RE: Conventional treatment resistant Anti GBM disease 20 minutes ago

Similar associations of anti-GBM disease with COVID19, HIV and Influenza A exist. As far as I can tell, no TMA was concomitantly present . I know o...

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RE: Pseudohypertension or true uncontrolled HTN 48 minutes ago

With a positive Osler sign , this is most likely Pseudo -hypertension due to Monkebergs arterial sclerosis. X-rays of the arms will likely reveal a...

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RE: Pseudohypertension or true uncontrolled HTN 1 hour ago

Im not sure you will be able to tell without an arterial line? Im also not sure it is worth it Personally I would add 5 amlodipine (5 not 10, ...

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Pseudohypertension or true uncontrolled HTN 2 hours ago

An 88 yr old male with a normal renal fn ( creat 0.96, eGFR 72) was referred to me today for uncontrolled systolic HTN. 4 months ago, his SBPs at h...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 3 hours ago

Here is the article in question. Files Attached Documentrecurrent fainting with peritoneal dialysis start, ? vagal reaction Attachments

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RE: Conventional treatment resistant Anti GBM disease 3 hours ago

Thanks @prof glassock What about kidney biopsy of patient with dengue ? Any tma? --------------------------------- Muhammad Soobadar MBChB UK ...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 4 hours ago

baseline BP is good, and yes supine positioned ------------------------------ Radu Raducu MD MD Sanford Hospital BIsmarck ND (203) 606-7322 ----...

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RE: simultaneous liver kidney transplant 4 hours ago

Dear Dr David Goldfarb Thanks for the reference. I will talk with my lab and then will contact the author regarding the same . Thanks again --...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 5 hours ago

This thread has been highly instructive. Thanks for sharing literature Dr Rubin and Dr Lerman on different benign to maligant pathways of CRC and t...

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RE: simultaneous liver kidney transplant 5 hours ago

@Satish Balan, with respect to measurement of plasma oxalate, see this reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC12231001/ The usual meth...

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RE: Conventional treatment resistant Anti GBM disease 6 hours ago

I have no perdonal experience with this combination- but Dengue and anti-GBM has been reported (with anti-MPO ANCA ) See Lizarraga K et al. Clin Ne...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 6 hours ago

Just to be sure, what is her baseline blood pressure and is infusing dialysate in the supine position? ------------------------------ Satish Bala...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 7 hours ago

Unlike Roger, this is a situation where I find urine chems very helpful. I would do a 24 hr urine collection for K and creatinine, with a serum K a...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 8 hours ago

these are results so fa 1. Cancer post kidney transplant BRONZE CONTRIBUTOR Mark Lerman Posted ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 8 hours ago

If you want to share your email address with me privately, my email address is MJL 972@aol.com. I can then email you the information that you need ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 8 hours ago

You must be a member of the American Society of Transplantation, and then once you're a member, you join the kidney pancreas community of practice....

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RE: Dual mutations of uncertain significance 8 hours ago

DGKE is a recessive gene, therefore, in this case, the most parsimonious conclusion is that the case is, at best, a heterozygous carrier of a VUS. ...

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RE: Conventional treatment resistant Anti GBM disease 8 hours ago

Thanks for case Vascultis titres negative ? I don’t have experience in eculuzimab in this context I would continue with oral cyclo and get fertilit...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 9 hours ago

I found two case reports in Peritoneal Dialysis International in 1993. Very similar to what Dr. Raducu is describing. In one report from Spain, two...

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Conventional treatment resistant Anti GBM disease 9 hours ago

I will be grateful for inputs on this case of a 20 year old college student who came with fever, oliguria and AKI. His IgM anti Dengue antibody was...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 13 hours ago

Initial Bx done over 20 years ago. We don't have the records. She is reluctant for another Bx. However, She appreciate that should the proteinuria ...

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RE: Dual mutations of uncertain significance 18 hours ago

Thanks for sharing your thoughts. May be that is how they found out that eculizumab does not work for those with DGKE mutations.

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RE: Dual mutations of uncertain significance 18 hours ago

Patients with DGKE variants have been treated with eculizumab. There are reports of alternative complement pathway disorders in these patients but ...

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RE: Role of Complement Blocker in Infectious GN ?? 20 hours ago

In this case I prefer Option #1. No good evidence favoring therapy with C blocker at this point. It make take more time for full recovery of acute ...

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RE: Dual mutations of uncertain significance 23 hours ago

You are correct, thanks for pointing that out.

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RE: Dual mutations of uncertain significance 23 hours ago

Is Eculuzumab therapy effective for native or recurrent TMA in DKGEpsilon mediated disease. I don't think so . Can anyone clarify this for me? --...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 23 hours ago

I resonate with the very pragmatic approach of Dr. Rodby to patients like the one posted. The inner detective present in Nephrologist often drives ...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 1 day ago

Here is my take on this, perhaps over simplified but has served me well. 25% kidney function is NOT enough to explain hyperK based on low gfr, I...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 1 day ago

I would think evaluation for hypoadrenalism. Likely lost one adrenal with nephrectomy for RCC. The remaining adrenal may have suffered vascular inj...

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RE: Dual mutations of uncertain significance 1 day ago

Of course there are always firsts. We do not know everything about VUS and even atypical HUS. If I were you, I would keep a close eye on him post-t...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 1 day ago

not on any betablocker just finish work up for transplant and cardiac is ok, primary disease is ALPORT syndrome, i am holding am BP meds but i don'...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 1 day ago

no pain, really fast recovery but she scare the nurse 2 times now, patient says she thinks she can deal with it but I am concern, will start traini...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 1 day ago

Has she had a biopsy? What is her lesion I always worry about SLE exacerbation during pregnancy and I typically increase therapy. I like your i...

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RE: recurrent fainting with peritoneal dialysis start, ? vagal reaction 1 day ago

The bradycardia really makes it seem like vasovagal. Is there pain as the patient instills? regardless this does not sound good. A poster case r...

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recurrent fainting with peritoneal dialysis start, ? vagal reaction 1 day ago

wanted to get the forum input regarding a new dialysis start for patient on peritoneal dialysis patient developed recurrent episodes of what loo...

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RE: Dual mutations of uncertain significance 1 day ago

If you look at the clinical manifestations of DGKE nephropathy, the presentation is almost always in infancy and early childhood. I don't know if t...

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RE: Role of Complement Blocker in Infectious GN ?? 1 day ago

Hello again If anyone is following this case , the patient had a eGFR around 85 ml/min prior to his PSGN At 12 weeks post AKI sec to PSGN his ...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 1 day ago

Dr. Lerman how can we have access to American Society of transplantation's kidney pancreas community of practice ? ------------------------------...

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RE: Dual mutations of uncertain significance 1 day ago

All these are good questions: Since DGKE mutation is heterozygous, unlikely to recur. Collagen mutation is also heterozygous. Again, we do not ...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 1 day ago

Thanks Pt is already on HCQ. Yes, I will consider adding Tacrolimus. ------------------------------ Dr Mohamed Buhary MBBS, CCT, FRCP Consul...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 2 days ago

I have also posted this case on the American Society of transplantation's kidney pancreas community of practice. That allows this post to be viewed...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 2 days ago

Tacrolimus would be fine. Thsnks for the information on Voclosporin availability in the Gulf of Arabia region. ------------------------------ Ri...

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RE: Dual mutations of uncertain significance 2 days ago

A heterozygous mutation of Collagen IV alpha 3 can cause CKD in the Alport Syndrome spectrum category but it is very unlikely that post-transplanta...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 2 days ago

Voclosporin.... Is not available in this region, Kingdom of Saudi Arabia, UAE , Gulf regions ... Rumors were because of the high alcohol content !!...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

JD: I have been trying to reach you. This is re: a project I had mentioned to you in the past. For some reason, emails are bouncing back. Prem Cha...

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Dual mutations of uncertain significance 2 days ago

I require helpful suggestions for managing a 38 year old male born of non consanguineous parentage presenting with bilateral echogenic shrunken kid...

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RE: One and half nephrectomy, normal looking GFR but hyperkalemia, question on K physiology 2 days ago

You want to consider looking for a kidney K secreting defect measuring U K-Cr or TTKG. If abnormally low proceed with a more formal workup includin...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 2 days ago

After 23 years without any allograft rejection the risk of stopping MMF and inducing a rejection episode is very , very low (but not zero) (Dr. Rub...

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RE: Sigmoid Adenocarcinoma in Renal Tx patient on MMF/CyA/Pred - to Stop MMF or not 2 days ago

As per our extensive discussion as to whether a distal (left sided ) colon cancer is related to MMF ? And no evidence of extension beyond resection...

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RE: SLE - Pre-Pregnancy Immunosuppression swap dilemma 2 days ago

Would add hydroxychloroquine if not already on it --------------------------------- Edgard Wehbe MD, FASN Wichita Nephrology Group Wichita KS ...

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