Timing of blood sampling in twice-weekly hemodialysis regimens 21 minutes ago

It is becoming increasingly common to initiate hemodialysis with a twice-weekly schedule as part of an incremental hemodialysis approach. I am wond...

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RE: MPGN with IgM, C1q, kappa and lambda, no Immune Complexes 2 hours ago

It's always hard to interpret someone else's immunofluorescence report. If there are no immune type deposits on EM, then I would favour a TMA proce...

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RE: Alveolar haemorrhage in ANCA vasculitis 3 hours ago

PLEX has a very limited role in ANCA Vasculitis with pulmonary involvement in absence of anti-GBM disease. I personally do not recommend its use in...

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RE: another ANCA case 3 hours ago

Relapsing anti-PR3 ANCA Vasculitis is fairly typical, especially with interruption of regular maintenance dosing of RTX. Avacopan has no real benef...

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another ANCA case 4 hours ago

Hello, I came across the following case from friend who reached out to me for a family member. 75 yo F with HTN and osteoporosis 10/2023 Lef...

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RE: Alveolar haemorrhage in ANCA vasculitis 5 hours ago

Beat --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Alveolar haemorrhage in ANCA vasculitis 5 hours ago

Thanks for update pet scan when steroids at reduced dose Any sensory deficit ? Ncs /emg could be helpful Cardiac mri seems reasonable I would inv...

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RE: recurrent intracerebral hemorrhagic stroke in a young female known case of hypertension VS ANCA associated vasculitis 5 hours ago

Thank you, Prof. Lerman. In 2023, at the age of 37, during her first event, her blood pressure was recorded at 200/100-110. However, it was su...

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RE: Severe Hypomagnesemia 6 hours ago

Sorry if I missed was serum bicarbonate elevated? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical D...

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RE: Severe Hypomagnesemia 6 hours ago

That's good to know. I just looked and they have many lactate forms, including SR.

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RE: Severe Hypomagnesemia 7 hours ago

Magnesium lactate is available on Amazon. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine a...

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RE: Severe Hypomagnesemia 7 hours ago

Sorry-I misinterpreted your post. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA L...

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RE: Severe Hypomagnesemia 7 hours ago

Sorry, I meant no OTC, No herbal supplement and no other meds X 2,000 IU daily Vitamin D3. ------------------------------ Bijan Roshan MD, FASN S...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 7 hours ago

IMO -has criteria for PA -SALINE suppression with low serum k is not valid- response to spironolactone is very suggestive of PA. with normal k, imp...

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RE: Severe Hypomagnesemia 7 hours ago

What herbal supplement is he taking? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCL...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 7 hours ago

The PRA and aldosterone levels cannot be interpreted while he is on the medicatiions you describe, but the clinical picture Strongly suggests Prima...

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RE: Biopsy or not to Biopsy 8 hours ago

Have you carefully examined his skin for angiokeratomas (buttocks and scrotum especially ) ? Does he have acroparasthesias ? Any absence of perspir...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 8 hours ago

As of now, there is no firm evidence linking episodes of dyslipidemia accompanying steroid sensitive nephrotic syndrome with the later incidence of...

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RE: Somewhat suppressed aldo, Primary aldosteronism or not? 9 hours ago

Sorry the title should have read somewhat suppressible aldosterone --------------------------------- Edwin Anand, M.D. Nephrology Practice of Nia...

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RE: Biopsy or not to Biopsy 10 hours ago

He does not have hypertension , and is not on any medications for proteinuria either . Except for the albuminuria all his labs are normal for now ...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 11 hours ago

If untreated with statin and no ace inhibitors Guess a registry study could answer this question for lets say miminal chsnge relapsers who arr st...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 11 hours ago

Thanks so much Will execute plan Can I ask this patient was yo have one relapse a year over next 2-3 years but let’s say rapid response to steroid...

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Somewhat suppressed aldo, Primary aldosteronism or not? 11 hours ago

A 44 yr old white male with a hx of HTN for about 5 yrs was admitted to the hospital with severe HTN with a palpitatoins, BP was 230/130 on present...

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RE: Severe Hypomagnesemia 13 hours ago

No PPI. No other meds, etc, supplement, herbal x 2000 iubvitamin d by us for borderline levels. Normal PTH.

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RE: Severe Hypomagnesemia 13 hours ago

PPIs? (even though this is urinary wasn't) history of amoinoglycosides? CNIs? Ampho? ------------------------------ Roger Rodby MD, FASN...

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RE: Severe Hypomagnesemia 13 hours ago

No alcohol intake ( I even checked PETH test for him). Both RA and asthma in remission. Was on extended realese 15 mg daily upadacitinib (Rinvoq) a...

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RE: Severe Hypomagnesemia 14 hours ago

How much alcohol does he consume per week? What are the current medications are used to treat asthma and RA? ------------------------------ Richa...

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Severe Hypomagnesemia 14 hours ago

I have this patient: 30 YO gentleman with History of Rheumatoid Arthritis, Asthma, anxiety who was admitted with to hospital after routine labs sho...

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RE: IgA nephropathy in a 28 yo 14 hours ago

The rationale for "aggressive" therapy is well stated by Dr. Rodby- but do we know that anti-April or anti-April/BAFF is better than MMF + systemic...

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RE: Alveolar haemorrhage in ANCA vasculitis 14 hours ago

Just to update all Bronchoscopy was not suggestive of pulmonary haemorrhage. Echocardiogram show severely impaired LV systolic function. BNP ele...

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RE: Simple question - EDEMA 15 hours ago

The extended duration of spironolactone can avoid some of the rebound Na retention, but I would still not use it , if possible . No easy cure for t...

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RE: Biopsy or not to Biopsy 15 hours ago

4th opinion, you should flattered, until he gets a fifth opinion and then your ego can take a hit. well this does not appear to be tubular prote...

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RE: Simple question - EDEMA 15 hours ago

Good luck, this condition is a great mystery to me and the problem is that diuretics may exacerbate the situation and create diuretic dependence...

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RE: IgA nephropathy in a 28 yo 15 hours ago

yes advanced disease, but that does not necessarily tell me there is no role for, eg an APRIL or APRIL BAFF inhibitor? To me she is doomed long ter...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 16 hours ago

I agree with Dr. Venkat. Also, no reason to start RASi. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Scho...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 17 hours ago

Since cholesterol is down to 5 mmol/L (~ 200 mg/dL) will hold off on statins. Cholesterol may improve further if proteinuria remits completely and ...

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RE: IgA nephropathy in a 28 yo 18 hours ago

Is hematuria/hemoglobinurua (1+ ot greater) p present, if so, i would try a short course (3 months ) of moderate dose oral steroid ( in a tapering ...

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RE: recurrent intracerebral hemorrhagic stroke in a young female known case of hypertension VS ANCA associated vasculitis 19 hours ago

MPO-AAV due to hydralazine usually responds well to stopping hydralazine and IS with positive long term prognosis . The difficult decision is wheth...

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RE: recurrent intracerebral hemorrhagic stroke in a young female known case of hypertension VS ANCA associated vasculitis 19 hours ago

What was BP when patient presented with stroke ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Di...

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RE: Simple question - EDEMA 1 day ago

I would withhold all diuretics, including spironolactone, if possible. ------------------------------ Richard Glassock MD, FASN Emeritus Professo...

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RE: recurrent intracerebral hemorrhagic stroke in a young female known case of hypertension VS ANCA associated vasculitis 1 day ago

Thank you, Dr. Glassock. Given her functional status and active vasculitis, is it appropriate to treat her with rituximab? For your kind opinion...

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RE: Simple question - EDEMA 1 day ago

Thank u.. I just read the chapter and interesting concepts . Will try to completely stop her diuretics . It does say to consider blocking the. R...

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RE: Treatment of membranous nephropathy with microsherular substructure 1 day ago

Based on this information I would give hydroxy chloroquine, low dose steroids and MMF. No reason to be super-aggressive with therapy . Hard to say ...

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RE: Biopsy or not to Biopsy 1 day ago

1. Genetic studies were sent yesterday to rule out fabrys , Alport etc 2. The proteinuria has been present for around a year 3. uACr = 0.49 and u...

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RE: Biopsy or not to Biopsy 1 day ago

thanks Dr. Glassock-exclude FABRY'S after r/o orthostatic proteinuria-excellent point! ------------------------------ [Mark] [Lerman] [MD,FASN,FA...

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RE: Treatment of membranous nephropathy with microsherular substructure 1 day ago

complement don elate 2025 at that time c31.13g/l C$ 0.33 g/l ssa+, SSB+( we acn't get levels just positive negative Her plasma albumin was 34 i...

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RE: Lipid Management In Young Patient With Steroid Responsive Do 1 day ago

Fit and well and slim --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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Lipid Management In Young Patient With Steroid Responsive Do 1 day ago

Appreciate input 18 year old male kb for nephrotic syndrome - showed minimal change . Cholesterol 7 has gone to 5 remission after 8 weeks ans now ...

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RE: Alveolar haemorrhage in ANCA vasculitis 1 day ago

Muhammad Soobadar - "@ lerman - not in this case but if acute presentation of pulmonary haemorrhage with haemoptysis but no hypoxemia with multisys...

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RE: Biopsy or not to Biopsy 1 day ago

Thanks prof glassock --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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