RE: Duration of PKD treatment with tolvaptan 8 hours ago

Thanks Dr. Chebib. Much appreciated ! ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -------------------...

View Discussion

RE: Liver Tx Alone In CKD patients 8 hours ago

The biopsy is more useful to avoid simultaneous kidney transplant. Assuming the biopsy does not show much glomerulosclerosis or IFTA, then we can a...

View Discussion

RE: Duration of PKD treatment with tolvaptan 9 hours ago

We would treat with tolvaptan until reaching dialysis or few days before planned preemptive kidney transplantation. There is evidence that tolvap...

View Discussion

RE: Duration of PKD treatment with tolvaptan 10 hours ago

@Fouad Chebib ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL (773) 505-3198 ...

View Discussion

RE: Liver Tx Alone In CKD patients 14 hours ago

Is the planned liver transplant from a living donor also? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------------------...

View Discussion

RE: Liver Tx Alone In CKD patients 15 hours ago

Thank you Dr Venkat In Egypt we have live donor program only. The deceased program on the way to be implemented. So, after liver tx , we can do k...

View Discussion

RE: Kidney Transplantation immunity 18 hours ago

In my admittedly limited experience mixed ABMR and TCMR in an HLA -identical match (non-HLA antigen mediated rejection) is associated with a very p...

View Discussion

RE: Duration of PKD treatment with tolvaptan 18 hours ago

In my opinion, the answer to this question is unknown, but very likely it needs to be continued until the patient develops Stage 4 or 5 CKD. Need i...

View Discussion

Duration of PKD treatment with tolvaptan 19 hours ago

Hello everyone After a patient has been placed on tolvaptan for PKD, how long does the treatment have to last? Thank you --------------...

View Discussion

RE: Kidney Transplantation immunity 21 hours ago

Totally agree The pair are low immunological risk. The ATG. Can be avoided and also getting active HcV during transplantion now ADMats it's not con...

View Discussion

RE: Liver Tx Alone In CKD patients 1 day ago

Another option to consider in your patient: If coagulation tests and platelet counts are satisfactory, kidney biopsy to assess extent of glomerulos...

View Discussion

RE: Liver Tx Alone In CKD patients 1 day ago

That is a difficult case. Predictive value of microalbuminuria for progressive CKD and eventual ESKD in diabetics is no longer considered be as str...

View Discussion

RE: pauci-immune GN - ?post Mounjaro 1 day ago

Thank you everyone for taking your time helping with this case. Greatly appreciated ------------------------------ EVG -------------------------...

View Discussion

RE: SIADH in a patient with SAH 1 day ago

I agree with this your astute analysis. The case for CSW can only be possible, or tenable if it were that in any acute intracranial event inducing...

View Discussion

RE: Kidney Transplantation immunity 1 day ago

BP control? Since HLA-matched donor, need to consider non-HLA antibody. If directed against endothelial cell antigen, antibody may be agonistic to ...

View Discussion

RE: Kidney Transplantation immunity 1 day ago

Curious if you have access to dd- CF DNA testing which should be elevated in AMR and useful in monitoring response to treatment? agree with nonHLA ...

View Discussion

RE: Kidney Transplantation immunity 1 day ago

The patient's serum creatinine (SCr) has been fluctuating but remains elevated, generally trending between 2.4 to 2.75 mg/dL. This suggests persist...

View Discussion

RE: Liver Tx Alone In CKD patients 1 day ago

Thanks Dr venkat Last consultation I saw, 59 y male with ESLD, long standing diabetic (12y) with evidence of D. Retinopathy S crear is constantl...

View Discussion

RE: Kidney Transplantation immunity 2 days ago

Very surprised by biopsy findings suggesting mixed AMR + possible TCMR. What is the SCr trend? ------------------------------ K.K. Venkat MD Troy...

View Discussion

RE: Kidney Transplantation immunity 2 days ago

Good Afternoon, The histopathology report for the kidney graft biopsy is attached here. On Thu, Sep 12, 2024, 12:54 PM Riyadh Mohi Abboud Alsaeg...

View Discussion

RE: Kidney Transplantation immunity 2 days ago

Good Afternoon, The histopathology report for the kidney graft biopsy is attached here.Best Regards

View Discussion

RE: Treating Metabolic Acidosis long-term 2 days ago

Yes, patient again refused arterial blood gases today when offered, and our lab does not do Venous blood gases. His bicarb has dropped to 17 today,...

View Discussion

RE: SIADH in a patient with SAH 2 days ago

"CSW is a "zombie disease". It just refuses to die. It is the Rasputin of Nephrology . Always fun to discuss it in the context of hyponatremia, but...

View Discussion

RE: Did you administer mesna during IV cyclophosphamide treatment for glomerulonephritis? 2 days ago

Have never used Mesna. Even in the old NIH protocol I haven't used a dose more than 750 mg in anyone probably because we here were extremely scared...

View Discussion

RE: Liver Tx Alone In CKD patients 2 days ago

Wherever possible I would also do renal biopsy to identify the underlying disease and estimate the degree of IFTA which would help us in decision m...

View Discussion

RE: SIADH in a patient with SAH 2 days ago

CSW is a "zombie disease". It just refuses to die. It is the Rasputin of Nephrology . Always fun to discuss it in the context of hyponatremia, but ...

View Discussion

RE: SIADH in a patient with SAH 2 days ago

In the case presented here it would be physically impossible to develop rapid recurrence of hyponatremia, after correction and treatment interrupti...

View Discussion

RE: Liver Tx Alone In CKD patients 2 days ago

You appear to be referring to eligibility for combined kidney-liver transplantation under the CKD category. Current guidelines require eGFR below 6...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 2 days ago

What is the cardiovascular status of this patient? It is almost certain that this patient has atherosclerotic changes in coronary, cerebrovascular ...

View Discussion

RE: Did you administer mesna during IV cyclophosphamide treatment for glomerulonephritis? 2 days ago

Yes I was confused, we just gave Lupron pre cyclophosphamide to a young woman with lupus just this week, to protect her ovaries, and that was on ...

View Discussion

RE: Did you administer mesna during IV cyclophosphamide treatment for glomerulonephritis? 3 days ago

I thought MESNA was primarily used to prevent hemorrhagic cystitis with high dose oral or IV CYC. Does it also have a beneficial effect on protecti...

View Discussion

RE: Did you administer mesna during IV cyclophosphamide treatment for glomerulonephritis? 3 days ago

We consult the fertility team and they typically give it - used to be a big deal now not at all. ------------------------------ Roger Rodby M...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

ARBs have been shown to improve renal hemodynamics in small vessel disease , as they help reduce intraglomerular pressure, and slow the progression...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

Thanks for your input John. I think the though of small vessel arterial disease makes sense. And regarding offering RAAS blockade for non-protei...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

I agree Dr. Satish. That is why I am trending her creatinine until my next follow up. ------------------------------ Muhammad Shoaib MD Transplan...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

Regarding her blood pressure change during the time she was not on losartan, I am not sure. Although it is a great question and I will inquire abou...

View Discussion

RE: SIADH in a patient with SAH 3 days ago

I agree with Dr. Mellas. CSW is a "non-entity". I also agree that oral urea, Tolvaptan and ,in very selected cases , water deprivation are very eff...

View Discussion

Liver Tx Alone In CKD patients 3 days ago

Hi everyone I came across many consultations recenty from the liver transplant team about patients who are ESLD and candidates for liver Tx with r...

View Discussion

RE: SIADH in a patient with SAH 3 days ago

@ Mellas.If given IV NS and the [Na] falls this is quite consistent with SIADH whereby the H2O is absorbed, If the CSW diagnosis is right, if giv...

View Discussion

RE: SIADH in a patient with SAH 3 days ago

I do not think that duration of hyponatremia has much diagnostic significance. Other opinions welcome. ------------------------------ Richard Gl...

View Discussion

RE: SIADH in a patient with SAH 3 days ago

My personal belief is that cerebral salt wasting does not exist. If given IV NS and the [Na] falls this is quite consistent with SIADH whereby the ...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

The presence of patent renal artery stents in the face of CKD does not R/O small vessel arterial disease which can behave like RAS when exposed to ...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

This is a very interesting question. According to the literature average decrease in eGFR with patent renal arteries and CKD is about 4 cc per minu...

View Discussion

RE: SIADH in a patient with SAH 3 days ago

Very unusual to see such a big drop in pNA after stopping Tolvaptan in a day with fluid restriction and urea support Did we check U osm and Una o...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

Thanks for the response Dr Shoaib. One value of creatinine may not be very representative. Anyway she has maintained stable renal function all this...

View Discussion

RE: Thiazide Induced AKI, Need For Review 3 days ago

I come across the similar situations and I have the same thought process regarding their utility in the first place. I would appreciate input from ...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

I answered the question in my response to Dr Satish. Thanks for your input Dr Mark. ------------------------------ Muhammad Shoaib MD Transplant ...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

Thanks for your input Dr Satish Her baseline creatinine has been around 1.7 with eGFR ranging from 28 to 32 while she was on Losartan. One of ...

View Discussion

RE: RAAS inhibition in a patient with bilateral renal artery stenosis s/p bilateral stent placement 3 days ago

What was change in serum creatinine after stopping losarten and after restarting ? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,F...

View Discussion

RE: Did you administer mesna during IV cyclophosphamide treatment for glomerulonephritis? 3 days ago

I suggest exclusively using the EULAR low Dose IV CYC regimen where MESNA infusions are unnecessary. Very few Nephrologists use the older high dose...

View Discussion