RE: autonomic dysfunction and dialysis 3 hours ago

Thanks for all the good advice Sent from my iPhone

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RE: Cryoglobulinemic MPGN 4 hours ago

IgM kappa generally means a lymphocyte clone, but this one may be deeply embedded in a tissue environment, and the peripheral B cell depletion is s...

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RE: Cryoglobulinemic MPGN 4 hours ago

Do paraffin IF on the kidney biopsy of 8-27-2020. I might give Obinutuzumab a try, then Daratumumab. --------------------------------- Richard Gl...

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RE: Cryoglobulinemic MPGN 4 hours ago

What a case! Great job keeping him alive and off HD. Rituxan seemed ratio work but not last, cyclophosphamide same. Is this a lymphocyte clone, ...

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RE: Cryoglobulinemic MPGN 5 hours ago

Thank you Dr Glassock for the prompt response. Should I then re biopsy him to get the above info? . ------------------------------ Indira Chervu M...

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RE: Cryoglobulinemic MPGN 5 hours ago

If you want to look for a post-HCV PGNMID, I think you should do a Paraffin-iF and maybe study for IgG subclasses. -------------------------------...

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RE: Cryoglobulinemic MPGN 5 hours ago

It looks like the patient has evolved to a post-HCV MGRS with a IgM Kappa anti-IgG Clone. The remissions and relapses following RTX might suggest t...

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RE: autonomic dysfunction and dialysis 6 hours ago

If you end up starting IHD--presumably for symptom relief--you could consider it as a form of palliative care; to make the patient feel better. Tha...

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RE: Cryoglobulinemic MPGN 6 hours ago

correction to above post, the relapse in aug 2020 has some dates mentioned as 2021 Sorry my error, covid is making me lose track of days and years!...

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RE: Hyperaldosteronism In Hemodialysis Patient 6 hours ago

I certainly do agree with  Dr Glassock's logic and approach. If I were caring for this patient I would probably draw a pre dialysis renin and Aldo ...

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Cryoglobulinemic MPGN 6 hours ago

68 y/o W/M with goiter secondary polycythemia from cigarette use, first seen by me in June 2014 for AKI and proteinuria in the setting of a diarrhe...

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RE: autonomic dysfunction and dialysis 7 hours ago

Unfortunately not wealthy enough but keeping options open Sent from my iPhone

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RE: autonomic dysfunction and dialysis 8 hours ago

If he is wealthy it may be worth it to have someone help him with PD . Could prob get away with NIPD, dry during day, and have this person stay ove...

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RE: Hyperaldosteronism In Hemodialysis Patient 8 hours ago

Agree with both prior posts by Dr Glassock, and I still think an aldosterone antagonist will help regardless of the pathophysiology of his HTN. -...

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RE: Hyperaldosteronism In Hemodialysis Patient 9 hours ago

Interestingly, only 1 of the 4 cases described in the references supplied by Dr. Rodby had a proven unilateral aldosterone secreting Adrenal tumor ...

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RE: autonomic dysfunction and dialysis 9 hours ago

Fully understand. Tough choices ahead. But if the patient understands the issues and wishes to proceed with HD, despite the challenges, you have a ...

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RE: Hyperaldosteronism In Hemodialysis Patient 11 hours ago

We really do need to know the aldosterone:plasma renin activity ratio and possibly an abdominal CT to visualize the Adrenal glands to further inter...

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RE: Membranous nephropathy, where to go from here for treatment 11 hours ago

Interesting case. Was the “angiosarcoma” tested for B19/B20 antigen expression?. If + that would explain the results. Thanks for the post. -------...

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RE: Hyperaldosteronism In Hemodialysis Patient 13 hours ago

My guess is that renin and aldo levels will fluctuate wildly in a hemodialysis patient depending on the time of sampling. I suspect the best time t...

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RE: Membranous nephropathy, where to go from here for treatment 13 hours ago

The possibility that rituximab affects podocytes directly is fascinating. I had an interesting ad hoc experience with a 25-year-old male having a d...

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RE: Hyperaldosteronism In Hemodialysis Patient 14 hours ago

The renin angiotensin aldosterone axis is due for new studies  in chronic hemodialysis and peritoneal dialysis patients for example  if a patient h...

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RE: autonomic dysfunction and dialysis 14 hours ago

Midodrine did not help. Northera "too effective" but ntp at bedtime and elevation of head of bed mitigates supine hpt. Sent from my iPhone On Aug...

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RE: autonomic dysfunction and dialysis 14 hours ago

Thanks for your help. I have had all those discussions with patient and wife. He is just "too alive" mentally and very intellectual pretty upbeat (...

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RE: autonomic dysfunction and dialysis 15 hours ago

PD would be the way to go but the family situation seems like that is untenable. Most hypotension on HD is related to volume removal, if diuretics ...

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RE: Hyperaldosteronism In Hemodialysis Patient 15 hours ago

https://academic.oup.com/ndt/article/22/3/917/1900454 https://www.cureus.com/articles/35917-primary-hyperaldosteronism-in-end-stage-renal-disease-...

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RE: Hyperaldosteronism In Hemodialysis Patient 15 hours ago

How did they diagnose hyperaldo in this pt? Do you have the renin Aldo data? Esrd should cure the hypoK but this patient still makes a fair amount ...

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RE: Hyperaldosteronism In Hemodialysis Patient 15 hours ago

Serum aldosterone levels are quite commonly elevated in patients receiving RRT for ESKD (about 60%).  This may indicate a higher mortality risk.  I...

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Hyperaldosteronism In Hemodialysis Patient 20 hours ago

30 year old male patient with a background of IgA nephropathy for many years, commenced on hemodialysis before 6 months due to uremic symptoms. He ...

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RE: autonomic dysfunction and dialysis 20 hours ago

Tough case.  It seems fairly likely that the patients QOL will actually worsen when dialysis is instituted, but I agree with Dr. Rodby that this is...

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RE: autonomic dysfunction and dialysis 20 hours ago

HD seems only option realistically. Normally I like to wait until the last minute symptomatic, but it might be better to start on the earlier side...

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RE: 46 yo Caucasian female with multisystem disease Renal biopsy -TMA with Positive antiphospholipid antibody 21 hours ago

There is further drop in serum creatinine this morning 3. 27 mg. Last 24 hours no change in UOP 900 ml. She received plasma exchange this morning. ...

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autonomic dysfunction and dialysis 1 day ago

83 yo male with urinary retention, indwelling Foley, severe Parkinson's disease related autonomic dysfunction with multiple episodes of orthostatic...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

Thank you all for your insight.  He's thankfully vaccinated as of April. ------------------------------ Leah Metz MD Onalaska WI 608-775-1673 ----...

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RE: 46 yo Caucasian female with multisystem disease Renal biopsy -TMA with Positive antiphospholipid antibody 1 day ago

Not proceeding with IVI IG and Plasma exchange as the  patient's renal function is improving ; now the credit is given to them -------------------...

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RE: Hyponatremia in a dog with ascites 1 day ago

Thanks - is the CT image of post IV contrast ? If so can you post a pre- contrast image? Did you aspirate fluid from peritoneum and peri- renal flu...

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RE: Not biopsying with ANCA? 1 day ago

Dr. Rodby- you raise a crucial point- how much IFTA and GS in a very adequate kidney biopsy leads to a decision of futility? I think, like many thi...

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RE: Not biopsying with ANCA? 1 day ago

It is, "Just do it!" vs "Just say no" (to biopsy in some patients)! ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ---------...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

Dr. Venkat- Many Thanks for the references. Always very interesting . I wish we had some similar information on MN. If a direct action were invol...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

Dr. Rodby, I have copied below three references for direct glomerular effect of rituximab: Nephrology (Carlton) . 2017 Jan;22(1):49-57.  do...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

All great points  thank you ------------------------------ Michael Germain MD Springfield MA (413) 733-9666 RTANE ------------------------------

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RE: Not biopsying with ANCA? 1 day ago

This is very funny. I assumed that renaissance man Richard Glassock was making some obscure reference to an ancient Eastern Philosophy. I even st...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

“There are studies showing that rituximab may have direct glomerular effects and its anti-B cell action may not be essential in treating glomerulop...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

Interesting point about direct actions of RTX on glomerular permeability in MN. The reasonably tight connection between RTX induced decline in auto...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

There are studies showing that rituximab may have direct glomerular effects and its anti-B cell action may not be essential in treating glomerulopa...

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RE: 46 yo Caucasian female with multisystem disease Renal biopsy -TMA with Positive antiphospholipid antibody 1 day ago

I have seen interventions (such as renal biopsy or initiation of anti-rejection therapy) being performed without noting that SCr from the morning o...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

Very rarely patients do not show B-cell depletion after RTX, presumably due to neutralizing HACA. This will only be detected by measuring B-cells a...

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RE: Hyponatremia in a dog with ascites 1 day ago

Peritoneal fluid creatinine is close to the SCr level - this is compatible with the peritoneal fluid being lymph. The high percentage of  mononucle...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

I have used CD19 to see if I should redose earlier, but not to wait to redose even if it makes sense, this is for induction while watching pla2r co...

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RE: Membranous nephropathy, where to go from here for treatment 1 day ago

I agree Till then…. Sent from my iPhone

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RE: Not biopsying with ANCA? 1 day ago

Aha!!  The Nike approach to kidney biopsy decision making. ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geffe...

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