Radioiodine treatment in Patient with CKD stage 4 12 minutes ago

I have a 66-year-old male with diabetic nephropathy with CKD stage IV, creatinine of 3.1 and a GFR of 21 mL/min as of May 2026,, CLL, coronary arte...

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RE: transplant recurrent FSGS 22 minutes ago

@Astrid Weins @Ibrahim Batal As already stated, this is a very difficult problem but, nowadays, we have an objective tool to assess the possibi...

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RE: transplant recurrent FSGS 50 minutes ago

Wow, I had a patient who lost 2 transplant to recurrent disease then on the third with aggressive pheresis was able to keep it, and was eventually ...

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transplant recurrent FSGS 2 hours ago

I have a 37 year old man with ESRD. He presented ~ 2020 with new onset nephrosis, FSGS on biopsy, and progressed to ESRD within one year. He receiv...

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RE: High output HF from AVF? 2 hours ago

No, no tortuous or large. And always, "eye test" is important. Thank you. ------------------------------ Esra Ekiz, MD Nephrology Attending Ph...

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RE: High output HF from AVF? 2 hours ago

AVF occlusion test was done with no improvement in BP, so yes, I too said the same but the question came from ICU as hypotension was not able to be...

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RE: High output HF from AVF? 2 hours ago

Volume overload improved to some extent, though there is still room to go. Our fistula surveillance studies are reported as proximal-mid-distal b...

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RE: MPGN with negative IMF 3 hours ago

Few cases with fibrillary GN without igg have been described( very rare) consider DNAJB9. Long shot May be pathologist can comment -------------...

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RE: Post Partum AKI 3 hours ago

I don't doubt the renal disease but the high proteinuria of 13 g you mentioned above. My next step would be the biopsy. Here I get results within o...

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RE: MPGN with negative IMF 3 hours ago

Is BP well controlled? TMA in the setting of uncontrolled hypertension can cause an MPGN-pattern of injury. ------------------------------ K.K. V...

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RE: MPGN with negative IMF 3 hours ago

Would you be able to post the anonymized pathology report and/or images from the case. Main ddx of MPGN pattern without deposits would be chronic...

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RE: yeast peritonitis and return to PD. 3 hours ago

Sorry, I thought it was the second episode. I had a patient with yeast peritonitis. Restarted after 3 month and a few months later he had the same ...

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RE: MPGN with negative IMF 4 hours ago

If the search for monoclonal gammopathy is unrevealing. I would arrange for IF staining of the biopsy for Fibronectin or send the biopsy specimen f...

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RE: MPGN with negative IMF 4 hours ago

This pattern of injury is most compatible with a MGRS mediated renal limited TMA. Please re-review the EM for signs of sub -endothelial lucencies a...

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MPGN with negative IMF 7 hours ago

Dear all, My colleague has an 83-year-old female patient who presented to her clinic with progressive renal dysfunction (creatinine 90 umol/L in ...

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RE: Pd Patient And Lipid Lowering Agent 10 hours ago

For the PISCES trial. see Lok C et al NEJM, 2026. It currently applicable only to HD patients, but I do not see why it would not work in PD . Just ...

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RE: Membranous Nephropathy treatment 12 hours ago

Not sure about membranous but in Anca vasculitis , CD20 counts more predictive of relapse over Anca titers --------------------------------- Dr. H...

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RE: Pd Patient And Lipid Lowering Agent 14 hours ago

The entire concept of treating to prevent ASCVD in dialysis patients has been turned upside down with the findings of the PISCES trial that showed ...

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RE: Membranous Nephropathy treatment 15 hours ago

Thanks. The infusion is not hard to get in Atlanta

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RE: Membranous Nephropathy treatment 17 hours ago

Hi James , I understand you find infusion hard to get in your centre I would personally check ELiSA and then give rituximab 1g and then 14 days la...

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Pd Patient And Lipid Lowering Agent 19 hours ago

Dear colleagues , Primary care physician has queried use of lipid lowering agent in established pd patient Not tolerating statin question about us...

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RE: yeast peritonitis and return to PD. 19 hours ago

No previous peritonitis . You mean doing echocardiogram , Ct whole body ? Pet ? Blood cultures negative Never fungaemic and clinically well ( afte...

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RE: Post Partum AKI 20 hours ago

Yes, vaginal discharge mixing with urine can confound interpretation of proteinuria. However, this patient has edema, hypoalbuminemia and increasin...

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RE: FSGS vs C3G and Canavan Disease 22 hours ago

Just as a followup, after nearly 4 weeks the patient still has persistent protienuria of 14 grams per day Her LM showed MPGN and IF ( though inco...

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RE: High output HF from AVF? 1 day ago

!! Alejandro C Alvarez St. Louis, MO alejoclaudio@gmail.com

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RE: AI in Epic? 1 day ago

Thank you, Dr. Glassock, that's good to know. I was able to update my account on UpToDate to add on that option under my user settings. An extra fe...

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RE: High output HF from AVF? 1 day ago

Above appreciated and more valuable than this, but I like the "eye test", for whatever it is worth, I have only seen high output heart failure in L...

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RE: AI in Epic? 1 day ago

As far as know the decision is up the health system that purchases/ leases the EPiC Program with or without embedded UpToDate option ---------...

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RE: AI in Epic? 1 day ago

that's good to know, but how do you elect for that option? ------------------------------ Mark Cook DO Pikes Peak Nephrology Associates Colorado ...

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RE: High output HF from AVF? 1 day ago

Dr. Ekiz, Those Blood flow volume values are unreliable, as evidenced in the wide range of the measurements above (assuming it is a surgical AVF ...

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RE: AI in Epic? 1 day ago

AI is already available in EPIC with the option of embedded UpToDate (Expert AI). Full disclosure- I am Editor in Chief of the glomerular disease s...

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RE: High output HF from AVF? 1 day ago

Has the volume overload improved with CRRT, and what happened to blood pressure during that time? I don't think a shunt flow of 900 ml/min caused t...

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AI in Epic? 1 day ago

Hi, does anyone know when artificial intelligence for epic will be available for providers? ------------------------------ Mark Cook DO Pikes Pea...

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RE: Post Partum AKI 1 day ago

Postpartum and without curettage, lochia often persists for up to 4 weeks. During this time, proteinuria cannot be interpreted. If necessary, pleas...

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RE: yeast peritonitis and return to PD. 1 day ago

Fungal peritonitis is rare in patients who are not immunocompromised. Was the same pathogen identified in the second episode of peritonitis as in 2...

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RE: low phosphate and smoldering myeloma 1 day ago

In regards to the PO4 loss in the urine ,let's assuming with normal eGFR , his PO4 excretion per day is around 40 mmol/day. However with eGFR of 4...

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RE: Membranous Nephropathy 1 day ago

A CNI will not help ( much) for inducing a lasting immunological remission.- I do not recommend this option. ------------------------------ Richa...

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RE: Post Partum AKI 1 day ago

But was it looked for? Is this the first pregnancy or one of multiple. If multiple, , any toxemia events or proteinuria with prior pregnanies.? -...

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RE: Post Partum AKI 1 day ago

No proteinuria reported in the 1st trimester. --------------------------------- Wael Jebur MD drwaellatif@hotmail.com Dubai ---------------------...

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RE: Membranous Nephropathy 1 day ago

Consider combining a CNI with antiCD 20 inhibitors . The combination seems to work very well. Risk of recurrence is high when you with hold CNI tho...

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High output HF from AVF? 1 day ago

Dear community, Here is a 69 y/o gentleman w ESRD (presumed to be 2/2 FSGS + post nephrectomy for RCC) on HD via R BC AVF since 2022, w asx CAD, ...

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RE: Membranous Nephropathy 1 day ago

You could try a short 8 week course of CYC ( 1-1.5mg/kg po) to see if you can prolong the B-cell reducing effect of OBI and yield am more prolonged...

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RE: low phosphate and smoldering myeloma 1 day ago

Thank you for your prompt answer. Back in February his ratio was 17. So he is edging on the myeloma stage. ------------------------------ Mario ...

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RE: low phosphate and smoldering myeloma 1 day ago

Dr. Rubin: A FLC ratio > 8 is a risk factor for high risk MGUS. A ratio > 20 is a risk factor for smoldering myeloma for progression to multiple ...

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RE: Membranous Nephropathy 1 day ago

Update: ANCA Negative C3, C4 normal DS DNA Negative ------------------------------ Sachin ------------------------------

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RE: low phosphate and smoldering myeloma 1 day ago

@Nelson Leung Is a huge Kappa/Lambda ratio (as in this case) enough to label this patient as suffering from a high risk smoldering myeloma? As su...

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RE: low phosphate and smoldering myeloma 1 day ago

The data is compelling to treat the MM. The 24h urine phosphate is actually on the low end. If the patient intake is sufficient, intestinal wasting...

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RE: Membranous Nephropathy treatment 1 day ago

Elisa is also available. ------------------------------ James Wells MD Atlanta GA (770) 934-2585 ------------------------------

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RE: yeast peritonitis and return to PD. 1 day ago

Thanks really helpful --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Membranous Nephropathy treatment 1 day ago

And I you have Elisa you can do repeated measurement and check treatment response . IFA is not used for monitoring ( under correction of prof gla...

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