RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 3 hours ago

The use of IVIg to treat immune complex (?IgA N) Crescentic GN with RPGN is interesting but there is a complete lack of evidence for efficacy in th...

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RE: Hypercalcemia: What is the diagnosis? 3 hours ago

Low normal IPTH, Stage 3A CKD hypercalciuria, hypercalcemia with normal Vitamin D levels suggests an exogenous calcium load or bone dissolution. Wh...

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RE: Hypercalcemia: What is the diagnosis? 4 hours ago

Serum phosphate level? Actual 25-OH and 1-25 OH vitamin levels? TSH? Urinalysis? Renal imaging - calculi/nephrocalcinosis?  Male or female patients...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 4 hours ago

We had a similar patient withs crescentic GN and COVID-19+ . We used metyprednisolone and iv gamaglobulin. We prefer not to use antiproliferative d...

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RE: Hypercalcemia: What is the diagnosis? 4 hours ago

What meds are they taking? Serum albumin levels ? Dietary history? --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP...

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RE: peritonial dialysis sugar control 5 hours ago

During the period the patient is in training I would try to obtain as many readings as possible at different time points in the dwell so you can gi...

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RE: peritonial dialysis sugar control 6 hours ago

Thank you all so much Manisha

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Hypercalcemia: What is the diagnosis? 6 hours ago

Dear all: I have a couple of patients (one in 50s and another low 70s) with mild hypercalcemia (10.8-11 mg/dl; our lab normal range is 8.6-10.9 mg...

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RE: Not biopsying with ANCA? 6 hours ago

Dr. Rodby is correct, and I would surmise that this discussion could go on endlessly- and no one will have the “last word”. I am curious, however, ...

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RE: peritonial dialysis sugar control 6 hours ago

This is a problem with PD.  For decades we have been dreaming of a sugar-free solution.  As Dr. Singh has noted, pre-diabetics may become overtly d...

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RE: peritonial dialysis sugar control 6 hours ago

We used to put insulin in the PD bags but I think this has gone by the wayside.  Icodextrin is one means of limiting glucose exposure But I think y...

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peritonial dialysis sugar control 6 hours ago

I have a new patient training for pd -diabetic - was on janumet 50/ 1000 bid At first exchanges -his sugars rose by 100 ( from 144 at start to 250...

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RE: Not biopsying with ANCA? 7 hours ago

The only thing I have left to say (I promise!) is that if you do not want to wait for pathology to treat, and in many cases you should not wait, I ...

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RE: Not biopsying with ANCA? 8 hours ago

no worries thank you again Dr Glassock ------------------------------ Alan Friedman MD Kidney Medical Associates Bronx NY ------------------------...

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RE: Not biopsying with ANCA? 8 hours ago

Should have said "does not".  My apologies for any confusion that may have resulted from my poor proof-reading. ------------------------------ Ric...

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LMPP Application Period Closes Wednesday, July 28th 8 hours ago

The application period for the Loan Mitigation Pilot Program (LMPP) will close this Wednesday, July 28th. The LMPP program aims to decrease the lo...

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LMPP Application Period Closes Wednesday, July 28th 8 hours ago

The application period for the Loan Mitigation Pilot Program (LMPP) will close this Wednesday, July 28th. The LMPP program aims to decrease the lo...

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LMPP Application Period Closes Wednesday, July 28th 8 hours ago

The application period for the Loan Mitigation Pilot Program (LMPP) will close this Wednesday, July 28th. The LMPP program aims to decrease the l...

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RE: Not biopsying with ANCA? 9 hours ago

According to the “Jayne Criteria” this patient does require a kidney biopsy (right now)- treatment (RTX or CYC + rapid steroid taper) can be instit...

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RE: Not biopsying with ANCA? 11 hours ago

not oliguric. it just seemed i was definitely going to move forward with treatment and was not too concerned re chronicity issues thought maybe thi...

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RE: Risky Pregnancy in a transplant patient 11 hours ago

Thanks- it’s really not that complicated IMO this patient has significant increased risks for pregnancy as we have detailed several times in this t...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 11 hours ago

PLEX for covid is one thing, but I do not understand the interest in Plex for IgA or a non specific crescentic GN (or even for SLE, which does not ...

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RE: Tablo in ICU CRRT care 11 hours ago

The VA has been using Tablo machines x 1-1.5 years (during the pandemic 2020) and there have been a lot of reports of machine malfunctions and high...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 12 hours ago

It is important to get an accurate diagnosis of her kidney disease.  The timing of kidney transplant in the future and implications for disease re...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 12 hours ago

on a side note Plasmapheresis has been anecdotally used in COVID 19 cytokine storm with reported positive results. uncontrolled observational studi...

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RE: Tablo in ICU CRRT care 12 hours ago

Appreciate your upfront disclosure Tactics from Tablo appeared too aggressive based on no published data I have no vested interest either way ----...

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RE: Not biopsying with ANCA? 14 hours ago

I'll take the contrarian view and advocate for the biopsy whenever possible/available. Here's @David Jayne's suggestions on when to avoid a biopsy...

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RE: Tablo in ICU CRRT care 14 hours ago

Full disclosure, I am in the NxStage Scientific Advisory Board.  But I have heard of these $$ saving claims for many other people. From what I und...

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RE: Not biopsying with ANCA? 14 hours ago

Dr Glassock, point taken for sensitivity and specificity for Ag specific assays. If you had 80 glomerular sclerosis and 80% IFTA, and pt oliguric, ...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 14 hours ago

Interesting the focus is on plex, which is not been shown to be beneficial for either class 4 lupus or crescentic IgA.  I think you are doing the r...

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RE: asymptomatic pyuria and cataract surgery 14 hours ago

Good point but that does not mean it has to be treated; based on the AAO recommendations I would not, however there is the reality of the surgeon, ...

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RE: asymptomatic pyuria and cataract surgery 14 hours ago

This thread illustrates how one bad but very uncommon outcome can influence a practice for a lifetime. Heuristic methods prevail. ---------------...

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RE: Crescentic GN with Covid when may I treat? 2weeks later maybe? 17 hours ago

Ugh!! The modern definition of being between a rock and a hard place. I have serious doubts that any form  of IS with or without PLEX is going to d...

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RE: asymptomatic pyuria and cataract surgery 17 hours ago

In my case, the urine studies were done a few days earlier when patient had visited ED for abdominal pain. --------------------------------- Awai...

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Crescentic GN with Covid when may I treat? 2weeks later maybe? 20 hours ago

I have a 30 year old patient belonging to another nephrology team who ended up with me due to a lack of beds during the pandemic as their facility ...

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RE: Not biopsying with ANCA? 22 hours ago

In general, a kidney  biopsy is reasonable  when the likely findings will contribute in a material way to decisions  regarding management.  In this...

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RE: Not biopsying with ANCA? 23 hours ago

I do not have a problem treating without a biopsy in this case, but what is the reason to avoid it? Just curious. ANCA is not as sensitive or speci...

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RE: Risky Pregnancy in a transplant patient 1 day ago

Dr. Lerman: the following is some information I found regarding recommended duration without mycophenolate or everolimus prior to attempting pregna...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

May be it is a hydralazine wave? we have had 3 cases in last 4 months- may be more vigilant and close scrutiny of biopsy. all of the cases resolved...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

I agree with Dr. Rodby that now is the time to begin to withdraw steroids and MMF. A slow taper , with frequent monitoring, seems very reasonable. ...

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RE: AKI in non-small cell lung cancer 1 day ago

Unlike pemetrexed/other established tubulotoxic anti-cancer therapies, since finding isolated ATN in pembrolizumab engenders no concern for rechall...

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Tablo in ICU CRRT care 1 day ago

Wanted to ask the group on use of Tablo in ICU setting for management of AKI with hemodynamic compromise for inpatient HD services we are currently...

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RE: Not biopsying with ANCA? 1 day ago

i can get more specifics but for sake of quick response i believe her crestinine was about 1.8 two months ago with a normal baseline 6 months ago. ...

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RE: Hydralazine associated Lupus Nephritis/possible vasculitis 1 day ago

I probably would have given Rituxan, even despite the argument to not need it, bc now I would feel comfortable tapering her off the steroids and no...

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RE: asymptomatic pyuria and cataract surgery 1 day ago

"The American Academy of Ophthalmology recommends against routine medical tests before cataract surgery, although pre-operative medical tests can b...

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RE: Not biopsying with ANCA? 1 day ago

Just curious, does the patient have extra renal symptoms? The eGFR is 11 but that may not be reliable in AKI, I assume though you have a baseline c...

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RE: Not biopsying with ANCA? 1 day ago

thank you Dr Glassock ------------------------------ Alan Friedman MD Kidney Medical Associates Bronx NY ------------------------------

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RE: asymptomatic pyuria and cataract surgery 1 day ago

With over 2M cataract surgeries performed per year in the USA with a post-operative risk of bacterial endophthalmitis risk of about 4 cases per 10,...

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RE: Not biopsying with ANCA? 1 day ago

So long as you have tested for anti-GBM antibody with a sensitive assay and it is negative, I think you can proceed to therapy without a kidney bio...

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RE: Risky Pregnancy in a transplant patient 1 day ago

@Silvi Shah Hi Silvi. I just read the elegant and very informative meta-analysis and systematic review (attached) that you and your group publishe...

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