RE: Pauci Immune Crescent GN. 32 minutes ago

Dr Glassock, if the DMSA scan does not show any scars then of course my hypothesis goes out of the window. Occam wins again. However I was wonderin...

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RE: Refractory HTN 3 hours ago

I should additionally mention that the few cases I have seen  with Ask-Upmark kidneys and severe refractory hypertension were all < 40 years of age...

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RE: Refractory HTN 5 hours ago

If you Google Ask-Upmark Kidney you will see a lot of  References.  I have seen a few cases of unilateral disease.  All were cured by unilateral ne...

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RE: Refractory HTN 5 hours ago

This is a pretty classic presentation for the Ask-Upmark Syndrome (congenital unilateral kidney hypoplasia /dysplasia  causing refractory  severe h...

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RE: Refractory HTN 5 hours ago

Yes, the values for PAC and PRA must be switched.  Please correct and recalculate ARR.  The hypoplastic (? Dysplastic) kidney is likely the source ...

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RE: AVF Pain During The Last Part Of HD session 6 hours ago

Could be that needle positioning is contributing (i.e. tip against the wall), especially if the AVF is tortuous.  Would suggest duplex ultrasound a...

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RE: Refractory HTN 6 hours ago

What is the ARR? I think there switching in the aldosterone and renin unit (as PAC unit is ng/dl and PRA in ng/ml/h). Regarding poorly controlled a...

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RE: AVF Pain During The Last Part Of HD session 6 hours ago

Dear Dr. Wasse, Can you kindly elaborate further on your thougjts regarding this pain related to hemodialysis, as its not a rare event in hemodialy...

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Refractory HTN 7 hours ago

Hello, I would like to hear your opinion regarding this case: 61 y/o, female, HTN since 2020 referred by cardiologist in 10/2021 for resistant hype...

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RE: Exhausted dialysis options 8 hours ago

Very important you document well and clearly your communication with her and her family ..unfortunately the outcome will be very  sad ! usually the...

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RE: Pauci Immune Crescent GN. 12 hours ago

Reverend Occam May be unhappy with your formulation but Doctor Hickam will be very pleased. If a DMSA scan fails to show any cortical scars overlyi...

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RE: Pauci Immune Crescent GN. 15 hours ago

The history of recurrent urinary tract infection in this lady since the age of 12 years definitely suggests anatomical abnormality of the urinary t...

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RE: IgA Nephropathy with Crescents 15 hours ago

I do agree with the general opinion about this being a chronic disorder with little chance of improvement with immunosuppression. However I am curi...

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RE: Re: Remdesivir yours in CKD patient's with GFR less than 30 mL/minute 17 hours ago

Agree- Timing is everything with Remdesivir for COVID therapy. --------------------------------- Richard Glassock MD, FASN Emeritus Professor D...

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RE: Re: Remdesivir yours in CKD patient's with GFR less than 30 mL/minute 18 hours ago

I have seen remdesivir given in the 3 scenarios you mention and would not have any hesitation except perhaps with worsening aki without another exp...

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RE: Board recertification 18 hours ago

Agree totally. I did not attend but purchased the course later in 2021 and it was extremely helpful. I did attend the conference in San Francisco i...

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RE: Board recertification 18 hours ago

Attend and participate in the ASN-BRCU Program given  each year, usually in Chicago. (COVID willing) ------------------------------ Richard Glasso...

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Board recertification 19 hours ago

I am due for my recertification in 2022. What is the best study source? Is the new Longitudinal Knowledge Assessment a good idea to maintain certif...

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RE: Raised Aldosterone with Normal Renin Levels 23 hours ago

apologies for the absence. Just recovered from company with COVID.  she was not on any OCP or spironolactone. I just started Spironolactone after s...

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RE: Pauci Immune Crescent GN. 1 day ago

This case demonstrate that small kidney size is not a contraindication for biopsy and may has diagnostic yield. Expected to find higher ( more tha...

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RE: Immune complex GN and AMR 1 day ago

Dr. Trivedi Apology for misunderstanding, what I mean is HLA classes (ABC, DP, DQ,DR). And not epitope --------------------------------- Hayder A...

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RE: Lupus nephritis 1 day ago

I would also ask for Anti GM Ab, ANCA to role out double positivity as possible cause of resistance. Inclined towards at least 3to 4 doses of iv cy...

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RE: Immune complex GN and AMR 1 day ago

Many thanks Dr.Glassock and Dr.Venkat.  Dr.Aledan- thank you for the comments. We do not do epitope level high resolution HLA matching and also w...

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RE: Immune complex GN and AMR 1 day ago

Since he has AT1-ab (albeit weak), you may want to change lisinopril to an ARB. AT1-ab is agonistic and stimulates the AT type 1 receptor directly ...

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RE: Immune complex GN and AMR 1 day ago

Dr. Aledan- all good points. I was thinking of and ICGN because of sub-endothelial and mesangial  ED deposits and the IF  findings, but I Agree th...

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RE: Immune complex GN and AMR 1 day ago

Dr. Glassock, can ICGN occurred in the absence of glomerular inflammation on LM? Agree there is subendothelial deposit in this case but i think thi...

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RE: Immune complex GN and AMR 1 day ago

Interesting case Dr. Trivedi! What is the MFI levels of this class II dnDSA and to which epitope of class II? With presence of peripheral transpla...

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RE: Immune complex GN and AMR 1 day ago

I thought that the C4d stains were “strongly positive”. The overall picture is compatible with AMR + possible superimposed ICGN (recurrent ??). Wit...

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RE: Immune complex GN and AMR 1 day ago

He had some leukopenia in past which we attributed to myfortic. His Hgb and PLT. trending down since appearance of DSA. There is no vascular findin...

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RE: Immune complex GN and AMR 1 day ago

IF: 4 Gloms none are sclerotic. It shows diffuse granular glomerular capillary basement membrane positivity for IgG, IgM, IgA, Kappa, Lambda, fibri...

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RE: Exhausted dialysis options 1 day ago

Terrible situation. We feel your concern and angst. Not much you can do. I would leave the PD Cather in. She is in a death spiral that is very diff...

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RE: Pauci Immune Crescent GN. 1 day ago

This biopsy has all of the pathological characteristics of “pauci-immune necrotizing and Crescentic GN” which is a pattern of injury not a specific...

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RE: Pauci Immune Crescent GN. 1 day ago

Valid question but when I consider immune or paucity immune it is the setting of an inflammatory lesion and I do not believe that mesangial deposit...

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RE: Exhausted dialysis options 1 day ago

Yeesh, we have all seen these patients. You can do only so much and it may sound callous but her personality is part of her disease and may not be ...

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Exhausted dialysis options 1 day ago

Hello, I have a 38-year-old patient on PD who is very non-compliant with her dialysis treatments. Because of her non-compliance and aggressive nat...

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RE: Pauci Immune Crescent GN. 1 day ago

This question may not be relevant to the treatment but with "full house" mesangial immunofluorescence and immune complex deposits present in the me...

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RE: IgA Nephropathy with Crescents 1 day ago

A C1 lesion indicates a fairly ominous prognosis. In addition to optimizing conservative therapy and BPControl would probably treat with steroids i...

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RE: Pauci Immune Crescent GN. 1 day ago

I do not know shorthand. I wonder if the new generation sod nephrologists does? Sent from Outlook

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RE: Pauci Immune Crescent GN. 1 day ago

BTW IMHO IDK either :) --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL (31...

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RE: Pauci Immune Crescent GN. 1 day ago

Thank you so much. Even when I was practicing, I disliked the use of these abbreviations but realize that they do speed things in communication S...

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RE: Pauci Immune Crescent GN. 1 day ago

Small vessel Vasculitis- abbreviation used as this is ANCA negative Disease . ------------------------------ Richard Glassock MD, FASN Emeritus P...

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RE: IgA Nephropathy with Crescents 1 day ago

SCr already elevated 3 years ago and stable SCr/GFR over past 3 weeks of observation suggest a chronic, slowly progressive, sclerotic process, unli...

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RE: Pauci Immune Crescent GN. 1 day ago

SVV stands for? ------------------------------ Anatole Besarab MD ABesarab Consulting Bend OR (734) 417-4793 ------------------------------

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RE: Immune complex GN and AMR 1 day ago

Agree with Dr. Glassock that chronic antibody-mediated rejection (AMR) with transplant glomerulopathy (TG) is the major cause of renal dysfunction ...

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RE: Discrepancy between BMP Bicarb and Blood gas Bicarb - significant 1 day ago

Here is a screen shot of the papers I have pseudohypobicarbonatemia As you can see most are either hypertriglyceridemia or paraproteinemia, or unkn...

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RE: IgA Nephropathy with Crescents 1 day ago

Thank you for the advice, it appears to be chronic. ------------------------------ Dr V Lachman Nephrologist South Africa ------------------------...

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RE: IgA Nephropathy with Crescents 1 day ago

No autoantibodies, anca negative. Compements normal. Piptazosin was used alone. Crp and pct normalised. Unfortunately we dont get EM. Thank you so...

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RE: IgA Nephropathy with Crescents 1 day ago

I get the sense here that this is chronic iga nephropathy. I agree with RAASI maybe SGLT2I later, and probably a trial of Prednisone. Eventuality I...

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RE: IgA Nephropathy with Crescents 1 day ago

What about C3 and C4? cANCA and pANCA? What about serum albumin? Any WBC in urine (AIN)? Does EM was done? Does markers of infections normalized su...

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IgA Nephropathy with Crescents 1 day ago

I have a 51 year old male who has been hypertensive for 25years referred now to me having presented with a pneumonia, covid negative. He is known t...

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