Haemodialysis patient with high calcium and low Po4 29 minutes ago

Dear experts Would be grateful for your inputs on following clinical scenario: 86yrs; ESKD secondary to primary membranous GN (pos anti PLA2R...

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RE: Patient with ANCA positivity and no GN on biopsy 29 minutes ago

Thanks- let us know how things go. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----------------------...

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RE: Patient with ANCA positivity and no GN on biopsy 3 hours ago

I appreciate the input and guidance from my colleagues. I have asked the patient to stop the allopurinol already. She has an appointment next week ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 4 hours ago

This sample of photomicrographs suggests a glomerular disease, not a "hypertensive Nephropathy". I suggested an IgA/C3 ratio as studies from Japan ...

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RE: Patient with ANCA positivity and no GN on biopsy 4 hours ago

We have all made our suggestions and now we await the results. What treatment dis you decide to offer this patient and what were the results of you...

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RE: Patient with ANCA positivity and no GN on biopsy 5 hours ago

Agree with Dr. Hirsch and I think we should not put more weight on serology similar to LN as ANCA may be non-pathogenic and we should correlate ser...

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RE: Treatment of Sclerotic glomerular disease 5 hours ago

immunosuppressive therapy is not indicated, In my opinion, but genetic testing may reveal a cause. I assume that the global sclerotic lesions have ...

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RE: Patient with ANCA positivity and no GN on biopsy 7 hours ago

Respectfully, I do not think anyone is "ignoring" the ANCA anymore than anyone is ignoring the possibility that it is a false positive or due to Al...

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Treatment of Sclerotic glomerular disease 8 hours ago

A 49 year-old male patient was admitted due to "frothy urine for over 2 years ". The patient first noticed frothy urine in 2022 but had no lower l...

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RE: Patient with ANCA positivity and no GN on biopsy 8 hours ago

The discussion is also about an ANCA- induced medullary vasculitis secondary to Allopurinol. Is RTX needed to treat this condition ?. The key quest...

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RE: Patient with ANCA positivity and no GN on biopsy 10 hours ago

Doe the discussions were about the use of RTX for presumed AIN as primary therapy and to avoid the use of steroids? Am I missing something? ------...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 14 hours ago

Sorry i got only those photos that may be uploaded. ------------------------------ Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ------------...

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RE: Dialysis/Hemolysis 18 hours ago

The labs came back hemolyzed. The lab was following the hemolysis index which was high. It cleared after 1-2 days and the f/u samples normalized af...

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RE: Dialysis/Hemolysis 18 hours ago

so are you saying the hemolysis was longer than the ER visit? How did you know continued hemolysis if the Hgb wasnt dropping? And what was the e...

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RE: first inflow alarm in peritoneal dialysis 18 hours ago

My experience is that PD catheters either work well or they dont and those that dont rarely can you make them work better, unless there is obvious ...

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RE: Patient with ANCA positivity and no GN on biopsy 18 hours ago

Dr Hirsch, we are on the same page in maybe less is more, but my less is less steroids and achieving that through rituximab, which I feel is infini...

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RE: Patient with ANCA positivity and no GN on biopsy 19 hours ago

Of course, this case raises questions about specificity, not sensitivity, of ELISA for anti-MPO -antibodies, Generally, such ELISA have very high s...

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RE: Patient with ANCA positivity and no GN on biopsy 20 hours ago

Interesting case My question to all is, how sensitive and specific is ANCA serology for diagnosing AAV? Many studies have shown considerable v...

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RE: Patient with ANCA positivity and no GN on biopsy 22 hours ago

Too bad- although a "negative" ANA and a "positive " antidsDNA is uncommon, no test is 100% sensitive. A number of such patient are reported in the...

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RE: Patient with ANCA positivity and no GN on biopsy 23 hours ago

ANA was negative , our lab will not run the Anti DNA Ab and Anti Smith Ab if ANA is negative. ------------------------------ Zubair Ahmad MD Tuls...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Just curious -was the ANA and anti- DNA antibody negative in this patient?. "False Positive " antiMPO ANCA have been described when cationic MPO su...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

The specimen had 19 glomeruli and only one showed obsolescence. None of the glomeruli had any evidence of any lesion at all levels -------------...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

This case show significant Proteinuria and hematuria that goes with glomerulonephritis , kidney biopsy show mesangial proliferation and interstitia...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Dr. Hirsch. Thanks for posting your very well reasoned suggestions for management of this case. The notation of a stable serum creatinine since Apr...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

The cr has been stable from April to now at 2.4. This is not a RPGN "emergency" in which we need to be maximally aggressive on day one, or need to ...

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RE: first inflow alarm in peritoneal dialysis 1 day ago

it is good option, will be considered defiantly thank you ------------------------------ Maryam Alahmed MBBS dr NGHA riffa 32338389 ----------...

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RE: first inflow alarm in peritoneal dialysis 1 day ago

hi dear, I positioned the patient to lie down in the same manner as he does at home, and successfully initiated automated peritoneal dialysis (AP...

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RE: first inflow alarm in peritoneal dialysis 1 day ago

hi Maryam . have you tried to use manual PD? the fact that the alarms are triggered when pt is bedside and not when you did in the PD unit, may be ...

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RE: first inflow alarm in peritoneal dialysis 1 day ago

Morning dr Maryam. Before shifting him to HD , what is the position of the patient while in bed? . If you connected him in the unit and it worked f...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Is she is treated with steroids and Ritux, both bases will be covered. I wonder if steroid avoidance is sought then I think there is not much exper...

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first inflow alarm in peritoneal dialysis 1 day ago

good day all, I requesting your expert opinion on one PD case. 54 years old ESRD due to DKD, started on PD 2 month back which was smooth at the...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

The patient has a positive anti-MPO and has received Allopurinol. We all agree that Allopurinol must be stopped. Are you willing to ignore the ANCA...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Dr. Jabur- would it be possible for you to post a (deidentified) image of the global glomeruloscleroisis seen in this patients biopsy? ----------...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

How does one tease out interstitial nephritis due to drugs from one due to ANCA. If it's the drug associated AIN, cessation of Allopurinol is cruci...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Obsolescent glomerulosclerosis is compatible with aging and ischemia- solidified glomeruloscleroisis is more compatible with an intrinsic Glomerulo...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Dr. Glassock, will you kindly elaborate on IgA/C3 and how its reliable in diagnosing IgA nephropathy? ------------------------------ Wael Jebur ...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Dr. Glassock. The global glomerulosclerosis was obsolescent type and immunoflorescent staining was performed on intact glomeruli. May I ask wha...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 1 day ago

Thank you for all your replies. He records showed normal renal function and minimal proteinuria before gastric reduction surgery. He lost almost ...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

Sound like acute interstitial nephritis from allopurinol or omeprazole and positive ANCA from allopurinol is a red herring. I would start small do...

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RE: Dialysis/Hemolysis 1 day ago

Thank you for your input, I appreciate it! I should've added that the hemolysis resolved ina bout 2 days for all patients. The last patient had a f...

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RE: Patient with ANCA positivity and no GN on biopsy 1 day ago

there can also be a sampling error, but to have a creatinine of .9 to 1.9 in a year without finding a segmental necrotizing lesion in a sample size...

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RE: Renal biopsy for low C4, and history of subacute cutaneous lupus, ANA positive 1: 320 and speckled but C3, urinalysis, double-stranded DNA antibody are normal , urine protein undetectable and creatinine stable > 1 year 1 day ago

I will not put a needle in a kidney with stable CKD that is not excrete an access proteins and obvious not inflamed in a lupus patient (quiescent K...

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RE: Dialysis/Hemolysis 1 day ago

I respect your diligence. I doubt I would have even noticed it, 3 patients in 1.5 years doesntseem possible to be a HD technical issue or it would ...

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Dialysis/Hemolysis 1 day ago

Hi- over the last 1.5 years, we have had 3 patients who went to the ED after dialysis for various reasons who were noted to have hemolyzed labs. Th...

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RE: Renal biopsy for low C4, and history of subacute cutaneous lupus, ANA positive 1: 320 and speckled but C3, urinalysis, double-stranded DNA antibody are normal , urine protein undetectable and creatinine stable > 1 year 1 day ago

What is lower limit of normal in your lab In our lab 17 c4 will be in normal range Perhaps labs doing different assays Does not look like c4 consu...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

Allopurinol is a potent inducer of hypersensitivity Vasculitis . It should be stopped. I would treat this patient with steroids , in rapidly descal...

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RE: Treatment of Membranous glomerulonephritis - clinically low risk with renal biopsy showing advanced chronicity 2 days ago

Thanks prof fogo. What does deposit being rarefied means? If you have electron lucent deposit does that mean MN is inactive ? And do we use stag...

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RE: immune mediated glomerular disease vs hypertensive glomerulopathy 2 days ago

If APOL1 risk allele, it will be a confounding factor but based on the are, it is possible. I do not know how easy for Dr. Jebur to get genetic tes...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

I just talked to the pathologist, he had verbally told me it was more then 12 but forgot to put it in the final report. Will confirm the exact numb...

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RE: Patient with ANCA positivity and no GN on biopsy 2 days ago

What is the full list of medications? How many glomeruli were in the kidney biopsy sample? ------------------------------ Richard Glassock MD, F...

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