. --------------------------------- Ro...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 9 hours ago

“Several microangiopathic diseases, including disseminated intravascular coagulation and thrombotic microangiopathies, generate fibrin strands that...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 9 hours ago

I'd be careful not to throw out the value of a low haptoglobin, abberencies which are more likely to be reported, need to be taken with a grain of ...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 9 hours ago

Targeted Genetic profiling of patients suspected of having a hereditary disease is now widely available at reasonable cost and  likely has greater ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 9 hours ago

Sorry-  I thought schistocytes  were seen In a peripheral smear.  Can you confirm this.  It may be important. ------------------------------ Richa...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 10 hours ago

Many thanks Drs. Lerman and Venkat.  I have always thought that undetectable serum Haptoglobin  levels were a quite reliable sign of extravascukar ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 10 hours ago

Found the following reference which describes two SLE patients with very low haptoglobin levels without evidence of hemolysis or worsening anemia. ...

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RE: Hypercalcemia: What is the diagnosis? 11 hours ago

Not sure it changes treatment since patient has significant hypercalcuria and nephrolithiasis. Hopefully the stone experts will weigh in on whether...

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RE: Hypercalcemia: What is the diagnosis? 12 hours ago

Would suggest measuring ionized calcium, especially with 1st patient having albumin 4.7 ------------------------------ Mitchell Kirsch MD Suffolk ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 12 hours ago

If TTP was confirmed with Adamts13 <10 % - the following article may be useful regarding treatment for Jehovah’s Witness https://doi.org/10.1182/...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 12 hours ago

Haptoglobin levels typically decrease with hemolytic anemia including autoimmune hemolytic anemias --------------------------------- [Mark] [Lerm...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 12 hours ago

I discussed with Hem/Onc on board as haptoglobin 137 ---> 127) and total bili is normal. Also pt is Jehovah's witness so will refuse FFP or blood...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 12 hours ago

To my memory, haptoglobin levels do not decline with extra-vascular hemolysis as occurs in warm antibody induced hemolytic anemia. Please correct m...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 12 hours ago

Did WBC and/or platelet counts drop along with hemoglobin? If platelets did not drop, TMA becomes unlikely. Isolated hemolytic anemia could be auto...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 13 hours ago

Anti-viral therapy alone won't do much without RTX and steroids. IS therapy is a fundamental requirement in cases like this. ---------------------...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 13 hours ago

This is a great situation where a urinary CD163 would be helpful. --------------------------------- Tejas Desai, MD Founder, NOD Analytics Charlo...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 13 hours ago

So this is LN as predicted, with a superimposed TMA. The plot thickens. Considering the biopsy risks, I would treat empirically with Steroids, CYC ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 13 hours ago

Very interesting case and fascinating discussion by all-agree with Adamts13 but would strongly consider PLEX if shistocytes on smear. Seems like bi...

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RE: Hypercalcemia: What is the diagnosis? 14 hours ago

Great point Dr. Leung - since initial labs were unremarkable should definitely be checked . Just seems unlikely without history ( large multi vitam...

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RE: peritonial dialysis sugar control 14 hours ago

Thank you Joanne for your educational points. Plan on reading the JASN paper. Mario ------------------------------ Mario Rubin, M.D. Houston TX (7...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 14 hours ago

Hemolysis!!! Schistocytes in the smear? A new twist which requires additional studies such as ADAMST13, alternate complement mutations/antibodies. ...

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RE: MPGN +/- Cryo in HCV patient ... what would you do? 14 hours ago

Starting antiviral therapy

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RE: peritonial dialysis sugar control 14 hours ago

Hi Mario Tor-Erik Wideroe used to examine the kinetics of insulin absorption across the peritoneal membrane.  If I recall (and Prof Krediet would k...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 14 hours ago

Slowly but surely! I personally don't think that genomics-proteomics, etc. has yet reached " a prime time stage " and replaced the well documented ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 14 hours ago

Haptoglobin < 1 LDH 317 (82 - 234) Reticulocyte 3.21% TB 0.2 Finally ANA results are available: ANA TITER 1:1,280, speckled Hydralazine was start...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 15 hours ago

Please ref to paper on line link reports July 16 Comparing trans jugular to traditional biopsy --------------------------------- Bajinder Reen MD...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 15 hours ago

I am not a “kidney biopsy nihilist”, but we need to adapt to modern times . Sophisticated serology and genomics have significantly altered the role...

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RE: Hypercalcemia: What is the diagnosis? 15 hours ago

To be transparent, vitamin A level is not on the list of things I check initially for hypercalcemia.  I've only seen 1 case so it is not that commo...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 15 hours ago

Thanks- I did not realize that a trans-jugular liver biopsy technique cannot easily be adapted to a kidney biopsy, unless you have kidney- specific...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 15 hours ago

Thank you Dr. Bleyer for your prompt response, teaching and guidance. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 -...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 15 hours ago

IN the UMOD form of ADTKD, the patients usually have hyperuricemia, but in the MUC1 mutations, they do not.  We would be happy to provide genetic t...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 15 hours ago

@Deborah Adey Thank you Dr. Leung for sharing your experience. I was not aware that the TJ needle used for renal biopsies is no longer available. ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 15 hours ago

The transjugular kidney biopsy was such a great tool in patients with thrombocytopenia or were on anti-coagulant.  The other thing is if a bleed do...

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RE: Hypercalcemia: What is the diagnosis? 15 hours ago

24 hour urine: calcium was 290 mg/day on one occasion and 550 mg/day on another uric acid ~800 mg/day on both occasions citrate ~800 mg/day on one ...

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RE: peritonial dialysis sugar control 15 hours ago

@Manisha Singh Thank you. I am sure your center has reviewed the published literature on the causes that you cited before you all decided to do aw...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 15 hours ago

The lack of hyperuricemia is against the most common forms (Umod) of ADCTID. @Anthony Bleyer We will appreciate your comments and also some guidanc...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 15 hours ago

@Nelson Leung I have attached two nice articles (single center and systematic review) which document the safety and efficacy of the TJKB procedure...

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RE: Hypercalcemia: What is the diagnosis? 15 hours ago

You said hypercalcuria in one patient - what was actual value of 24 hr calcium and creatinine. Was any other 24 hr urine values obtained ? Uris aci...

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RE: Hypercalcemia: What is the diagnosis? 16 hours ago

I will offer checking Vitamin A to my patients. For the first patient, is it of any harm to use thiazide diuretic to lower calciuresis, if I cannot...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 16 hours ago

Kidney biopsy or genetic screening first? I prefer screening first as if Positive will be more definitive than the likely non-specific Kidney Biops...

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RE: Hypercalcemia: What is the diagnosis? 16 hours ago

The most common cause of vitamin a toxicity is taking large amounts of vitamin supplements. Seems very reasonable to check a vitamin a level and bo...

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RE: Hypercalcemia: What is the diagnosis? 16 hours ago

I agree with Dr. Leung- Vitamin A in excessive dosage can cause hypercalcemia , most likely by an effect on bone metabolism. It is seen more freque...

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RE: Hypercalcemia: What is the diagnosis? 16 hours ago

From UpToDate Causes of hypercalcemia Parathyroid mediated Primary hyperparathyroidism (sporadic) Inherited variants Multiple endocrine...

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RE: peritonial dialysis sugar control 17 hours ago

Medication loss, erratic absorption and concern for steato-hepatitis are why we moved away from insulin in bags. Also multiple punctures more infec...

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