Denosumab in Chronic kidney disease patients 15 minutes ago

You input is appreciated . I have a 60 year old with stage 4 chronic kidney disease secondary to diabetic nephropathy was diagnosed with osteopor...

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RE: Timeline to use a new AV graft 1 hour ago

I wanted to add a few more references to Dr Rodby's collection on flow in arteriovenous fistulas, autologous or bridge grafts. In addition we...

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RE: Target Weight In New HD Starter 5 hours ago

I do not believe that is it is used much. We at HFHS=West Pavilion DU had about 240 patiens. We had 20 Fresenius machines in which the crit -l...

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RE: Timeline to use a new AV graft 8 hours ago

I usually wait only 2 weeks before allowing cannulation of a new AVG. The main barrier to earlier cannulation is patient pain associated with tryin...

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RE: Clinical trials for patients with Familial FSGS 8 hours ago

The DUPLEX trial of Sparsentan enrolled some Genetic FSGS patients, but unfortunately it had no benefits for eGFR. I know of no clinical trials for...

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Clinical trials for patients with Familial FSGS 10 hours ago

Hello, I have a 27 year old female with familial FSGS (NPHS2) with c.965G>C and c.686G>A variants, both heterozygous. She continues to ha...

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RE: Timeline to use a new AV graft 10 hours ago

A lot of difference of opinion here- is the Vascular Surgeon really "wrong "- his opinion seems conservative and reasonable, under most circumstanc...

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RE: Timeline to use a new AV graft 10 hours ago

As for CHF and AVF, I think that is one of the most overlooked aspects of ESKD treated with AVF. To make my biased point I will upload my enti...

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RE: Timeline to use a new AV graft 10 hours ago

I don't agree with any of the statements except Dr. Rodby . The time to first canulate a n AVG depends on many factors as initially mentioned by...

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RE: Hyponatremia and misdiagnoses in a dog 13 hours ago

Bicarb hasn't been checked since 2022, it was normal at that time: 22 (ref range 13-27). Plan is to recheck it with electrolytes as we begin to tap...

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RE: Timeline to use a new AV graft 13 hours ago

I agree with Dr Hendrix. The surgeon expresses an important concern about AVFs and CHF; however, a fixed rule is rarely a good idea, especially in ...

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RE: Target Weight In New HD Starter 14 hours ago

Dr. Besarab- thanks for your very welcome comments coming from a long experience with handling fluid volume excess in dialysis patients. Your very ...

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RE: Dense deposit disease after kidney transplant and treatment options 14 hours ago

Thanks Dr. Balan. The case under discussion has recurrent DDD in a kidney allograft. Observational Experience with Eculizumab in this situation is ...

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RE: Target Weight In New HD Starter 14 hours ago

I agree that the great majority of incident ESRD patients are not at "ideal Body weight," and have extracellular volume excess. Please see the two-...

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RE: Hyponatremia and misdiagnoses in a dog 15 hours ago

On last analysis, blood glucose was 78 mg/dL and BUN was 18 mg/dL, both within the canine reference range. ------------------------------ JD Fost...

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RE: Timeline to use a new AV graft 15 hours ago

I also agree with the surgeon. A 4 week delay will allow most all of the post-op swelling to resolve making the initial cannulation much easier for...

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RE: Hypertension in athletic healthy patient 16 hours ago

Roger, Thanks for raising these points: I. Are the any clues, eg the degree of Aldo renin ration, absolute level of aldo etc? For instance, renin...

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RE: Dense deposit disease after kidney transplant and treatment options 16 hours ago

@Richard Glassock I am not sure the data on eculizumab is as good in C3GN as in complement mediated HUS. I thought cyclophosphamide for severe ca...

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RE: Dense deposit disease after kidney transplant and treatment options 19 hours ago

Thank you Dr. Glassock for the quick response .Unfortunately no EM report available . We are suspecting this is recurrent DDD after transplant ! It...

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RE: Dense deposit disease after kidney transplant and treatment options 22 hours ago

Do you have EM on any of the pre-transplant native kidney biopsies? De novo DDD post transplant is exceedingly rare . This is missy likely recurren...

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Dense deposit disease after kidney transplant and treatment options 23 hours ago

26-year-old female diagnosed with ESRD in 2015 after she had nephrotic syndrome An initial kidney biopsy done in 2012 for work-up for nephrotic sy...

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RE: Hypertension in athletic healthy patient 1 day ago

I think the (classic) tip-off to a carcinoma if functional is the co-secretion of multiple hormones; aldo might even be low from excess cortisol, D...

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RE: Target Weight In New HD Starter 1 day ago

If available, I would use Crit line to estimate dry weight . If not, probe dry weight using conventional signs (BP, symptoms). A 3% weight loss dur...

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RE: Target Weight In New HD Starter 1 day ago

Thanks prof glassock. You would use crit line in first hd and use that to guide fluid removal and dry weight . And let says new starter to HD has h...

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RE: Timeline to use a new AV graft 1 day ago

I agree with the vascular surgeon. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----------------------...

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RE: Target Weight In New HD Starter 1 day ago

Nearly all ESKD patients starting dialysis have excess ECFV that cannot readibly be detected by a standard PE. If the systolic BP is elevated and L...

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Target Weight In New HD Starter 1 day ago

Hi for new starters on HD how do we get a target weight ? I examined someone today and in our unit we do BCM. Clinical exam ( chest , jvp , periph...

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RE: Hypertension in athletic healthy patient 1 day ago

@Steven Gorbatkin "3.1 We recommend that all patients with PA undergo adrenal computed tomography (CT) as in the initial study in subtype test...

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RE: Hypertension in athletic healthy patient 1 day ago

I agree with Dr. Hirsch that a further workup may not be helpful for some patients. if a patient has no desire for surgery or other invasive tests ...

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RE: Timeline to use a new AV graft 1 day ago

A lot depends on the type of material used for the graft. Do you know what was used? @Monnie Wasse ------------------------------ Roger Rod...

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Timeline to use a new AV graft 1 day ago

We have a new vascular surgeon in town He wants to wait 4 weeks before using AV graft he has placed He also refuses to place a AV fistula in a pa...

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RE: IgA nephropathy with positive ANCA 1 day ago

With the onslaught of studies and agents for IgAN and so many different clinical and histologic presentations, I think all IgAN treatment decisions...

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RE: IgA nephropathy with positive ANCA 1 day ago

The optimal treatment of "crescentic" disease without RPGN in IgAN (?IgAV) with or without ANCA is one of the great unresolved conundrums in IgAN T...

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RE: IgA nephropathy with positive ANCA 1 day ago

The impact of treating a c2 (finrocellulsr) lesion in IgAN with "stable" , but reduced, kidney function using iS (RTX or other ) is not well unders...

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RE: IgA nephropathy with positive ANCA 2 days ago

I think I would treat the pr3, that level concerns me. I may be treating a lab test alone, a false positive if you will, but I'd rather error on th...

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RE: Renal infarction 2 days ago

Yes.In acute events IR usually evaluate and intervene if feasible by thrombolysis. in cases of smaller branches that are not amenable to interventi...

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RE: IgA nephropathy with positive ANCA 2 days ago

Checking CRP and ESR may help regarding possibility of active vasculitis. Since the initial biopsy in 2018 already showed crescents, it will be imp...

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RE: Renal infarction 2 days ago

Yes (by brain, assume meant head & neck). --------------------------------- Oded Friedman ---------------------------------

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RE: IgA nephropathy with positive ANCA 2 days ago

Can you supply the Oxford -MEST-C score, the urine sediment findings and the current level of urinary protein excretion and aFANA?. We also need to...

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RE: Hyponatremia and misdiagnoses in a dog 2 days ago

A plasma bicarbonate level availabls? ------------------------------ Alejandro Alvarez Ortiz MD Nephrology and Hypertension Specialists St. Louis...

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RE: Renal Biopsy In PAN 2 days ago

Probably not life-threatening. A more conservative approach to therapy may be indicated, and the ANCA titers and kidney biopsy will likely help the...

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RE: Renal infarction 2 days ago

Thank you so much Dr Marwan Abu Minshar . So will the angiogram be helpful ? Who would intervene if something is found ? IR? ------------------...

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IgA nephropathy with positive ANCA 2 days ago

A 34-year-old man with a history of IgA nephropathy, which has been evident since 2018 with crescent formation, was initially treated with a short ...

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RE: Renal Biopsy In PAN 2 days ago

No lung or heart affection or CNS affection , creat 200 --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 5...

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RE: Renal Biopsy In PAN 2 days ago

Knowing if cystic artery involved in GB (= MVV) vs acanthocytes/RBC casts (= SVV/GN) might help. I’d think therefore to biopsy only if: ANCA neg...

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RE: Renal Biopsy In PAN 2 days ago

What is the current Scr? Any sign of cardiac or lung involvement.? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949)...

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RE: Renal Biopsy In PAN 2 days ago

This patient CKD base creat. 180 , so this not life threatening organ involvement is that correct ??” --------------------------------- Mohamed Ma...

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RE: Renal Biopsy In PAN 2 days ago

If PAN is confirmed by angiography or kidney biopsy (the latter often shows only non-specific features), the treatment is oral steroids, perhaps co...

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RE: Renal Biopsy In PAN 2 days ago

Thank you for the input Which better for abdominal angiogaraphy MRA Or Ct angio And if confirmed PAN What is your opinion regarding treatment o...

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RE: Renal Biopsy In PAN 2 days ago

PAN often skips the kidney small vessel parenchyma, glomeruli, vessels are too small. And ANCA is usually negative in PAN This patent has mild ev...

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