RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 37 minutes ago

Ultrafiltration is an excellent option for a case like this. Remove a couple of liters a day until euvolemia and decongestion is acchieved. Ultra...

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RE: pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 3 hours ago

What other medications.? In patients such as these i typically stop calcium channel blockers/ vasodilators and find they often duress with a higher...

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RE: Lupus nephritis III/IV 4 hours ago

All good points Dr.Masri. I think an active surveillance based on a combination of home-based monitoring snd periodic serology is s reasonable stra...

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RE: Lupus nephritis III/IV 7 hours ago

In a case of a " good candidate" for stopping maintenance therapy; maybe we can consider a combined surveillance strategy ( monthly labs ) and dail...

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RE: Atypical Nephretic nephrotic syndrome 8 hours ago

Thank you very much for your insightful comments and valuable input, I agree with your assessment. At this stage, I plan to continue the patient on...

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pulmonary hypetension, nephrotic syndrome refractory to diuresis, SCUF? HD with UF Only? 19 hours ago

Hi all! I have a 65F Bcr 1.2-1.6 recently, DM HTN with pulmonary hypertension coming in with very very severe edema, she was weeping from her ext...

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RE: Lupus nephritis III/IV 20 hours ago

Some patients with class III or class IV LN on biopsy have severe clinical presentation with marked increase in SCr (including RPGN-like course) an...

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RE: Lupus nephritis III/IV 20 hours ago

Drs. Hirsch and Rodby- what would you do if your 25 year old patient with Class IV LN in a complete clinical remission for 1 year on MMF 2.0 gms pe...

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RE: Monosodium Urate Stone (MSU) 20 hours ago

Dr.Asplin can fill us in on this very rare cause of urinary stones. I suppose that it is managed in the same way as uric acid stones - K citrate sn...

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RE: Lupus nephritis III/IV 22 hours ago

This is to be sure, absent an RCT, mostly speculative, but IMHO, the argument behind Dr Rodby's approach (which I share) is that negative serology ...

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RE: Biopsy dilemma in setting of severe refractory ITP 23 hours ago

Until we can get the kidney biopsy catheter back, we cannot perform it safely and we have abandoned it. By the way, it takes a radiologist about 5 ...

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RE: Lupus nephritis III/IV 1 day ago

Good thread . Lot of good advice. I use serology, rather than repeat KB to determine when it is "safe" to discontinue IS in patients with treated "...

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RE: Lupus nephritis III/IV 1 day ago

I am in the longer than shorter camp and I have patients on indefinite maintenance, but that is hardly a universal opinion and dare I say may be un...

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Lupus nephritis III/IV 1 day ago

General question , I believe was also discussed previously but I wanted to see general opinion/practice among different doctors here. how long d...

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RE: Atypical Nephretic nephrotic syndrome 1 day ago

EMs are still pending , if you see mesangial deposits that may go along with the almost full house IF which is not typical for PLA2R MGN. Was there...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

Thanks Dr.Leung. Very helpful detail. I assume that you have abandoned the procedure at the Mayo Clinic for kidney biopsy . ---------------------...

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RE: Atypical Nephretic nephrotic syndrome 1 day ago

This is a fairly common conundrum in clinical practice. One disease (Reverend Ockham's Razor) or two( (Hickams dictum )? Hard to tell in this case....

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Monosodium Urate Stone (MSU) 1 day ago

I have a nephrolithiasis patient (in hospital for obstruction, got ureteral stents, improving), the stone analysis came back as monosodium urate. T...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

We used to do it at Mayo. Our radiologists got pretty good at it with tissue acquisition rate of over 90%. The problem is that we can no longer obt...

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RE: Atypical Nephretic nephrotic syndrome 1 day ago

The severe interstitial led jobs are cdrtub,y compatible with NSAUD induced. the anti-PLA2R antibody may be real or a false positive-gard ti tell w...

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RE: Atypical Nephretic nephrotic syndrome 1 day ago

Thank you for your comment , we have only serum APLA2R level , and it was 100 . Unfortunately we don't have APLA2R stain for biopsy . I really ...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

Thanks everyone The IR consultant I spoke to has done it( So junior IR consultant when I mentioned it have never heard of it) but that senior cons...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

Correct. It is my impression that this is a procedure being performed in very ill patients and it should only be done by individuals with lots of e...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

Thanks Dr. Rubin. Can I assume from your comments for the availability of TJKB performed by skilled operators would be unlikely in a hospital witho...

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RE: Atypical Nephretic nephrotic syndrome 1 day ago

The antigen associated most closely with NSAID MN is PCSK6. Anti-PLA2R antibody positive MN is very rarely, if at all , caused by NSAID expisure . ...

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Atypical Nephretic nephrotic syndrome 1 day ago

A 35-year-old previously healthy male presented to the emergency department with bilateral lower limb edema for 10 o He reported a history of upp...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

It represents Files Attached DocumentRE: Biopsy dilemma in setting of severe refractory ITP

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Just curious. How many liver Transplant programs in the USA Maintain transjugular kidney biopsy as a standard procedure in their armamentarium . Dr...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Dear all, I had been a part of some early attempts at trans jugular biopsy in the early aughts with a military IR procedurist who's probably a mu...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

The perspicacious comment of Dr. Rubin is greatly appreciated. My suggestion that transjugular kidney biopsy (TJKB) is largely a museum piece , is ...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

I do agree with everyone that a renal biopsy would be probably redundant in this lady. I would definitely put her on Raasi. Progression to ESRD is ...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Personally, I think that before we close the door on this modality and find a suitable place in a museum for it, we must query those centers with v...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

When talking to woman of reproductive age, how do you approach the fact that having children with intact renal function is better than having chi...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Thanks Dr. Whittier,.. it sounds like transvenous renal biopsies are museum pieces not real procedures. I cannot ever recall being involved in this...

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RE: Biopsy dilemma in setting of severe refractory ITP 2 days ago

Our own IR stopped due to the time commitment of the procedure. they felt it was a negligible safety difference, and sometimes the procedures would...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

Dr. Rodby and Dr. Glassock, is there any chance that she may not have Alport? There is some data showing other types of pathology such as IgA or FS...

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RE: Col4A5 mutation pt - Would you biopsy? 2 days ago

Thanks to everyone for your input! very helpful. ------------------------------ Yongen Chang MD, PhD, FASN University of California Irvine Orang...

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RE: Col4A5 mutation pt - Would you biopsy? 3 days ago

Here is the viewpoint of a provider treating young patients: With a confirmed COL4A5 mutation and preserved kidney function, biopsy is unlikely to...

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RE: Col4A5 mutation pt - Would you biopsy? 3 days ago

I fully agree with Dr. Rodby. With these clinical and genetic findings a kidney biopsy would be redundant. She should be treated for X-linked Alpor...

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RE: Col4A5 mutation pt - Would you biopsy? 3 days ago

I would not, a clearer diagnosis without a biopsy cannot exist IMO. She will probably do OK, but bc she is only 27, I think I would still treat ...

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RE: lupus podocytopathy 3 days ago

Or unlikely --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus podocytopathy 3 days ago

47 pregnancy less likely --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: lupus podocytopathy 3 days ago

Thanks dr zineb. This is systemic sle and lupus podcytopathy I would treat with mmf an steroids ( more for extra renal) I would not only focus o...

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Col4A5 mutation pt - Would you biopsy? Tuesday, March 31 @ 2:18 PM

Hi, just wondering everyone's take on this - I have a 27 year old female patient with strong family history of presumed Alport's in her two brother...

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RE: Terlipressin Use and hepatorenal syndrome–AKI Monday, March 30 @ 8:25 PM

I suppose you don't know if the patient responded to albumin as volume or a specific HRS treatment independent of volume (HRS by definition has to ...

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RE: Looking to decode this allograft biopsy Monday, March 30 @ 7:55 PM

I do have Black and white but not colored pictures, same read on 2nd opinion. Crescents are likely pseudo as mentioned. Could be CNI but see a...

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RE: Looking to decode this allograft biopsy Monday, March 30 @ 7:51 PM

See attached Allosure levels Never crossed 0.2 MFI was 1800 for Cw and just below 5000 for DR ------------------------------ Sandee...

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RE: Terlipressin Use and hepatorenal syndrome–AKI Monday, March 30 @ 7:41 PM

.Appreciate your thoughtful comments. Appreciate your comments on usage of albumin I participated on the ATTIRE trial. the pendulum swing appropr...

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RE: Looking to decode this allograft biopsy Monday, March 30 @ 6:50 PM

Dr. Magoon, I still have a couple of questions and comments you gave us the DSA with their MFI and said that these have been consistently decrea...

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RE: Looking to decode this allograft biopsy Monday, March 30 @ 5:21 PM

The lack of the actual histological pictures makes a possible diagnosis very uncertain. Nonetheless, I will "dare" to suggest that he has a de-novo...

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