RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 6 hours ago

In many, but not all, cases Collapsing Glomerulopathy seems to be the signature lesion of an “interferon storm” , especially in the presence of pre...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 7 hours ago

That is such an interesting question. Ever since TULIP3 I have wondered whether all AA patients with HIVAN, SLE should be typed for APOL1 and if fo...

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RE: Lupus nephritis with Tubercular pleural effusion 8 hours ago

All good points. The combination of SLE and infection with M. TBC is a bad sign with a quite high mortality rate. The Class III LN will require com...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 8 hours ago

Thanks. If the donor was AA and presumed to have 2 APOL1 high risk alleles and if the recipient shows no further improvement or relapses with Colla...

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RE: Lupus nephritis with Tubercular pleural effusion 8 hours ago

Note that steroids are routinely used with tuberculous meningitis/constrictive pericarditis concurrent with ATT as well as with significant paradox...

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RE: AKI -Anuria 8 hours ago

Dr. Mohiuddin had called me about this patient. She had already decided before calling me that bilateral ureteric stenting or percutzneous nephrost...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 9 hours ago

Dr. Glassock: I was wrong. It is the donor's APOl-1 mutations that will be important in this scenario. I will try to find out if donor was African ...

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RE: AKI -Anuria 9 hours ago

Yes, IR team put ​in bilateral PCNs. UO is from bilateral PCNs No UO in foley Cr trend down was 5-6 hrs past PCN placement. Repeat Renal function w...

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RE: tunneled catheter removal 10 hours ago

Operator: anyone who is comfortable removing an ingrown cuff - Factors that affect this: 1. cuff position - while many practitioners are trained to...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 10 hours ago

Dr. Agha brings up good point if donor was AA. --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] [Past Medical Director Kidney ...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 10 hours ago

Fascinating case. I echo Drs Glassock and Friedman that this smells of APOL1 associated CG. APOL1 gene transcription is very sensitive to interfero...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 10 hours ago

Agree rapid improvement most consistent with CMV induced TMA and FSGS - will be interesting to see if proteinuria returns to normal- if not rebiops...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 10 hours ago

I think that Collapsing Nephropathy and TMA commonly commonly co-exist. Which cones first, I do not know. Sent from my iPhone

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 10 hours ago

I think it is the Donor APOL1 risk allele status that really counts in this condition. Sent from my iPhone

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 11 hours ago

Drs. Glassock and Friedman rightly point out the possibility of donor APOL-1 mutations with de novo collapsing FSGS in the transplanted kidney and ...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 11 hours ago

My personal analysis of the above patient: 1. What was reported as Banff 1A, T cell-mediated rejection might be CMV-induced acute interstitial neph...

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RE: sodium bicarbonate catheter lock solution 11 hours ago

Bicarbonate 8.4 and 7.5%cath lock has been reported to reduce bloodstream infections in HD catheter-dependent patients in a single center study ( E...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 11 hours ago

I agree. See below reference if you haven't already seen. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251748/ ------------------------------ Oded...

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RE: DKD With Proteinuria , AKI And Pyuria 11 hours ago

Renal US 11 cm kidneys no Doppler reading UA RBC2-5 Dial anti platelets for 12 months --------------------------------- Mohammad Alsawah MD Detroit...

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RE: Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 11 hours ago

Was the Donor A-A? If so I suspect thid might be post-Transplant de novo APO/L1 related Collapsing Nephropathy. Very bad news. Sent from my iPhone

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RE: tunneled catheter removal 11 hours ago

IMO, this reflects "local politics". Anyone qualified can do it wherever they are properly set up to do it. I have had patient catheters removed va...

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RE: new onset nephrotic syndrome 11 hours ago

"His UPCR is down to 5.7, was 10.9 by 24 hours collection , albumin to creatinine ratio down to 3765 from too high yo calculate ratio and blood lev...

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RE: AKI -Anuria 12 hours ago

What did I miss? PCN tubes placed at midnight? But the "proof is in the pudding", or in this case post obstructive diuresis, Did that occur? ------...

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RE: Water For HD Teaching 12 hours ago

While we are waiting for Rodger's lyrics (and I admit, my dream is to be in a flash mob), I have a few very basic suggestions, capitalizing on see ...

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Renal Transplant Recipient with Severe Nephrotic Syndrome and AKI in the Setting of CMV Viremia 12 hours ago

I wish to share the case report of a renal transplant recipient who developed severe nephrotic syndrome and AKI in the setting of CMV viremia and l...

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RE: AKI -Anuria 13 hours ago

Thank you Dr.Glassock Respectfully

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RE: AKI -Anuria 13 hours ago

​Yes a great lesson learnt -Acute anuria, with suspected obstruction, can present without any dilatation of Pelvicalyceal system, consider all ther...

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RE: Polydipsia, polyuria 13 hours ago

Yes. ------------------------------ Parvaneh Abtahi MD Nephrologist Reading Nephrology sinking spring PA (610) 823-3897 ---------------------------...

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RE: AKI -Anuria 13 hours ago

A really good lesson was learned here- acute, bilateral total ureteric obstruction does not have to lead to marked ureteral dilatation proximal to...

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RE: Polydipsia, polyuria 13 hours ago

If the uOSM given is close to a 24 hour average value then the 24 hour urine output would be about 4 liters instead of 10L per day if daily osmolal...

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RE: Glomerulonephritis with unconsciousness 13 hours ago

The serum C3 levels is in the wrong units- should be in mg/ dL or mg/L. Please repost. Sent from my iPhone

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RE: Polydipsia, polyuria 13 hours ago

Unless the values of a urinary osmolality of 210mOsm/kg and a urine output of 10.5L/d are incorrect this must be an Osmotic diuresis (2200mOsm excr...

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RE: Glomerulonephritis with unconsciousness 13 hours ago

C3-0.7 ng/dl, BP-140/90 mmhg with antihypertensives, Urine-protein ++++, RBC -15-17/hpf, no cast , plasma sodium-128meq/l -------------------------...

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RE: Polydipsia, polyuria 13 hours ago

I suspect primary polydipsia as well. I am ruling out Sjogrens. I have asked him to modify his diet. There was a case report of infectious mono pre...

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RE: tunneled catheter removal 13 hours ago

Great discussion about the technical aspects of tunneled CVC removal. Would like to get everyone's thoughts on process of care pathways for the rap...

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RE: Polydipsia, polyuria 13 hours ago

Everything that we say is speculation until we have a relatively reliable 24 hour urine volume and osmolality. The osmolar excretion that is being ...

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RE: AKI -Anuria 13 hours ago

​Thank you all for encouraging, to go after the diagnosis of Obstructive uropathy. A big thank you to our IR team, for agreeing to do PCNs at midni...

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RE: Polydipsia, polyuria 13 hours ago

I agree. This is likely a mixed polyuria. If I had (I don’t) a reliable copeptin assay, a baseline value could rule out NDI, otherwise you’d have t...

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RE: AKI -Anuria 14 hours ago

Without a dilated pelvicalyceal system, doing a PCN by IR is technically very difficult. Getting stents in by a good urologist would be more easy. ...

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RE: Polydipsia, polyuria 14 hours ago

Uosm of 210 is pretty low for an osmotic diuresis alone, but he clearly has a very high osmotic load so clearly his urine output is being driven by...

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RE: Polydipsia, polyuria 14 hours ago

I'm not sure a copeptin level would help...I would think that it would be suppressed in someone who has primary polydipsia (appropriately or centra...

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RE: Glomerulonephritis with unconsciousness 14 hours ago

Perhaps CVST could cause such a diffuse sensorial defect but an embolus unlikely I would think. I was wondering about PRES or osmotic demyelination...

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RE: Glomerulonephritis with unconsciousness 14 hours ago

Would add on the venous hypercoagulable side CVST. Also, age > 12 & low C3 argues against MCD & for such pathologies as postinfectious GN, C3G & AN...

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RE: Lupus nephritis with Tubercular pleural effusion 14 hours ago

Having started 4 drug regimen in full dose, you can put her on iv methylpred. Can start MMF after a month or so. Since this is a pleural effusion, ...

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RE: Polydipsia, polyuria 14 hours ago

To clarify if 24 hr urine osmolality remains this low and polyuria is confirmed then osmotic diuresis unlikely. But will await the additional data ...

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RE: canagliflozin for proteinuric ckd in diabetic with rapid progression 14 hours ago

https://www.doximity.com/doc_news/v2/entries/24074639 ------------------------------ Keith Klein MD, FASN Cedar Sinai Medical Center Beverly Hills ...

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RE: Polydipsia, polyuria 15 hours ago

Agree with a obtaining Additional data as suggested but a urine osmolality of 210 makes an osmotic diuresis highly unlikely in my opinion ---------...

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RE: Polydipsia, polyuria 15 hours ago

The data you present are incompatible with a diagnosis of DI. The patient is excreting about 2200 Mosm of solute per day, at least 3 X normal. We d...

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RE: Polydipsia, polyuria 15 hours ago

Polyuria ,urine osm [More]

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RE: Recurrent Symptomatic Sonographic Cystitis With Negative Urine Culture Responding To Empiric Antibiotics 15 hours ago

Yes that's right. The new version of the CBNAT is much more sensitive. However, a tuberculosis culture is the definitive test to rule out M tb. Act...

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