RE: Case 8 hours ago

Was the hematuria macroscopic or microscopic? What was the dose of paracetamol and rivaroxiban. Any distal features of cholesterol embolism (blue t...

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Case 8 hours ago

80 year old Past medical history AF on rivaroxiban , bilateral cataracts and AMRD. Presented to hospital on 27/12/24. He had haematuria . Family do...

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RE: Possible Pd Case 8 hours ago

Thanks so much dr Bargman --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Paternity under Tolvaptan 10 hours ago

About 5% of male patients with ADPKD are infertile, due to sperm abnormalities. I do not think that Tolvaptan therapy has any benefits or harms for...

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RE: Paternity under Tolvaptan 10 hours ago

Given that ADPKD is really a systemic polycystin problem and many organs other than the kidneys can be involved, I found this that may be relevant ...

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RE: Dialysate flow rate 10 hours ago

For PD KT/V we use Ideal body weight for V. UpTODate states this is fine for the reasons above. We cannot do this for HD bc KT/V is from the MEASUR...

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RE: Potential Donor with TRPC6 inactivating mutation 13 hours ago

Great practice point Dr. Lerman. Genetic testing of potential tecipients awaiting live donor kidney transplants is greatly underutilized at present...

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RE: Potential Donor with TRPC6 inactivating mutation 13 hours ago

Completely agree with excluding this donor in view of the positive genetic testing. This is exactly why most genetic experts recommend first testin...

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RE: Membranous Nephropathy And Hypothyroidism 14 hours ago

Thank you very much for your valuable input @Roger Rodby @Richard Glassock The patient received Rituximab today, and will follow her anti PLA2R abs...

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RE: Dialysate flow rate 17 hours ago

The above is why I listed huge patients as one of the possible exceptions to the quest for some particular kt/v. Increasing blood flow (and, in tur...

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RE: Potential Donor with TRPC6 inactivating mutation 17 hours ago

The TRPC6 gene variant here is reported as likely pathogenic. The interesting part here is that the genetic variant has variable penetrance meaning...

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RE: Anyone know what happened to the Innovations in Kidney Education Contest? 18 hours ago

Hello, Dr. Topf, Thank you for your post. ASN decided to pause the Innovations in Kidney Content the last couple of years due to declining intere...

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RE: Potential Donor with TRPC6 inactivating mutation 21 hours ago

Of course, the donor may harbor other genes or epigenes that modify the expression of the mutated gene, such that she may never manifest tge phenot...

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RE: Dialysate flow rate 1 day ago

The Watson formula greatly overestimates the V term in KT/V urea calculation in massively Obese subjects . A bioelectrical impedance value for V is...

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RE: Dialysate flow rate 1 day ago

A one size fits all approach does not work in hemodialysis but that is what CMS seems to favor. I am not sure what Kt/V minimum target is appropria...

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RE: Granulomatous interstitial nephritis 1 day ago

Wouldn't anuria be very uncommon in granulomatous interstitial nephritis due to Tuberculosis ? ------------------------------ Richard Glassock M...

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RE: Dialysate flow rate 1 day ago

I think that any KT/V calculated in a patient weighing 150 K or more would likely be erroneous. What evidence is there that a high KT/V in massivel...

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RE: Dialysate flow rate 1 day ago

I am the medical director of a large dialysis unit in NYC. Our facility administrators are adamant about a Kt/V target of 1.4 or higher and the uni...

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RE: Granulomatous interstitial nephritis 1 day ago

Is he originally from CA or somewhere else, eg TB endemic region? --------------------------------- Oded Friedman ---------------------------------

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Is it too crazy to train fellows to run a hemodialysis once in a while? Used to happen in Dark Ages. Makes you a little more humble. Jorge Roman-L...

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RE: Potential Donor with TRPC6 inactivating mutation 1 day ago

Let me start by stating that I would not accept this donor either. As you have determined from your review of the literature, both gain of function...

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RE: Granulomatous interstitial nephritis 1 day ago

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Dr Saad: Fabulous commentary, thanks. The question about Lokelma relates to Dr Saad's #2. In my experience, the K binder always given in the ER ...

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RE: Granulomatous interstitial nephritis 1 day ago

Thank you all. Some details on the timing of studies, including imaging: 12/23 CXR clear 12/23 CT head neg 1/3 MR abdo pelvis wo contrast: edemat...

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Potential Donor with TRPC6 inactivating mutation 1 day ago

I would like to get the community input on the following potential donor: 51-Year-old female with no significant PMH who is being worked up as a ...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Any thoughts on Lokelma? RN not always possible - we also had some remote patients situations and fires preventing the patients transport ------...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Thank-you for these thoughtful comments. These will help to inform a conversation about this issue with my renal section physicians and dialysis nu...

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RE: Membranous Nephropathy And Hypothyroidism 1 day ago

I agree fully with Dr. Rodby. Because of the "rapidity " of the relapse and the magnitude of the antiPLA2R antibody levels , after 4 infusions of R...

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RE: Dialysate flow rate 1 day ago

Yes, the major dialysis companies have guidelines that you are supposed to meet .... and we get "grades" from them and the government... However...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 1 day ago

@Agnes Fogo OK, I am confused (not unusual). Is DNAJB9 a normal constituent of the GBM or a chaperone protein expressed intracellularly (mainly i...

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RE: Paternity under Tolvaptan 1 day ago

I assume you are asking about male fertility on tolvaptan? There is no information on this but male fertility is rarely affected by any medication ...

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Paternity under Tolvaptan 1 day ago

One of my patients (35 yo, M) with ADPKD has concerns regarding paternity under Tolvaptan treatment. I would like to have your valuable opinion on ...

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RE: Membranous Nephropathy And Hypothyroidism 1 day ago

I dont think anyone would argue with treating PLA2R+ nephrotic syndrome without a biopsy these days. We may not all do it routinely but that test i...

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RE: Membranous Nephropathy And Hypothyroidism 1 day ago

An important point imto add is that biopsy was not done at the time of diagnosis and CYC was started without bioosy, just based on her anri PLA2R a...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 1 day ago

It is not clear at all whether DNAJb9 is pathophysiologically responsible for FibGN- so far, it has not been demonstrated whether a marker of the p...

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RE: Dialysate flow rate 1 day ago

True. Mandate to have minimum K t/ V and Some patients just don't make it every month. ------------------------------ Kashif Chaudhry MD Canton M...

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Membranous Nephropathy And Hypothyroidism 1 day ago

I have a 56 years old female patient who was diagnosed in april as having anti PLA2R abs positive MN and hypothyroidism, no other secondary cause w...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

Dr. Topf- Many thanks for your post. This is not really a "Standard of Care" issue. Too many variables at play to establish a"one size fits all" ...

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RE: Dialysate flow rate 1 day ago

Just curious- what do you mean by "struggling with clearance"- do you mean KT/V.? What is the nature of the "struggle"? -------------------------...

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RE: Dialysate flow rate 1 day ago

I appreciate you all. The conclusion is that QD above 600 is not adding a whole lot value to the care but if one is struggling with clearance , the...

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RE: Standard of care for nephrology consultation prior to acute hemodialysis 1 day ago

I think the most important part of this story is "But the ER and ICU teams were beside themselves over my failure to provide immediate dialysis" ...

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Anyone know what happened to the Innovations in Kidney Education Contest? 1 day ago

It was last awarded in 2022 and the webpage says it was paused for 2023 and to check back in 2024. Has ASN moved on from this initiative? ------...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 1 day ago

And the design of the ASN Community site tends to attract reports of rare variants of common or uncommon disease . Definitely not a random sample ....

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

Paper attached. Nice review of this disease from 2019 (first reported as DNAJB9 related only 2 years earlier in 2017) Nasr SH, Vrana JA, Dasari...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

See Samih Nasr and Fogo, Kidney Int 2019 ------------------------------ Agnes FogoDesignation] Professor Vanderbilt University Medical Center Nas...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

See Nasr and Fogo KI 2019, 96:531 Sent from my iPhone

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

Fibrillary GN classically is diagnosed by deposits that have randomly arrange fibers by EM and that are Congo red negative. Nearly all cases are Ig...

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RE: Granulomatous interstitial nephritis 2 days ago

The ancillary features in this case make me strongly suspect that it is nether bacterial or fungal infection related and not a hypersensitivity rea...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

The message here is that this is NOT polyclonal LCDD- it is most likely a rare example of DNAJB9 negative Fibrillary GN or an uncommon variant of I...

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RE: Patient with LCDD on kidney biopsy but no clone found in the bone marrow 2 days ago

Can you elaborate on that, clearly your statement is saying that DNAJB9 staining is not necessary for the diagnosis of Fib GN, but isnt that HOW th...

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