RE: Persistent NAG Metabolic Acidosis 17 minutes ago

Cording to the recommendation of endocrine specialist:, "once 25 hydroxy vitamin D is 20 or higher, need to repeat 24 hour urine calcium, , 24-hour...

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RE: Persistent NAG Metabolic Acidosis 32 minutes ago

You mean distal RTA by d RTA? ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ------------------------------

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RE: Persistent NAG Metabolic Acidosis 37 minutes ago

Thank you. Yes, you are correct . According to ultrasound on 18 April,: Left renal atrophy. Severe hydronephrosis of the right kidney. On 18...

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RE: Persistent NAG Metabolic Acidosis 42 minutes ago

Urine pH was 5 last checked on 18 May, 2022 and has always been 5 checked seven times from January, 2018 to May, 2022. Urine volume recorded as inp...

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RE: 78 yO F With Immune MPGN 1 hour ago

Here is the first (that I was aware of) report of reversible AKI from RAASI from diffuse small.vessel disease acting like bilateral large vessel di...

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RE: 78 yO F With Immune MPGN 1 hour ago

I agree with Dr. Gharub. The functional consequences of severe arteriolar hyalinosis (as an equivalence to bilateral RAS ) is under-appreciated Cli...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 16 hours ago

Increasing ANCA levels may not reliably predict relapses, but I woukdnt say there is no value in increases https://pubmed.ncbi.nlm.nih.gov/32601...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 17 hours ago

As KDIGO mentioned ANCA titre should not be use to guide treatment and does not strongly predict relapse. Why should we change the maintenance prot...

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RE: Hypokalemia 22 hours ago

Could this be a case of Licorice ingestion ? sorry if this Has been discussed . ------------------------------ Mowaffaq -------------------------...

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RE: A 60 year old kidney donor with diabetes 23 hours ago

This is exactly how this father feels. If that was not to his daughter, I would not have even considered this. Once again, I appreciate your thoug...

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RE: A 60 year old kidney donor with diabetes 23 hours ago

Of course I am not biased being the father of two adult daughters! But ethics aside, parents are often willing to make "extreme" sacrifices for the...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 23 hours ago

I want to highlight the following points: - More relative tolerance of this type of patients to hyperkalemia - Arrhythmogenic effect of B2 agonist....

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RE: A 60 year old kidney donor with diabetes 23 hours ago

Thanks. ------------------------------ Mohammed Tawhari MD McMaster university Ancaster ON (905) 920-3799 ------------------------------

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

The risk of daughter dying in next ten years is almost 100% The risk of father developing CKD over 10-20 years is far less I would do the transpla...

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RE: 78 yO F With Immune MPGN 1 day ago

Severe arteriolar hyalinosis may be considered as functional equavalent of bilateral renal artery stenosis and ACEI/ARB may worsen GFR. So a holida...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

With CKD, a NAGMA, and high normal serum K he may have a dRTA due to prior obstruction. The normal U NH3 may be misleading since during a metabolic...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

To me, the impressive increase in iPTH level with such modest impairment of GFR and accompanied by hyperphosphatemia and low level hypercalcemia.ne...

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RE: 78 yO F With Immune MPGN 1 day ago

Myfortic is available. I can try that along with 5-10 mg of prednisone. ANCA is negative. I was thinking irbesartan you need to maximize due to sig...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Does he have residual hydronephrosis following correction of bladder neck obstruction? Type-IV (hyperkalemic) RTA secondary to obstructive uropathy...

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RE: 78 yO F With Immune MPGN 1 day ago

The patient has severe arteriolar hyalinosis. Will consider d/c irbesartan for a while and monitor the effect on GFR. Patient is on multipharmacy f...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

given normal urinary ammonium, NGMA is most probably due to GIT bicarbonate loss. What is the daily urine volume? Is urine ph acidic?decreased urin...

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Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

Male patient, anuric, chronic hemodialysis was admitted to hospital for routine colonoscopy. Last HD-session two days prior, S-Potassium 7,2 mmol/l...

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Persistent NAG Metabolic Acidosis 1 day ago

White gentleman age 71 who had right-sided hemicolectomy because of colon cancer around 2010. He reports ileostomy discharge sometimes liquid, some...

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

Thank you. Very much appreciated. Yes, it is a committee decision. Our committee deferred the decision as this was not the typical situation for t...

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RE: Hypokalemia 1 day ago

Update: K 3.2-3.8 : ON Amiloride 10 mg bid, KCL 40 mmol 4 times a day, Mg 400 mg bid Urine random Na 209, K 33,Cl 205,Ca 7,Cr 117. Now it fits more...

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

DOI: https://doi.org/10.1681/ASN.2020081238 describes a long term living donor risk calculator which might be useful for informed consent in this p...

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RE: A 60 year old kidney donor with diabetes 2 days ago

His fasting blood sugar was 9 mmol/l. We did not do glucose tolerance as his diagnosis with diabetes is secured and I don't see the GTT changing hi...

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RE: 78 yO F With Immune MPGN 2 days ago

Is mycophenolate sodium (Myfortic) available to this patient? May be better tolerated, especially if given as 360 mg TID (to lower peak blood level...

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RE: A 60 year old kidney donor with diabetes 2 days ago

What was fasting blood sugar and was a glucose tolerance test done and results if done? --------------------------------- [Mark] [Lerman] [MD,FASN...

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RE: A 60 year old kidney donor with diabetes 2 days ago

Thank you for your insights. keeping the family in a resource-rich country is not in our hands and we have no control on that. Will try to get hi...

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RE: A 60 year old kidney donor with diabetes 2 days ago

"Of note, this family is from a different country and hence can not go on the deceased donor list." " They don't have insurance and their transport...

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RE: A 60 year old kidney donor with diabetes 2 days ago

I am also leaning towards doing the transplant given the situation and the fact that he is giving the kidney to the daughter, who would otherwise n...

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RE: A 60 year old kidney donor with diabetes 2 days ago

I have been involved indirectly with a similar situation "overseas ", understanding the culture and mentality sometime help make the decision, the ...

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RE: 78 yO F With Immune MPGN 2 days ago

update on the case, pronase digestion and further eval of the kidney biopsy specimen not possible unless repeat bx but pt not willing, SPEP and fre...

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RE: A 60 year old kidney donor with diabetes 2 days ago

“First do no harm hard to argue with that but he has a daughter on hd for 7 years since age 17, and likely won’t make it past 30 if she stays on HD...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

Can’t form an opinion without serial PR3 levels. Sounds like all he ever had was renal involvement, now he is left with CKD 5 that seems clinically...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

Thank you for sharing I wouldn’t “sync” the dose of Rituximab with the titers and would continue same doses. The issue of duration of Rituximab f...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

If he has renal limited disease and unlikely to ever come off dialysis, why continue rituximab indefinitely? May be taper off rituximab over next 6...

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RE: A 60 year old kidney donor with diabetes 2 days ago

Thank you for replying. If we consider that the potential recipient, daughter, is at risk from being under-dialized and the father primary motivat...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

What is the anti-PR3 antibody level and his has it changed . I do not use ANCA titers for FU purpise. 2 years on dialysis makes it unlikely he will...

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RE: A 60 year old kidney donor with diabetes 2 days ago

For what it is worth, I think that invoking the Primum Non Nocere dictum would be highly relevant in a 60 year old Obese Diabetic with hyperfiltrat...

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RE: Maintenance therapy for MPO nephritis 2 days ago

I concur with Dr. Rodby on this issue , but the benefits of a Ponticelli-like regimen in "RTX resistant" MN has not been formally proven by a well ...

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RE: Maintenance therapy for MPO nephritis 2 days ago

“Thank you Dr Rodby and Glassock for the clarifications. I raised this issue because we encounter a low CD 19 post Rituximab and yet the anti PLA2 ...

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RE: Maintenance therapy for MPO nephritis 2 days ago

Thank you Dr Glassock I mean the anti-PLA2 antibodies are still present months after Rituximab and despite suppressed CD19 % Thank you for your t...

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RE: Maintenance therapy for MPO nephritis 2 days ago

Could your clarify what you mean by " Anti-PLA2R receptors are still elevated"?RTX does not have any effect on mature Plasma Cells which do not exp...

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RE: Maintenance therapy for MPO nephritis 2 days ago

Thank you Dr Rodby and Glassock for the clarifications. I raised this issue because we encounter a low CD 19 post Rituximab and yet the anti PLA2 r...

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RE: Maintenance therapy for MPO nephritis 2 days ago

MENTOR was not designed to study the impact of CD19 levels on outcomes after therapy of MN with RTX. Not surprisingly virtually all patients receiv...

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RE: A 60 year old kidney donor with diabetes 2 days ago

They don't have insurance and their transportation cost will be covered through a charity fund. The two sons have not come forward as potential do...

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increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

#White gentleman age 80, renal biopsy done in March, 2020, found -CRESCENTIC ANCA-RELATED PAUCI-IMMUNE GLOMERULONEPHRITIS; CONSISTENT WITH MIC...

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RE: A 60 year old kidney donor with diabetes 2 days ago

"Due to financial issues, she is receiving only one to two sessions per week and has been so for the last 3 months." Given the above problem, does ...

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