RE: Bile nephrosis with normal creatinine 20 minutes ago

A while ago , I saw a patient with a normal serum creatinine, oliguria and a serum Total Bilirubin of >40mg /dL due to fulminant Acute Hepatitis A....

View Discussion

RE: Canine hyponatremia, proteinuria and some urine clearance calculations 26 minutes ago

I think the core of this case is the presence of Nephrotic syndrome and blindness. Would do a kidney biopsy (with IF and EM) and / or genetic testi...

View Discussion

RE: Canine hyponatremia, proteinuria and some urine clearance calculations 41 minutes ago

electrolyte free water clearance is more correct than solute free water clearances and in one study of normal subjects was positive until urinary o...

View Discussion

RE: Canine hyponatremia, proteinuria and some urine clearance calculations 1 hour ago

Twitter question: "Consult on 9 yr dog with 2yrs of neuro signs and 2 months of hypoNa. UNa 45 UK 42 Uosm 322, UPC 5.4. PNa 128 POsm 268. Was asked...

View Discussion

RE: IgA nephropathy with ANCA vasulitis 1 hour ago

Is this patient a diabetic as small number of crescents can be present in diabetic. Which has no prognostic value --------------------------------...

View Discussion

Canine hyponatremia, proteinuria and some urine clearance calculations 1 hour ago

Hello everyone, Would appreciate any thoughts you may have on this consult. I haven't seen the patient, but this was the information sent to me: ...

View Discussion

RE: IgA nephropathy with ANCA vasulitis 1 hour ago

Lots of chronicity , but a relatively small sample. Clearly long standing IgAN. Does the urine sediment contains RBC casts and acanthocytes? What i...

View Discussion

RE: IgA nephropathy with ANCA vasulitis 3 hours ago

"B/G of obesity, Asthma, Gout, HTN." Dr. Rodby: I agree with you that it is difficult to decide whether ANCA-associated crescentic GN is a pathog...

View Discussion

RE: Bile nephrosis with normal creatinine 4 hours ago

I'm curious as to the indication for dialysis. While various albumin based forms of dialysis (MARS, SPAD) or a system like PROMETEUS can remove bil...

View Discussion

RE: IgA nephropathy with ANCA vasulitis 5 hours ago

Please repost with the patient's name blocked, we can still see it in several places. I would be careful not to make a treatment decision base...

View Discussion

RE: IgA nephropathy with ANCA vasulitis 7 hours ago

Has mild AKI (eGFR 50 ml) resolved? Did he have gross hematuria? UPr trend? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ...

View Discussion

IgA nephropathy with ANCA vasulitis 10 hours ago

54 year old presented with mild AKI (eGFR dropped to 50 from a baseline > 90). B/G of obesity, Asthma, Gout, HTN. work up because of active urine...

View Discussion

RE: Bile nephrosis with normal creatinine 1 day ago

My apologies to Juan Carlos. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

View Discussion

RE: Bile nephrosis with normal creatinine 1 day ago

Patients such as yours can have many etiologies of AKI, Hepatorenal syndrome, ATN, and the vague condition of bile cast nephropathy , a diagnosis s...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 1 day ago

Cylophosphamid given after PRES finding by imaging --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH KUWAIT 00965 513777...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 1 day ago

Does anyone think that the cyclophosphamide given could be a cause of PRES? Not sure how you would be able to tell. -----------------------------...

View Discussion

RE: Bile nephrosis with normal creatinine 1 day ago

Juan Carlos Velez (Ochsner Clinic) is one of the world's experts on BCN. ------------------------------ John Schwartz MD Dallas Nephrology Assoc...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 1 day ago

Since you have started cyclophosphamide, mycophenolate can be stopped. I assume WBC count is also improving (without filgrastim). Since platelet co...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 1 day ago

Yes ,till now the question is not answered. We need more studies on large number if patients for long periods --------------------------------- N...

View Discussion

RE: Treatment Of Anti Gbm And Anca Disease 1 day ago

With such a very high anti-GBM level, I think I would add PLEX, at least until the findings on kidney biopsy are available (% normal glomeruli). If...

View Discussion

RE: Treatment Of Anti Gbm And Anca Disease 1 day ago

Pulsed --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

View Discussion

RE: Treatment Of Anti Gbm And Anca Disease 1 day ago

Hi the team have pushed him and given him cyclophosphamide but no plex due to Anuria. He will have rituximab too . Has tunelled line over weekend ...

View Discussion

RE: Bile nephrosis with normal creatinine 1 day ago

Bile cast Nephropathy, cholemic nephrosis, bile nephrosis and Icteric Nephropathy are different names for same, typically underdiagnosed entity wit...

View Discussion

Bile nephrosis with normal creatinine 1 day ago

A 53-year-old female with a past medical history significant for GERD, hypertension, alcohol abuse, and gastric bypass presented with nausea, vomit...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 1 day ago

The question whether Belimumab (or RTX ) should or can be used to diminish the likelihood of a renal relapse in patients with Class IV LN in comple...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 1 day ago

Dr Glassock makes the point '' that the physicians' responsibility is principally to the donor, not coequal with the recipient". I couldn't agree m...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 1 day ago

I love this discussion!!!. A book could be written about the dilemmas of organ donation. The consideration of the donor and recipient as a single "...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 1 day ago

Besides "First Do No Harm", another cornerstone of ethics governing living kidney donation is "Donation Without Coercion". It has been argued that ...

View Discussion

RE: Cryoglobulin disease X dialysis interaction 1 day ago

There is this case report where CVVH filter repeatedly (pseudo-)clotted in pt with CG despite being plasmapheresed when RF wasn’t warmed but not wh...

View Discussion

RE: Renal Biopsy In Lupus Nephritis With Thrombocytopenia 1 day ago

After patient developed fits Cyclophosphamide started Cr rising reached 700 , ur 31 He is anuric HD started HB 9 plat improved 140 Neck swelling i...

View Discussion

RE: Cryoglobulin disease X dialysis interaction 1 day ago

Thanks Dr Rodby! I appreciate the input. Indeed I dialyzed IHD with IV heparin and did well. I tried to look in literature (quickly) about cryog...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 1 day ago

Ok thank you all 🌹i will continue lowest dose of prednisolone+ MMF + Hydroxychloroquine and follow up her Urinary sediments and Antids DNA and C3&...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 2 days ago

I second Dr Rodby's endorsement of Dr Steiner's previous comments as "cogent". I might even up it to "eye-opening" (to me, for sure.) If I may para...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

A recent CPC in the NEJM (reference below) presents a case of lupus MN in whom proteinuria increased to 3.6 g/g who responded to addition of belimu...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

The patients initial Proteinuria was > 3 gms per day making her a poor candidate for add on Belimumab., according to the post-hoc analysis of the B...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

Sorry- I misread the initial biopsy as Class V not class IV. I agree with Dr. Venkat and Rodby - taper steroids and maintain Myfortic. No pressing ...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 2 days ago

I also believe the ethical "Do no harm" concept for donors in flawed from the get go as was pointed out by @Robert Steiner in https://community....

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

I think Dr Glassock misread the Class as V when he asked for exostosin which only applies to ClassV I believe. Benlystsa was approved for lupus n...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

Less than 3 months since biopsy. Complements still lower end of normal/slightly low. Proteinuria improved. Need urine sediment and anti-DS DNA anti...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

This Study supports use of Belimumab --------------------------------- Nada Ezzat MD Al Jahra Hospital Al Jahra -------------------------------...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

Her Labs from admission till First visit in OPD --------------------------------- Nada Ezzat MD Al Jahra Hospital Al Jahra ---------------------...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

EXT I/II Abs are not available in Kuwait --------------------------------- Nada Ezzat MD Al Jahra Hospital Al Jahra ---------------------------...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

Biopsy Jan 2023 GROSS DESCRIPTION Received in formalin, labelled "RENAL BIOPSY" consists of 2 cores measuring 1.2cm and 1cm. All taken into 1 casse...

View Discussion

RE: Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

Great Question!! I hope you get lots of responses (all opinions, as this is an "'evidence -free zone.".) It would be nice to know if she has EXTI/I...

View Discussion

Belimumab Vs Retuximab In Lupus Nephritis 2 days ago

I have 14 years old girl with LN class IV recently diagnosed and she is now in complete remission. Rheumatologist want to give her retuximab but i ...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 2 days ago

The "perfect" health concept for living donor eligibility is a fading concept, but we still do not know where to draw the line when a donor has som...

View Discussion

RE: FSGS - Would you treat or not ? Primary vs FSGS 2 days ago

What is the BP of patient? If systolic above 120 RAASi in maximal tolerated dose (titration)+ SGLT2i would be as choice (DAPA-CKD, EMPA-Kidney stud...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 3 days ago

I agree that if this is "just" NASH then a transplant could proceed, but first he needs a thorough evaluation for causes of his chronic liver disea...

View Discussion

RE: Should a potential living kidney donor with NAFLD/ NASH be accepted? 3 days ago

I shared this post with a hepatologist colleague. He said that this potential donor deserves comprehensive blood tests (as already suggested by Dr....

View Discussion

RE: Treatment Of Anti Gbm And Anca Disease 3 days ago

I will do the same (pulse + PLEX) and biopsy on Monday if infection is under control. How many days since admission? Thanks --------------...

View Discussion