RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 5 hours ago

Tough case. Judgement call. No data to support any particular regimen as best. MMF has been marginally effective in maintaining remission in AntiPR...

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RE: C3 or IgA 5 hours ago

The patient had an URTI , followed be Nephrotic syndrome . First biopsy : had 30% IFTA ; Second Biopsy : had 40% IFTA The gap between the seco...

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RE: Initiating Statin In Dialysis Patient 6 hours ago

Thanks . Not diabetic Cholesterol 4.9 mmol/l LDL 3 mmol/l Triglyceride 2.4 mmol/l Hdl 0.8 mmol/l --------------------------------- Muhammad Soob...

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RE: Recalcitrant severe hyponatremia 6 hours ago

Thank you, Dr. Rodby, for your article. In it, 7 control and 8 hyponatremic psychiatric patients in the setting of a Clinical Research Center and r...

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RE: C3 or IgA 6 hours ago

De novo IgAN following Pegacetocoplan therapy. I doubt it. Can you arrange for Pronase digestion and Paraffin IF on the prior two kidney biopsies.?...

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RE: Initiating Statin In Dialysis Patient 6 hours ago

Go with the Data. No reason to start a statin What is his lipid profile? is he a diabetic? ------------------------------ Richard Glassock MD, F...

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C3 or IgA 6 hours ago

I have a young 29 year old male from Pakistan He had an infection, followed by worsening renal function Biopsy 1: C3G, C3 deposits 2+ ( externa...

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RE: Renal phosphate wasting 6 hours ago

When I've ordered intact FGF23 from Mayo in the past the lab comes with the disclaimer below. I wonder if the FGF23 levels of 68 pg/ml and 74 pg/ml...

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Initiating Statin In Dialysis Patient 6 hours ago

72 male patient established on hd Previous T cell Lymphoma in remission Bg left atrophic kidney Having transplant work up done Primary care doc...

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RE: Renal phosphate wasting 10 hours ago

When uou do the Alk phos, consider doing both total and bone specific Alk Phos. Might give some clues as to what the bone turnover is. ----------...

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RE: Renal phosphate wasting 11 hours ago

Subject: Re: Renal Phosphate Wasting with Elevated BMD - Further Thoughts Dear Dr. Landry, Thank you again for presenting such a compelling and u...

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RE: Renal phosphate wasting 11 hours ago

I have a very similar patient, also male. Equally stumped. Genetic testing also negative. PTH, FGF-23, vitamin D, SPEP, imaging all negative. Manag...

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RE: Recalcitrant severe hyponatremia 12 hours ago

Thank you everyone. It has been very informative! I have tried to approach this case via physiology. The pre treatment urine sodium [More]

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 14 hours ago

Positive PR3 would put her at high risk of recurrence ... Pulmonary lesions in AAV are usually life threatening ---------------------------------...

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RE: Recalcitrant severe hyponatremia 14 hours ago

Dr. Rodby- 'a touch of SIADH , polydipsia and low solute intake " - a triple Hickam!!! . I think you are probably correct, ----------------------...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 16 hours ago

PR3 was 148 - 23rd Apr prior to PLEX ---> recent PR3 is 75 ( two weeks after completing PLEX). Planning to repeat in two weeks antiHBc was POSITI...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 16 hours ago

"In thus case, a "do no harm" perspective would be appropriate". Indeed, that's exactly are my thoughts too. She only received PLEX and Prednisol...

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RE: Recalcitrant severe hyponatremia 19 hours ago

forgot to attach , here it is ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Nephrology Associates Ch...

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RE: Recalcitrant severe hyponatremia 19 hours ago

"Although I am not clear as the diagnosis of hyponatremia in this patient, I wanted to raise the issue of what is maximally dilute urine. Most text...

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RE: Recalcitrant severe hyponatremia 20 hours ago

Although I am not clear as the diagnosis of hyponatremia in this patient, I wanted to raise the issue of what is maximally dilute urine. Most textb...

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RE: Renal phosphate wasting 22 hours ago

Thank you for this suggestion. It would appear that a mild form of autosomal dominant osteopetrosis (Albers-Schonberg disease as the authors descri...

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RE: Renal phosphate wasting 23 hours ago

My apologies for leaving out PTH: it is 45 I did a screen for paraprotein with SPEP with no monoclonal protein detected He has a normal bicarbo...

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RE: Renal phosphate wasting 23 hours ago

Po4 is regulated by FGF 23 , Pth (do you have a PTH?) in advanced Vit D deficiency, and then there is Fanconi. is there any other evidence of Fan...

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RE: Help with suspected dialyzer circuit allergic reaction 23 hours ago

this seems like a type B (by timing) dialyzer reaction. Did you get a tryptase, this may tell you if this is a IGE mediated allergy. SO not a d...

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RE: Help with suspected dialyzer circuit allergic reaction 1 day ago

The ethylene oxide sterilization process PROBABLY varies form one company to another. Different companies may have longer times to allow the ethyle...

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RE: A 13 yr old girl with MPGN 1 day ago

Thanks- quite compatible with C3GN/IC-MPGN spectrum. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ----...

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RE: Renal phosphate wasting 1 day ago

Maybe this is an example of the very rare Osteopetrorickets Syndrome. See Mitri Z, et al Case Reports Endocrinol 2012; 238364. Just a guess. -...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

According to the report, she only received PLEX and steroids. No RTX. What does the urine sediment show, and what is the anti -PR3 antibody level n...

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Renal phosphate wasting 1 day ago

I'd like to ask for your input on a patient who came to see me for renal phosphate wasting. He is a 58 year-old very healthy male with no history o...

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RE: ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

What dose of Rituximab was given , perhaps a lower dose of 500mg instead of 1000mg ( if that is what was given) would suffice . Trials such as RAV...

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RE: Help with suspected dialyzer circuit allergic reaction 1 day ago

We use ABaxter (Revaclear or Thearnova) and Baxter cartridge lines. They are not ethylene oxide sterilized and we have used them in a patient who w...

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ANCA vasculitis with Pulmonary Hemorrhage - To Rituximab or MMF 1 day ago

Thanks in advance for your expert thoughts, 19 years old Female Cerebral palsy - bed bound and PEG fed and Suprapubic catheter Normal Kidney ...

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RE: Natural History of treated IgAN 1 day ago

Dr, Dastoor- thanks but the algorithm you suggest is really not really applicable to the patient posted. Also, Sibeprenulmab is not yet available f...

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RE: Natural History of treated IgAN 1 day ago

In have found the attached algorithm very useful in management of IgAN. Your patient with persistent proteinuria and proteinuria > 0.5 grams , wil...

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RE: Natural History of treated IgAN 1 day ago

Very complex case. No clear answer to your question based on literature. He has received prolonged therapy (3 years +) with combined MMF and TRF-Bu...

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Natural History of treated IgAN 1 day ago

Hello Folks: I take care of a 35-yr-old physician who first presented w. micro-hematuria & proteinuria in Mar 2020. Normal GFR, C3 & C4, Negative d...

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RE: Help with suspected dialyzer circuit allergic reaction 2 days ago

Thank you Anatole! Responses to suggestions and some updates from today. We had already tried did 2 liters of saline flushing the circuit befor...

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RE: Help with suspected dialyzer circuit allergic reaction 2 days ago

Are B Braun streamline airless bloodline sets heat sterilized?" B. Braun Streamline Airless Bloodline sets are not heat sterilized. They are st...

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RE: A 13 yr old girl with MPGN 2 days ago

Yes , EM : it says less than optimal study but they report electron dense immune complex deposits noted in the subendothelial, mesangial and para...

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RE: Recalcitrant severe hyponatremia 2 days ago

"I agree with Dr Rodby except for one issue, that being the U Na [More]

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RE: A 13 yr old girl with MPGN 2 days ago

Thanks. By the way, do you have an EM report from the original Kidney Biopsy.? ------------------------------ Richard Glassock MD, FASN Laguna Wo...

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RE: Help with suspected dialyzer circuit allergic reaction 2 days ago

Have you tried running a liter of saline through the circuit before connected to ner r to the dialyzer? Have you contacted Braun about this, they m...

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RE: A 13 yr old girl with MPGN 2 days ago

Thank you Dr Glassock, The complement pathway evaluation test has been sent and pending results. I will proceed with the genetic testing. Tha...

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RE: A 13 yr old girl with MPGN 2 days ago

Given the circumstances of this case, and the complete remission induced by MMF and steroids I doubt that a re biopsy is going to lead to a change ...

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RE: The patient who keeps on giving 2 days ago

No, not if CfH levels are normal. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 -----------------------...

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A 13 yr old girl with MPGN 2 days ago

I have a 13-year-old girl with a history of immune complex-mediated MPGN , first diagnosed at age 3 and a biopsy was done in 2016. Her initial pres...

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RE: The patient who keeps on giving 2 days ago

CFH levels are now normal ...so is there any point now ------------------------------ Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha K...

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RE: Recalcitrant severe hyponatremia 2 days ago

American or European. To answer this question , you need to decide , if u want to follow Up-to-date or European guidelines on hyponatremia . In t...

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RE: Help with suspected dialyzer circuit allergic reaction 2 days ago

Thank you Dr. Glassock I forgot to mention this part. She is not on an ACEi/ARB. ------------------------------ Maulin Shah MD, FASN Bay...

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RE: Help with suspected dialyzer circuit allergic reaction 2 days ago

Could this be hypotension because of interactions between ACE inhibitors and bradykinin release due to specific membranes (PES or PAN ). Is thex pa...

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