RE: Transplant Medications And COVID-19 2 hours ago

@Mark Lerman Dr Lerman, Covid positive without or with pneumonia? I guess we are going to see many asymptomatic or minimally symptomatic KTRs with...

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RE: Transplant Medications And COVID-19 3 hours ago

Agree with aggressive work up including bronchoscopy to confirm COVID19 and exclude bacterial and or fungal infection. What is CRP,ferritin, IL6 le...

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Vascular Access procedures in an Era of Covid 4 hours ago

I wonder what other's experiences are with regard to obtaining vascular access procedures (both surgical and Interventional) in an era of covid. Cu...

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RE: Lupus Nephritis 4 hours ago

Good point! I see her today in "video" clinic and will assess. ------------------------------ Brian Thornton MD Summit Nephrology Medical Group, In...

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RE: Lupus Nephritis 4 hours ago

Thank you for the input. Although she was worsening on MMF, she has had no response to the cytoxan and perhaps it is time to consider RTX and MMF. ...

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RE: Lupus Nephritis 4 hours ago

No current evidence of MAHA. No TMA noted on biopsy. Unfortunately the lab did not provide MPV. ------------------------------ Brian Thornton MD Su...

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RE: Lupus Nephritis 4 hours ago

​Brian Is she taking her prednisone? (And " She says she is " is not the right answer.) Joanne Bargman ------------------------------ Joanne Bargma...

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RE: Limiting staff exposure with CRRT/IHD in COVID 4 hours ago

I have heard suggestions of decreasing treatment times in hospitalized patients. My first concern would be that patients with respiratory compromis...

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RE: Transplant Medications And COVID-19 4 hours ago

Since superinfections are common in immunosuppressed transplant recipients (CMV predisposing to infections by other microbes is a good example) and...

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RE: Histiocytic Nephropathy 5 hours ago

Are there any therapies available directed specifically against CD-68 +ve cells? A hematologist/oncologist may be able to help. -------------------...

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RE: TMA with Covid-19 5 hours ago

Picture was not Consistent with DIC. Tocilizumab is a good option as we do have a available in the hospital for COVID-19 in severe cases. cr did co...

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RE: Transplant Medications And COVID-19 5 hours ago

Done with contrast to rule out PE. Showed diffuse ground glass opacities and no PE. --------------------------------- Mohammad Alsawah MD Detroit ...

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RE: Lupus Nephritis 6 hours ago

Sounds like she couldn't tolerate MMF due to GI issues and can't tolerate CYC because of cytopenias.  I was also wondering if you could convert you...

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RE: Transplant Medications And COVID-19 6 hours ago

False negative COVID19 tests are fairly common, depending on sampling method. False positive COVID tests are quite uncommon. Because this patients ...

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RE: Histiocytic Nephropathy 6 hours ago

Are the EM results available yet. Was a liver biopsy done? Sent from my iPad

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RE: Transplant Medications And COVID-19 9 hours ago

What would you do if they have bilateral lung infiltrate and fever and require high level of oxygen. It’s getting pretty common to see KTR in the i...

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RE: Histiocytic Nephropathy 9 hours ago

Now Day 9 of admission, patient continues to be anuric while on steroids( solumedrol pulse followed by Oral 1 mg per kg Prednisolone) As the patien...

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RE: Histiocytic Nephropathy 11 hours ago

Sorry for my previous misinformation.  I just Discussed with Dr.Swarnalatha our Renal Pathologist, she confirmed that the Oil red O stain was done ...

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RE: Histiocytic Nephropathy 11 hours ago

Lipid stain was not on frozen section. And the CD68 extensive positivity puts to rest the doubts about LCAT, it is histiocytic glomerular and inter...

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RE: LDL apheresis in recurrent FSGS 14 hours ago

Yes, when he was on intensive TPE schedule of three times a week early post transplant, proteinuria was down to subnephrotic range of 2-3 grams. --...

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RE: TMA with Covid-19 15 hours ago

I’d suspect Covid-19-assoc DIC on top of her established metastatic breast CA/chemotherapy-related TMA. Are labs c/w DIC? Did MAHA resolve post-dox...

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RE: LDL apheresis in recurrent FSGS 15 hours ago

Does proteinuria resolve with more frequent PLEX? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] [Past Medical Director Kidney ...

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RE: TMA with Covid-19 15 hours ago

Consider tocilizumab if D-DIMER,FERRITIN,CRP,,IL6 IS ELEVATED The content in this comment/discussion is not intended to be medical advice for a par...

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RE: Transplant Medications And COVID-19 15 hours ago

From AST - Immunosuppres s ion in COVID-19 positive patients There is absence of consensus at this point: In patients with COVID-19 without pneum...

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RE: covid 19, cytokines and crrt 15 hours ago

In addition to counterarguments already noted, another taken from toxicokinetics has to do with endogenous pro-inflammatory cytokine clearance in t...

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RE: Lupus Nephritis 17 hours ago

Is there any evidence of MAHA or TMA?With refractory LN and 65 % Crescents Class IVQ LN needs to be considered (Pauci immune MPA superimposed on Cl...

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RE: covid 19, cytokines and crrt 18 hours ago

Thank you Dr. Rodby. I read your editorial and appreciate you sending it. I agree that NxStage can achieve higher uf rates, I was just trying to po...

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Lupus Nephritis 18 hours ago

23 yo woman with probable two year history of lupus symptoms formally diagnosed after skin biopsy for cutaneous manifestation subsequently found to...

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RE: TMA with Covid-19 19 hours ago

I think to think of Ahus is. Good though In ards compliment activation plays role But before that you should also consider viral related macrophge ...

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RE: Unexplained AIN 19 hours ago

Hi everyone, So I have some updates, the latest Cr is down to 2.79 (the trend has been 4-->3.3-->2.79) on prednisone taper (decreasing by 10mg q 2 ...

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RE: Covid 19 Without Crrt Available 19 hours ago

Thank you ! Anyone using Cytosorb? ------------------------------ Paul El Azoury MD, FASN University of Vermont Champlain Valley Physician Hospital...

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RE: TMA with Covid-19 19 hours ago

Please check and see if the patient has hematophagocytic lymphohistiocytosis (HLH)- the plasma ferritin levees should be greatly elevated. If so, a...

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RE: Covid 19 Without Crrt Available 20 hours ago

I agree that “removing the cytokines” is not a scientifically based rationale for CRRT in a patient with severe COVID19, unless it is combined with...

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RE: covid 19, cytokines and crrt 20 hours ago

Attached is an editorial I wrote on this many years ago but principal still applies.  Studies using convection for sepsis have not shown it to be h...

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RE: covid 19, cytokines and crrt 20 hours ago

Thank you Dr. Desai. Very helpful. ------------------------------ Brian Michel MD Haddon Renal Medical Specialists Cherry Hill NJ 856 428 8992 ----...

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RE: Covid 19 Without Crrt Available 20 hours ago

"We are seeing a lot of AKI with COVID-19in the ICU , what will be the best timing for initiating CRRT ? Do you think it will make any difference i...

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RE: LDL apheresis in recurrent FSGS 20 hours ago

GFR has been around 65 with serum creatinine 1.2 to 1.4 range and serum albumin around 3.6-3.9. His replacement solutions with weekly TPE is 5% alb...

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RE: TMA with Covid-19 20 hours ago

Very sick patient. With COVID I doubt I would plex patient. I wonder if this is underlying aHUS and the second hit is this infection. -------------...

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RE: LDL apheresis in recurrent FSGS 20 hours ago

I had a patient many years ago who had a history of FSGS.  She had one transplant that was failing and required a second transplant.  She had a sis...

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CRRT - Citrate anticoagulation with Ca-containing solutions 20 hours ago

Hi, Do you have any experience using citrate anticoagulation for CVVH/CVVHD when the replacement fluid (or dialysate) has Ca++ content? We have a p...

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TMA with Covid-19 20 hours ago

Hi all  I have a patient who is 76 years old with breast cancer with mets to the bones and with a skin serum cr 0.9 in early December 2019 than u...

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RE: covid 19, cytokines and crrt 20 hours ago

Cytokine removal from the #NephTwitter community:  https://datastudio.google.com/s/k19-Xh85ozA You may also want to consider Cytosorb as well:  htt...

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RE: Covid 19 Without Crrt Available 22 hours ago

The case I was discussing was using the Tablo Machine. Both the bowls and the heparin are administered systemically as I believe we do not have a w...

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RE: Covid 19 Without Crrt Available 22 hours ago

The reference below is helpful as best   evidence based review knowledge that could be used to answer many queries on Renal replacement in AKI, Bef...

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RE: Transplant Medications And COVID-19 22 hours ago

Who really knows. There is much uncertainty because there has been so little time to collect useful data. From theoretical standpoint, I see little...

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RE: DIY Dialysate for CVVHD 23 hours ago

Thank you so much Dr. Remillard! I wish I knew how to operate the machine myself! ...something to look forward to :) ------------------------------...

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RE: DIY Dialysate for CVVHD 23 hours ago

Thank you so much Dr. Demirjian,this is extremely helpful! I am glad there are some things that we can still do ourselves :) ----------------------...

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RE: Transplant Medications And COVID-19 23 hours ago

​in my discussions with transplant team at Hackensack, they recommended the following. If only very mild sx, continue current therapy. Most inpatie...

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Limiting staff exposure with CRRT/IHD in COVID 1 day ago

​I was curious if any physicians could share what their respective hospitals have come up with to limit exposure to HD nurses and ICU RNs with CRRT...

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Transplant Medications And COVID-19 1 day ago

Dear Colleagues. Any recommendations on maintenance Transplant meds management (Prednisone, Tacro, MMF) in patients with COVID-19 infection? Thank ...

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