RE: Remote 2nd opinion: progressive CKD 7 hours ago

"1. Nicardia XL ( NIFEDIPINE) 30 mg BID 2. Arkamin (CLONIDINE) 0.1 mg TID 3. Metolar XL (METOPROLOL) 50 mg QD 4. Minipres XL (PRAZOSIN) 10 mg BID 5...

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RE: anca with ?myocbacterium 12 hours ago

thank you for quick info and reply, just scary knowing is infection potentially, waiting for official pcr gene on tue/wed- ID person was hoping its...

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RE: anca with ?myocbacterium 12 hours ago

you may be stuck with treating for both simultaneously https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-018-0732-3 ----------------...

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RE: Remote 2nd opinion: progressive CKD 13 hours ago

Which part of India this pt from. Could recommend Institute near by patient’s home --------------------------------- Bajinder Reen MD Brampton ON...

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RE: Remote 2nd opinion: progressive CKD 14 hours ago

Thank you Dr Venkat--much appreciated--UA is 3+ protein by dip and no blood or cells--UPCR 1.5-2.0 over the last few years Great recommendation...

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RE: Remote 2nd opinion: progressive CKD 14 hours ago

Urinalysis findings? UAlb/Cr and UPr/Cr ratio? Autoimmune serological markers, HIV, serum immunoelectrophoresis, kappa:lambda light chain ratio, PT...

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Remote 2nd opinion: progressive CKD 15 hours ago

Dear ASN Colleagues: Thank you in advance for ANY interest and input into a case. I have been asked by my institution to provide a remote second n...

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anca with ?myocbacterium 15 hours ago

79 yo female with bronchiectasis , hx of mycobacterium abscesses on culture but never treated july and august 2022, presents with sob, on was on h...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 18 hours ago

eGFR data is out to 3 years. The initial dip in eGFR with SGLT2i was followed by a lower slope compared to controls. In absolute terms the eGFR at ...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 18 hours ago

Is genetic testing indicated in this patient? I think so. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 19 hours ago

What are his NH4 and SO4 excretions while not taking alkali supplements? What are his serum and urine Mg? ------------------------------ John Asp...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 19 hours ago

Dr. Hiremath - are you suggesting that SGLT2i slow the physiologic loss of nephrons with normal aging? Perfectly health people lose nephrons with a...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 20 hours ago

Not a dRTA. seems like he has a metabolic alkalosis due to thiazides and or citrate. Would need to repeat labs off all meds. -------------...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 23 hours ago

I would hesitate to interpret subgroups the way you are doing Dr Hirsch. Subgroups are not individually powered to show significant effects - and t...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Lactose intolerant. Takes fair bit of vitamin D (which makes me nervous given the stones) bc Vitamin D levels won't normalize. No calcium supplemen...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Hypercalciurua, stones and metabolic alkalosis . . . . ? Milk-@Alkali Syndrome? ------------------------------ Richard Glassock MD, FASN Laguna W...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Yes--but started AFTER the litholink (recently). ------------------------------ Meera Bajwa MD Marin Nephrology Greenbrae CA --------------------...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

C1 or C2 lesions were not an exclusion criteria. In fact 46% of the MMF arm had C1 orC2 lesions. ------------------------------ Richard Glassock ...

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RE: C3 GN 1 day ago

Thanks Roger. Depending on the device one uses, , references can't always be seen...a problem for ASN to sort out ------------------------------ ...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Ooh he is on K citrate, how much? ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chi...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Yeah you're prob right. The think is never overtly hypokalemic again every since off the thiazide so never seen such a mild Gitelman. But you're ri...

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RE: C3 GN 1 day ago

"Roger: Can you plz give me the reference on the clinical course plot you posted? Having trouble reading it closely. Thx" The paper was attached ...

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RE: kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

I think a high HCO3 rules out D-RTA unless you were on high doses of HCO3 or Citrate etc. Diuretics usually force an acid urine I wonder if the st...

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kidney stones and RTA with high CO2 levels and high urine ph 1 day ago

Do you see distal RTA with normal or even high CO2 levels? I have a middle aged pt referred to me sometime ago for hypokalemia with sx--easily at...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

It seems to me there is an important piece of information that we need, and I can't find it in the NEJM article--with regard to the question of whe...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Indeed, this trial, if at all, reaffirms the KDIGO recommendation. However, @Richard Glassock - I do believe the MAIN trial excluded Crescentic IgA...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Dr Glassock., I understand what you are saying. Should this mean that when KDIGO puts out guidelines, racial differences in choice of therapy shou...

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RE: C3 GN 1 day ago

Roger: Can you plz give me the reference on the clinical course plot you posted? Having trouble reading it closely. Thx -------------------------...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

The Chinese / Non-Chinese dichotomy concerning efficacy of MMF in IgAN is impressive, long-standing and unexplained. The MAIN trials settles nothin...

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RE: C3 GN 1 day ago

Quite a contrast between clinical manifestation and histology shows how C3GN can insidiously damage kidneys. I would favour Pred+MMF since this com...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

Thank you for the excellent discussion of the issue. Question.: IgA is worldwide but is immune response the samein different ethnic groups? ? In Pa...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

Thank you very much Drs. Simon, Hiremath, and Glassock ------------------------------ Ira Meisels MD New York NY (212) 523-3530 -----------------...

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RE: C3 GN 1 day ago

Thanks for posting additional information. The markedly low C3 level (in the setting of presumably longstanding proteinuria), and the immunofluores...

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RE: MMF Monotherapy In IgA Nephropathy? 1 day ago

For those interested - a deeper dive into the trial here http://www.nephjc.com/news/mmf-iga Swapnil --------------------------------- Swapnil Hi...

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RE: Farxiga post transplant 1 day ago

Indeed - as we showed here https://pubmed.ncbi.nlm.nih.gov/27712852/ with RASi, one should be careful with extrapolation. The pathophysiology of ki...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

As the resident Flozin-manic Flozinator, I would like to chime in. From a statistical point of view, also look at the GFR slope analysis. Picture...

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RE: C3 GN 1 day ago

C3 12 mg/ dl ( 79-152) C4 17.9 mg/dl ( 16-39) C3 neph factor c4 and c5 neph factor Ab to h ,b, c3b C5-9 Factor h , factor I , membrane cofact...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

I agree with Roger. The decision to use these meds, like all other therapies, is a risk/benefit analysis. Unless/until there is evidence to suggest...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 1 day ago

Thank you very much Dr Rodby ------------------------------ Ira Meisels MD New York NY (212) 523-3530 ------------------------------

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RE: C3 GN 2 days ago

Would a C3Nef assay make a difference in your choice of therapy? Would a + test for anti-fH antibody do the same ? what about serum C3/C4 levels? ...

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RE: C3 GN 2 days ago

Can you please post the full de-identified renal biopsy (including EM) report? Could this be a burnt out post-infectious GN? Any clues as to how lo...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 2 days ago

There is what I call Flozinmania by many of my very respected colleagues, they want it put in the water supply... . Flozins do appear to have an ef...

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RE: C3 GN 2 days ago

Good question, made me read up on this "It is also noteworthy that corticosteroids have been used along with MMF in most studies. In some studie...

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C3 GN 2 days ago

I have a 45 yr old female who was rejected from life insurance due to proteinuria . She had upc of 2 gm/ gm and macr of 1543 mg/ gm . Creat of 0.57...

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RE: SGLT 2 Inhibitors in all CKD pts with eGFR > 20 2 days ago

Correction : I guess the low urine albumin groups that crossed the line included the pts with higher eGFR . Still uncertain what to do thanks ---...

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SGLT 2 Inhibitors in all CKD pts with eGFR > 20 2 days ago

My apologies if this has been addressed already: Since Empa-Kidney, I have been struggling with the following: Should I put all of my CKD pts with ...

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RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 2 days ago

Totally agree This patient after starting cyclo keeping improving reached 148 --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIS...

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RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 2 days ago

Rather than any absolute platelet count (or WBC count) cutoff, I use the following factors to decide about giving cyclophosphamide to a cytopenic l...

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RE: Nephrolithiasis and Osteoporosis 2 days ago

Thank you for your input. Potassium has typically been around 3.4-3.8. Therefore, I was thinking of using potassium citrate with plan to follow uri...

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RE: Nephrolithiasis and Osteoporosis 2 days ago

Your description certainly supports a distal RTA. Out of curiosity, is the patient also hypokalemic and have you evaluated for an autoimmune dis...

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