RE: Recurrent FSGS 1 hour ago

The clinical course of this patient suggests that the glomerulopathy  may  respond differently to therapy. Recurrence late posttransplant and promp...

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Headaches in dialysis patients 2 hours ago

I have had several patients who get headaches on dialysis - on each treatment. THese headaches often make them sign off early.  I am interested in ...

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RE: Calciphylaxis 2 hours ago

Thank you Dr Rodby for the nice summary. ------------------------------ [Amaresh] [Vanga] [MD] [Virginia Beach, VA] ------------------------------

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RE: Calciphylaxis 2 hours ago

Attached is a paper  and study We published in The American Journal Of The Medical Sciences November 2020 discussing about intensive hemodialysis i...

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RE: Monoclonal Gammopathy Of Renal Significance 4 hours ago

So tubular LCDD from MGRS. Out of curiosity, what was her serum (not urine) kappa LC? If for eg, the creat on that urine was 1.42 g/L or close to, ...

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RE: AKI and Acute B/L Pyelonephritis 4 hours ago

He is passing around a litre of urine on high dose diuretics. Urine Pyruia has come down from 2500 but still around 500. --------------------------...

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RE: Recurrent FSGS 4 hours ago

Recurrent FSGS does not respond well to steroids alone, as shown in recent report by Uffing CJASN February 2020, 15 (2) 247-256. Only 1 of 6 respon...

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Calcimimetics and Chf Arrythmias and Prolonged QT 4 hours ago

I have a 45-year-old dialysis patient with mom ischemic cardiomyopathy and Being worked up for combined cardio renal transplant at Cleveland clinic...

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RE: AKI and Acute B/L Pyelonephritis 4 hours ago

Though I think this is all due to Acute Pyelonephritis, Is there any role of kidney biopsy?  Drug induced AIN? perhaps?  If yes what would be the b...

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RE: Recurrent FSGS 4 hours ago

Would favor adding rituximab as some data supports better graft survival Rituximab and Therapeutic Plasma Exchange in Recurrent Focal Segmental Glo...

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RE: 72yr old patient with cirrhosis and acute kidney failure 4 hours ago

I am not a fan of UNa in general, but since the hallmark of HRS is an intense prerenal state I dont know how you can leave it out.  So many of thes...

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RE: Monoclonal Gammopathy Of Renal Significance 5 hours ago

A MGRS limiter to the tubules is not very common. Did any of the plasma cells demonstrate kappa restriction too? This could be treated with  bortez...

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RE: Recurrent FSGS 5 hours ago

Interesting point @Mark Lerman @Beatrice Concepcion --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush Universi...

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RE: Recurrent FSGS 5 hours ago

Patient with recurrent nephrotic syndrome 14 years post transplant,renal biopsy showing diffuse foot process effacement with early FSGS -Why can't ...

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Monoclonal Gammopathy Of Renal Significance 5 hours ago

dear all I would appreciate your valuable input regarding the following patient. 55-year-old woman referred to our office by her primary care physi...

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RE: 72yr old patient with cirrhosis and acute kidney failure 6 hours ago

Actually the guidelines do not include urine Na https://www.journal-of-hepatology.eu/article/S0168-8278(19)30410-6/fulltext ----------------------...

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AKI and Acute B/L Pyelonephritis 6 hours ago

49 year old genteman, langstanding DM and HTN, diabteic retinopathy but no albuminuria.  H/O UTI in Sep/2019 and Feb 2020, that were treated.  Till...

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RE: Calciphylaxis 7 hours ago

Calcemic Uremic arteriopathy (CUA) or calciphylaxis has a bad prognosis and is a painful demise. I believe there is an ongoing STS randomized trial...

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RE: 72yr old patient with cirrhosis and acute kidney failure 7 hours ago

Has the Ascites club included the UNa in their new criteria? Leaving it out in the past ignores the basic pathophysiology IMO. --------------------...

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RE: Recurrent FSGS 7 hours ago

Ofatumumab is a humanized anti CD20. Rituximab is murine (mouse) so it is used when there is a reaction to rituximab or sometimes when there is res...

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RE: 72yr old patient with cirrhosis and acute kidney failure 7 hours ago

Surprising that the albumin us normal. Was the hematuria due to cystitis as you say she is on fluconazole for Candida in urine. Candiduria may not ...

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RE: Recurrent FSGS 8 hours ago

I understand that the patient is undergoing regular weekly sessions of plasmapheresis. In that case rituximab is an excellent suggestion as she may...

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RE: Recurrent FSGS 8 hours ago

Late recurrence (14 years posttransplant), preserved renal function, (I presume) no FSGS lesion with only diffuse podocyte effacement on biopsy and...

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RE: Recurrent FSGS 8 hours ago

Any consideration about using ofatumumab ? Or LDL-apheresis?  More so in pediatric transplant patients but may need to think outside the box given ...

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RE: 72yr old patient with cirrhosis and acute kidney failure 9 hours ago

Hello Dr. Wehbe,  Thank you for your comment! Bilirubin was not particularly elevated (but I do not remember the exact number). I agree, I think in...

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RE: 72yr old patient with cirrhosis and acute kidney failure 9 hours ago

What was the patient bilirubin level?. Cholemic nephropathy ( despite being debatable ) could be added to the differential dg Normal blood pressure...

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Calciphylaxis 9 hours ago

I would like to apologize in advance if this topic was extensively discussed before.If this is the case then please direct me to the thread as I co...

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RE: 72yr old patient with cirrhosis and acute kidney failure 11 hours ago

Thank you Dr. Rodby! That is very helpful. I agree, a trial of Terlipressin is a good idea. My first impression was also not to biopsy her (some of...

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RE: 72yr old patient with cirrhosis and acute kidney failure 11 hours ago

Nicely summarized history. I agree seems like HRS except for the UNa but Lasix may be confounding it. What is her BP? There are those that woukd ex...

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72yr old patient with cirrhosis and acute kidney failure 12 hours ago

Hello,  I was interested in your views on the management of this patient I was called to assess yesterday. This was a 72 yr. old lady with liver ci...

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RE: Recurrent FSGS 12 hours ago

People wonder what primary FSGS is and this is it! Classic story. Rapid transplant recurrence probably identifies it better than anything else. I a...

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RE: Cyclosporin Discontinuation In Primary Membranous 17 hours ago

As I know dual RAAS is no longer recommended cause of risk of hyperkalemia, Also RAAS with spironolactone showed better anti proteinuric effect, bu...

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RE: Cyclosporin Discontinuation In Primary Membranous 17 hours ago

Thank you, now it's clear why better to check the level. I just wonder why no guidline for level monitoring, obviously it's necessary! ------------...

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Recurrent FSGS 19 hours ago

Hello, I am hoping to get some thoughts about this patient: 43 yo woman with history FSGS initially diagnosed age 8. She eventually developed ESRD ...

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RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 1 day ago

normal C4 makes cryoglibulinemia less likely   in non albumin proteinuria better to do serum free light chain and look for mononoclonal gammopathy ...

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RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 1 day ago

SCr 5.2 --> 4.5 --> 4.1 mg on steroids alone (high BUN probably from steroid effect) suggests AIN responding to steroids. If urine output is good a...

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RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 1 day ago

The RF and anti-Lo suggest an autoimmune disease. That high of a RF always makes me wonder about cryoglobulins. The anti Lo being Sjogren and that ...

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RE: Divergence of Cystatin C and Creatinine in 2 paediatric patients 1 day ago

Thank you very much, Dr. Leung, this is very interesting and helpful! I checked back with the paediatric oncologist and engraftment was taking plac...

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80 yr female, AKI, positive RF and anti RO, mildly consumed C3 1 day ago

80 yr old female, hypertensive for 10 yrs on valsartan/amlodipine presented with anorexia, nausea, vomiting. Laboratory workup revealed AKI, serum ...

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RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

Is there any added advantage of dual RAAS blockade in young  patients like above with out comorbids and not having underlying cardiovascular diseas...

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RE: Polyuria in healthy Community pt 1 day ago

oh right...not yet. Yes, weird. Will do so. ------------------------------ Meera Bajwa MD ------------------------------

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RE: Polyuria in healthy Community pt 1 day ago

Did you send the 24 hour urine for Na K and urea to see what is making up his very excessive 24 hour urine solute excretion?  !263 is a LOT of mosm...

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RE: Polyuria in healthy Community pt 1 day ago

Ok, repeat urine osmolality is 482 with 24 hour urine output of 2.6 Liters for a total of 1253mosm/24 hours. Is 2.6L technically even polyuria--bar...

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RE: ESRD on IHD needing MRI with gadolinium. 1 day ago

See Attached NKF ACR consensus position paper. Group II Gad agents should be safe Disclosure I am an author on this paper, but it was approved by N...

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ESRD on IHD needing MRI with gadolinium. 1 day ago

I am wondering the general opinion on totally avoiding gadolinium in a recommended study for a patient due to risk of NSF.  Avoid vs dialysis follo...

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RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

While there are no formal, controlled studies to guide target CNI levels in treating membranous nephropathy, lupus nephritis and other glomerulopat...

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RE: Vaccination in patients with IgA nephropathy 1 day ago

Thank you Dr. Rodby for the interesting link,  I have told my patients that risk of relapse/IgA flare is also present with COVID infection (or any ...

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RE: Vaccination in patients with IgA nephropathy 1 day ago

Thank you Dr. Amuluru, very interesting case. ------------------------------ Hamid Moradi MD, FASN Associate Clinical Professor Principal Investiga...

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RE: COVID19/ + MPO3/ Collapsing GN 2 days ago

“Is he on hydralazine, allopurinol or cocaine (levamisole) drugs know not cause +ANCA with or without clinical vasculitis? “ None BL Creat unknown ...

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RE: Cyclosporin Discontinuation In Primary Membranous 2 days ago

I think many people do follow levels and shoot for transplant therapeutic levels,  I stopped using CSA a while back for GN, but I always started lo...

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