RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 6 hours ago

Thank you very much for this practical recommendation. To use a higher Insulin-glucose dosage and a continuous infusion seems to be a good option ...

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RE: Continuous kidney replacement Therapy 9 hours ago

Hello Mowaffaq -- It's a good question There are no good studies indicating that either method (separate access vs. using the ECMO manifold) is sup...

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RE: Continuous kidney replacement Therapy 18 hours ago

We connect to the ECMO circuit. ECMO circuits are different at each institution so you need to find what works for you and work closely with your E...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 19 hours ago

"But I want to come back to my main, clinical-practical, question. Is there an evidence to give a second potassium shift therapy with insulin gluco...

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RE: Persistent NAG Metabolic Acidosis 19 hours ago

Dick, one minor point about stone composition: patients with primary hyperPTH do have "more" CaP stones, but CaOx stones still predominate. So in t...

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RE: Peritoneal Dialysis and Feline/Cat as a pet. 20 hours ago

Tarundeep in my experience if you ask patients to stop sleeping with their cat(s) or having them in their bedroom, they may say okay, but they won...

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RE: Continuous kidney replacement Therapy 21 hours ago

Thank you Dr .Rudnick for taking the time to explain and illustrate the various options , advantages and disadvantages … Really appreciated. Mowaff...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

Thank you very much for your comments. In that case the patient has normal body weight and no diabetes mellitus. He always consumes a high amount o...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Phosphorus level has actually gone down from 2.3 on 22 April to 1.9 on 1 July. Corrected calcium has gone down from 11.3 on 22 April to 10.7 on 1 J...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Thank you for the update. The PTH is still very high for someone with a stage 3A CKD. It is critical to see if the improvement in PTH levels is ass...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

blood level of parathyroid hormone is improved to 443 in July, 2022 from 678 in April, 2022 which correlates with improvement in the level of 25-hy...

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RE: Hypokalemia with Elevated BG, possibly DKA, Patient at home in Remote area 1 day ago

Thank you everyone for the responses. Especially useful were the comments reminding me to pass on volume repletion as a cornerstone of treatment at...

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RE: Hypokalemia 1 day ago

The 24 urine sodium do not reconcile with the early number of Na and Cl [More]

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RE: Peritoneal Dialysis and Feline/Cat as a pet. 1 day ago

Thank you, Dr. Rodby! ------------------------------ T. Kaur, MD Nephrologist ------------------------------

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RE: Peritoneal Dialysis and Feline/Cat as a pet. 1 day ago

"In conclusion, P. multocida peritonitis is rare in PD patients, and only 22 such cases have been reported. Its transmission almost always involves...

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RE: A 60 year old kidney donor with diabetes 1 day ago

This is not easy. Even though he does not have pathological proteins detected in his urine, he could still have sufficient DN +/- hyperfiltration i...

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RE: Continuous kidney replacement Therapy 1 day ago

Greetings, We have a good experience with combined CRRT machine with ECMO with the same vascular access basically inserted for ECMO. We are connect...

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Peritoneal Dialysis and Feline/Cat as a pet. 1 day ago

Hello Everyone, A PD patient just acquired a cat in the last 2 - 3 weeks after her dog died and is pretty resistant to giving it up. Usually, I a...

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RE: Continuous kidney replacement Therapy 1 day ago

Thanks a lot ! Sent from my iPhone

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RE: Continuous kidney replacement Therapy 1 day ago

Here is a more detailed explanation on the problems of combining the CRRT and ECMO into the same circuit Integrated approach The integrated approa...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 1 day ago

In my opinion, the real question is whether the mRNA vaccines can trigger antibody formation against more than just the m spike protein in some cas...

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RE: Continuous kidney replacement Therapy 1 day ago

Mowaffaq - we don't do this at our institution, I think to minimize technical complexity. I have attached a recent review on performing CRRT during...

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Continuous kidney replacement Therapy 1 day ago

Hello all , I wonder what is the community experience with incorporating the Continuous KRT into the ECMO circuit rather than using a dialysis cath...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

During a pandemic a lot of individual physicians are going to see one or possibly two cases of "COVID -associated " kidney disease. Many, indeed mo...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

" a few weeks of a NOAC is not that big a deal"-compared to warfarin. Probably true, but never formally proven in patients with Nephrotic Syndrome....

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

Thank you for sharing I agree that the risk of thromboembolism is lower in MCD/FSGS as opposed to other GN such as membranous but still it is not ...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

Less than 10 yrs ago, I had a physically active 56 yo AA male executive with obesity class I, hyperlipidemia and negligible microalbuminuria (less ...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

Thanks Dr Solemani for the references I think the discussion was in reference to CKD withy or without other factors, not ESKD clearly "horses...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

By "laughs," I mean that when I bring up baking soda, the team thinks I'm joking. Then, we do the calculations, and they see that I am not joking. ...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

The post by Dr. Cohney (above) may be in response to the management of hyperkalemia in ESRD patients, to which, I would like to indicate the follow...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 2 days ago

Thank you, David. It is plausible that the insulin resistance in uremic patients may actually be due to enhanced circulating levels of cardiotonic ...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

I dont know about laughs But, when I receive calls late on a friday about hyperkalaemia - its a lot easier to tell patients to take baking soda and...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 2 days ago

SCZ 10gms 3xdaoly x 48 hrs --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancre...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 2 days ago

Thank you for sharing the information ------------------------------ Rocio Eleid MD Yuma AZ ------------------------------

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 2 days ago

Great point Manoocher. Another possibility is that the patient is insulin resistant; history of DM not included in the case description. I think th...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

The term "multi-factorial" maybe very pertinent to the cause of non-gap acidosis in this patient. No single abnormality can explain the etiolog...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

Your math is pretty much on the mark. I get laughs (and queries from pharmacy) whenever I recommend baking soda. The molecular weight of sodium...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

My exact thoughts No matter how low look at it , warfarin is a huge pain Noacs have changed the decision tree a bit This is MCD Tip lesion Albu...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 days ago

Dr. Rodby: Thanks for your recommendations. Since severe nephrotic syndrome/hypoalbuminemia caused by MN has the strongest association with venous ...

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RE: Recalcitrant FSGS case 3 days ago

Probably not. CYC is generally not effective in steroid-resistant presumed Primary FSGS. ------------------------------ Richard Glassock MD, FASN ...

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RE: A 60 year old kidney donor with diabetes 3 days ago

Many thanks. Nice to see that most of the community is in favour of accepting this potential donor as long as we control his diabetes and have goo...

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RE: Simultaneous diagnosis of lung carcinoma and MPO-ANCA positive crecentic GN 3 days ago

Other issues : ? To what extent prognosis of lung cancer & molecular markers determine treatment and ? consideration of PD1 inhibitors Is Lung...

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RE: Recalcitrant FSGS case 3 days ago

would no one consider Cyclophosphamide monotherapy ------------------------------ Shlomo Cohney FASN, PhD, FRACP, MRCP, MBBS Associate Professor ...

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RE: SGLT2 inhibitors and Urine sodium Osm 3 days ago

Have seen a handful of cases where there was a temporal relationship and esp when patient on ARB (or presumably ACEi) Case last week with patien...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 3 days ago

I noticed that the K+ shift by insulin was not robust in this patient, despite receiving a good dose of insulin. The sub-therapeutic response of K+...

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RE: Persistent NAG Metabolic Acidosis 3 days ago

Check my math: 1 TBS Of NaHCO3 is 380 mmol? A teaspoon has 127 mmol? Tells you how much inert filler is in a NaHCO3 tablet -----------------...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 3 days ago

You generally have excellent pt judgement, what do you think? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush U...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 3 days ago

Personally with serum albumin 2, tip variant , MCD, I might not anticoagulate. If steroids are a big problem I would use a CNI and rituximab. S...

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RE: 78 yO F With Immune MPGN 3 days ago

diagnostic & therapeutic issues dictated by availability expense likelihood of best possible outcome with any of these manoeuvres Quality of...

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RE: A 60 year old kidney donor with diabetes 3 days ago

Clearly very difficult In principle, I would generally feel reasonably comfortable accepting donation from a patient of this age with well con...

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