RE: Gender Affirmation Therapy 6 hours ago

Interesting, could this mean that there is a product specific 'contaminant" in a specific testosterone parenteral preparation (Cypionate vs Enthana...

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RE: DOAC for prophylactic anticoagulation in MGzN 6 hours ago

For now, I have started him on Rivaroxaban (Apixaban was denied by his insurance), and Tacrolimus. Since pt has negative PLAR2, I am trying to get ...

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RE: Psychiatric Patients and Dialysis 7 hours ago

This Clinical Practice Guideline is about shared decision making. not what to do about non-compliant patients who are dangerous to themselves, dial...

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RE: Gender Affirmation Therapy 8 hours ago

I'm seeing a similar patient, 35 year old transgender on testosterone. Creatinine elevated from 1.0 mg/dl to 1.3-1.4 mg/dl. Patient has occasional ...

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RE: ? paraneoplastic vasculitis 9 hours ago

Thanks Roger and Richard ------------------------------ Sridevi Govindarajulu MBBS, MD NEPHROLOGIST NEPHROLOGY toowoomba QLD 0434621185 ---------...

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RE: ? paraneoplastic vasculitis 13 hours ago

"i am just a little bit perplexed at the lack of cellularity in the glomeruli when the bx was done" Pauci immune necrotizing gn is not really a ...

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RE: Psychiatric Patients and Dialysis 16 hours ago

This is the RPA position paper- the second edition from 2010. https://cdn.ymaws.com/www.renalmd.org/resource/resmgr/Store/Shared_Decision_Making_Re...

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RE: ? paraneoplastic vasculitis 19 hours ago

Here is a Bayesian analysis of the clinical paradigm a Priori probability of IE- 80% TEE negative. Sensitivity 81%, specificity 92% (from literat...

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RE: ? paraneoplastic vasculitis 20 hours ago

No Roger not on either of those drugs did have some non specific sx since the start of this year though with myalgia and neuropathic sx involving t...

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RE: ? paraneoplastic vasculitis 23 hours ago

Tx shall do ------------------------------ Sridevi Govindarajulu MBBS, MD NEPHROLOGIST NEPHROLOGY toowoomba QLD 0434621185 ----------------------...

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RE: ? paraneoplastic vasculitis 23 hours ago

Yes he had a bland urine sediment in Jan this year ie <10 red cells and nil albumin AKI developed during his sepsis his creatinine was 105 implant/...

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RE: ? paraneoplastic vasculitis 23 hours ago

Just to be complete, was the patient on hydralazine or allopurinol? ------------------------------ Roger Rodby MD, FASN Professor of Medicine ...

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RE: ? paraneoplastic vasculitis 23 hours ago

His transthoracic and transoesophageal echo was negative for vegetations ------------------------------ Sridevi Govindarajulu MBBS, MD NEPHROLOGI...

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RE: Gender Affirmation Therapy 1 day ago

Do you have access to a measured GFR (by Iohexol or iothalamate)?This might help sort out the possibility that this is a testosterone induced alter...

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RE: ? paraneoplastic vasculitis 1 day ago

Rheumatoid Factor is commonly elevated in Infection related GN but not in ANCA Vasculitis. ------------------------------ Richard Glassock MD, FA...

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RE: ? paraneoplastic vasculitis 1 day ago

35 g/mol is 35 mg/mmol which is 310 mg/g of creat, not very high for a GN with AKI? But biopsy showed a pauci immune segmental necrotizing GN with ...

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RE: Gender Affirmation Therapy 1 day ago

https://www.endocrinepractice.org/article/S1530-891X(21)01180-0/fulltext the CPK is alarming, could the injections alone lead to an increase is CK...

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RE: kidney stones 1 day ago

Thanks to all for the help. I am seeing the pt again this week and will update with 1,25 level and urea excretion when resulted. ----------------...

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Gender Affirmation Therapy 1 day ago

Good morning Want to get some advice on this case. 38 year old Caucasian has been on gender affirmation therapy of IM testosterone injection since ...

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RE: kidney stones 1 day ago

I agree with Stuart's comments. Also of interest would be some marker of protein intake (sulfate or urea excretion). We focus a lot on Na as a driv...

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RE: ? paraneoplastic vasculitis 1 day ago

Then too there is a very strong link between S. Faecalis Endocarditis and Colon Cancer in the elderly. ------------------------------ Richard Gla...

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RE: ? paraneoplastic vasculitis 1 day ago

Thanks so much for your prompt reply. I have requested an EM and results are pending Dont think a RF test was requested . May I pls ask the relatio...

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RE: ? paraneoplastic vasculitis 1 day ago

Thanks for posting this interesting case. Bacteremia /infective Endocarditis can mimic ANCA Vasculitis and represents a major diagnostic challenge....

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? paraneoplastic vasculitis 1 day ago

Dear All, I have an interesting 81 year old male with a diagnosis of colon cancer.The colonic bx was followed by enterococcus bacteremia treated wi...

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RE: Sparsentan comparison with ARB 1 day ago

In most studies, a new drug for glomerular diseases or CKD itself, is being used on top of maximum tolerable dose of ACEi or ARBs. Specific ACEi or...

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RE: AA amyloidosis 1 day ago

I am honestly not sure. I will touch base with the pathologist and find out. I will check for TB. I will contact the patient in the AM She is fr...

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RE: Sparsentan comparison with ARB 1 day ago

I think we well better understand the role of Sparsentan as a nephro-protective agent much better when we have longer term data on the effects of t...

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RE: kidney stones 2 days ago

That was what I was thinking, but need the 1,25 level and then can look for defect ------------------------------ Stuart Sprague DO, FASN Chief, ...

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RE: kidney stones 2 days ago

Decreased 24-25 hydroxy vit D level and undetectable / low activity of 24 hydroxylase enzyme activity will lead to the diagnosis ----------------...

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RE: kidney stones 2 days ago

If high 1-25 vit D level is confirmed, then possibility of 24 hyroxylase enzymes deficiency with variant mutation is a strong possibility with hype...

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RE: kidney stones 2 days ago

Agree with stopping the vit D and checking phos, not sure ionized calcium will help. His urine UA was not too high, again it would be nice to see t...

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RE: Sparsentan comparison with ARB 2 days ago

Irbesartan is one of the least commonly used RASi in IgAN. A comparison of Sparsentan to maximal labeled doses of other RASi such as Ramipril or Pe...

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RE: Sparsentan comparison with ARB 2 days ago

There is no information addressing your question. to my knowledge, this drug has been approved by the FDA based on one study done in patients with ...

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RE: kidney stones 2 days ago

thanks for the input. i will check 1,25 level. i did notice that his 25 level was 85. he is on 2000u/d of cholecalciferol. i can dc now even before...

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RE: Psychiatric Patients and Dialysis 2 days ago

I can remember two patients in my 40 years of taking care of dialysis patients who were extremely disruptive not only to the staff but a danger to ...

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RE: kidney stones 2 days ago

It would be nice to see the results of his full urine with supersaturations and blood, however, I would suggest having dietary changes to decrease ...

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RE: kidney stones 2 days ago

this is a 67 year old male. urine volume 1800 cc, so there is room for increased fluid intake. serum bicarb 27. i did notice that his last urine ph...

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RE: kidney stones 2 days ago

Age, gender, Serum HCO3? Urine volume? Im not sure about decision making based on that paper let me ask the experts @John Asplin @David Goldfarb...

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RE: Psychiatric Patients and Dialysis 2 days ago

UpToDate also has a good summary of evaluation and management of Psychiatric Illness in dialysis patients, ------------------------------ Richard...

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RE: Psychiatric Patients and Dialysis 2 days ago

It is not a position paper, but rather a management guideline. Check on the RPA website. ------------------------------ Richard Glassock MD, FASN...

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RE: PLA2R negative Membranous Nephropathy- Management Q 2 days ago

While you are at it, ask the pathologist to stain the biopsy for IgG subclasses, as tgus might provide a clue as to the antigen involved, but this ...

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kidney stones 2 days ago

I am seeing a patient who has had multiple episodes of obstructive uropathy secondary to stones. The stones have never been recovered and analyzed,...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

I can ask the pathologist if can be stained to look for Exostosin, thank you. ------------------------------ T. Kaur, MD Nephrologist -----------...

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RE: Psychiatric Patients and Dialysis 3 days ago

What is the RPA position ? Can anyone share ? Thanks Sent from my I-Phone

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

At this point, we don't have a lot of information about these patients. So yes, here it would only help when thinking of prognosis -------------...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

How does exotoxin staining change management other Than telling us may have better prognosis --------------------------------- Bajinder Reen MD ...

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RE: PLA2R negative Membranous Nephropathy- Management Q 3 days ago

Was Exostosin 1/2 staining done? May not fit the typical picture (most commonly associated with Lupus nephritis) but there are still many unknowns....

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RE: TNF induced IgA nephropathy 3 days ago

she has IgA vasculitis and crohns disease methotrexate is a good option to try as it is used in moderate and severe crohns(sc. IM)as induction and...

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RE: Psychiatric Patients and Dialysis 3 days ago

This is a very difficult question, no clear answer, the network in Massachusetts does not allow you to send them somewhere else, and hence the relu...

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RE: TNF induced IgA nephropathy 3 days ago

After several courses of steroids and failing MMF due to sepsis I put her on the oral Budesinide. She had already been off the Remicaide for severa...

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