Open Forum Digest for Wednesday December 7, 2022 27 minutes ago

On Wed, Dec 7, 2022, at 7:23 AM, American Society of Nephrology wrote: 1 announcement, 1 new thread and 21 replies from 13 authors in the "Open For...

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RE: Peritoneal dialysis power flush 1 hour ago

Regardless of When the PD Catheter was placed a KUB to determine position. If it was recently placed it is usually due to Migration or Omental wrap...

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NIH-funded training grant post-doctoral fellowships at UAB 1 hour ago

RFA for postdoctoral positions in Interdisciplinary Training in Kidney-Related research at the University of Alabama at Birmingham – 2023. Applic...

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RE: Hemodialysis Filter Discard 1 hour ago

Agree with Dr Glassock. What was the Hb pre-ESA therapy? A "hyper-response" to a Hb of 14 g/dL indicates extreme sensitivity and he might need a s...

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RE: TMA in Kidney Transplant Recipient 1 hour ago

Why no a transplant nephrectomy.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------...

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TMA in Kidney Transplant Recipient 1 hour ago

Dear Community: 20 yr old, primary kidney disease; renal dysplasia. Live related Kidney Tx 7 years ago, maintenace Pred, MMF, Tac. May 2022, graft ...

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RE: Hemodialysis Filter Discard 3 hours ago

would be interested to know what hgb was prior to initiating esa. ------------------------------ Brian Michel MD Haddon Renal Medical Specialists ...

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RE: Peritoneal dialysis power flush 3 hours ago

When a PD catheter is not functioning well, I would check its position first by a plain abdominal X-ray. Only when its position looks ok, the possi...

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RE: When to consider kidney biopsy for proteinuria that is associated with HELLP 12 hours ago

Thank you all for your input ------------------------------ Rehab Albakr MD Nephrologist ------------------------------

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Peritoneal dialysis power flush 15 hours ago

Interested in opinions regarding managing pd cath malfunction (not draining/slow flow) most clinics usually perform a "power flush" using a 60 ml s...

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RE: nedd help with IgA pt 16 hours ago

Thanks so much. I was unaware of this tool and can see it will be very helpful in coming up with a plan. I don’t have all the exact data in front o...

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RE: nedd help with IgA pt 17 hours ago

Good question. Unfortunately, the hypothesis you articulate has never been adequately studied in IgAN. Fundamentally, it is a trade off between und...

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RE: When to consider kidney biopsy for proteinuria that is associated with HELLP 19 hours ago

Concur with waiting a while longer. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 3145372356 -...

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RE: nedd help with IgA pt 19 hours ago

I should explain that one more factor in my considering more aggressive initial treatment is the patient's age-35. Over the past couple of years I ...

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RE: Suspected minimal change disease 1 day ago

Thanks so much for the info Dr. Glassock!! ------------------------------ James Matera DO Sr. VP of Medical Affairs/CMO CentraState Medical Center...

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RE: Suspected minimal change disease 1 day ago

See Pankhurst , et al NDT 2006;21:64-69 concerning incidentalomas on kidney biopsy. Bottom line, if you can't see it with imaging, surveillance onl...

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RE: Suspected minimal change disease 1 day ago

Thank you everyone. Will report back once the mammogram is resulted. ------------------------------ Louis Spiegel MD ------------------------------

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RE: Lupus Nephritis - now w change of class 1 day ago

Sounds like active LN, probably Class III/IV a/c. I am not convinced that a repeat kidney biopsy is needed. But she probably needs "re-induction " ...

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RE: Thymoma And Minimal Change 1 day ago

A specific role for T-cells in the pathogenesis of the pattern of injury lesion we have descriptively labeled as "Minimal Change Disease " is large...

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RE: When to consider kidney biopsy for proteinuria that is associated with HELLP 1 day ago

I agree with Dr. Glassock; I would definitely wait. It can take several months for proteinuria to disappear after severe preeclampsia/eclampsia - u...

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RE: Hemodialysis Filter Discard 1 day ago

No epo requirement is observed in number of dialysis patients. We always jump to r/o RCC. The reality that only small fraction of RCC express eryth...

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RE: Thymoma And Minimal Change 1 day ago

I recall work of french groups linking minimal change disease to T-lymphocytes. Will ATG be of value in such situation? --------------------------...

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RE: Suspected minimal change disease 1 day ago

No CYC, did relapse with steroids x 2, so got MMF and full remission after 4 months. ------------------------------ James Matera DO Sr. VP of Medi...

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RE: Suspected minimal change disease 1 day ago

Interesting finding-, co-incidental or causal. Difficult to be sure. What was the original treatment regimen for MCD?Did he receive any CYC? -----...

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RE: Lupus Nephritis - now w change of class 1 day ago

please refer to the history above i will summarize briefly - this is a 22yr old AA girl w bx proven pure Class V (last year) - did well on mmf, raa...

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RE: CKD after unilateral nephrectomy 1 day ago

Most standard 40 year old donors should have a baseline GFR > 90cc/min/1.73m2 and have a normal creatinine 6 months post unilateral nephrectomy. Th...

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RE: Recurrent treatment resistant FSGS that is TPE dependent 1 day ago

I agree- In fact, treatment of recurrent FSGS has been shown to be much less successful when PLEX (or Lipid Apheresis ) is begun AFTER well develop...

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RE: Recurrent treatment resistant FSGS that is TPE dependent 1 day ago

Lipid apheresis may have some advantages over plasmapheresis, however, I am worried about the rising creatinine. Once creatinine is above 2 mg/dl (...

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RE: CKD after unilateral nephrectomy 1 day ago

Here is a reference to a paper we wrote more than 10 years ago on this subject. Barri Y, et al Transplantation 2010; 90:575-580. The facts are stil...

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RE: Suspected minimal change disease 1 day ago

Agree with steroids. Have a similar case, MCD at age 19 Full remission since age 20, now 42 and recurrence. Bx MCD but also a "nest" of papillary c...

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RE: Suspected minimal change disease 1 day ago

I agree 100 % with Dr. Rodby. I would start steroids now, not wait for EM. This is a high risk situation for a VTE. The breast mass can be sorted o...

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RE: CKD after unilateral nephrectomy 1 day ago

Sorry about the split message. Depending on the balance of the opposing effects of these factors on GFR/SCr, 24-48 hrs post-uninephrectomy SCr is r...

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RE: CKD after unilateral nephrectomy 1 day ago

This is similar to what happens after uninephrectomy in living donors. SCr typically doubles (sudden 50% reduction in GFR), modified factors such a...

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RE: Subcapsular Hematoma/Page Kidney 1 day ago

My experience with Page Kidney is limited to kidney transplant recipients. My transplant surgical colleagues have evacuated the causative hematoma ...

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RE: Suspected minimal change disease 1 day ago

Once you determine this is MCD I would give steroids regardless if I thought this was secondary or not bc the patient is so nephrotic no recent CO...

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RE: Subcapsular Hematoma/Page Kidney 1 day ago

Update: I let bp drift higher, Hgb drifted down and got prbc and rose appropriately. Creat improving non oliguric. my partner took over today...

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Suspected minimal change disease 1 day ago

Hi everyone, I have a 47 yoF with nephrotic syndrome referred to me recently. Well preserved renal function with Cr [More]

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RE: Subcapsular Hematoma/Page Kidney 1 day ago

Re evacuating a sub capsular hematoma-in my experience urology routinely raises fear of uncontrolled hemorrhaging in this setting and states surgic...

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RE: Thymoma And Minimal Change 1 day ago

Sorry for the spelling errors. Not feeling very well today. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-888...

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RE: Thymoma And Minimal Change 1 day ago

I see your point- perhaps you could sustain a partial remission in the a Sven days of steroids by using CNI. Probably with a try but I am personall...

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RE: CKD after unilateral nephrectomy 1 day ago

I would request a re- review of the slides from the nephrectomy specimen - specifically to look for the extent of global glomerulosclerosis and glo...

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RE: Recurrent treatment resistant FSGS that is TPE dependent 1 day ago

I was not aware of this finding. In my experience Lopid Apheresis has been highly effective for recurrent primary FSGS. Do you have a citation for ...

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RE: CKD after unilateral nephrectomy 1 day ago

No excessive red meat intake, not on any other meds other than a statin. The pathology read on the non involved portion of the kidney did not any d...

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RE: Thymoma And Minimal Change 1 day ago

Currently no- onc does believe any advantage to up front therapy vs waiting for evidence of clin significant recurrence In response to khenar-trac...

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RE: Recurrent treatment resistant FSGS that is TPE dependent 1 day ago

Both Caucasian Early recurrence biopsy days post txp We havent used lipid apheresis given that there is no evidence for it 2 years post txp ----...

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RE: nedd help with IgA pt 1 day ago

mostly the IgA and c3 tubular deposits. i know it is not felt to correlate with severity but he also had a high serum IgA level. i realize that pro...

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RE: CKD after unilateral nephrectomy 1 day ago

The current eGFR is about 66% of the BL pre- Nephrectomy eGFR, which is a little less than expected, but in the absence of albuminuria or hypertens...

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RE: When to consider kidney biopsy for proteinuria that is associated with HELLP 1 day ago

This could be residual proteinuria from a bout of severe HELLpP. I would wait another 6- 8 weeks, and then re-evaluate before considering a kidney ...

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RE: nedd help with IgA pt 1 day ago

What features led you to surmise a state of "aggressive immunological activity" in this case? Just curious. ------------------------------ Richard...

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RE: nedd help with IgA pt 1 day ago

initially i was thinking just anti- proteinuria therapy but due to what i perceived as aggressive immunological activity i was leaning toward immun...

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