RE: Nephrotic Syndrome and Arterial Thrombosis 3 minutes ago

So Dr Glassock. What choice you prefers to add cyclop,rituxmab Or continue prednisone alone Also scrotal. us showed subcutaneous collection , Absce...

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RE: Nephrotic Syndrome and Arterial Thrombosis 34 minutes ago

I get very nervous about adding a pro-thrombotic agent, like TAC, in a patient with prior arterial or venous thrombi secondary to NS, but I guess y...

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RE: Minimal Change Frequent Relapse 1 hour ago

I strongly agree to this point to rule out secondary MCD , secondary to Lymphoma . In that case treatment has to be directed against Lymphoma in or...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 hour ago

I tried to get the pathology department to be present when IR did the kidney biopsy but they refused. It is still a problem for inpatients with acu...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 2 hours ago

With due respect, I beg to differ with a lot of peers and seniors in this group discussion. Being trained in Nephrology as well as in Critical Care...

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RE: Nephrotic Syndrome and Arterial Thrombosis 3 hours ago

Thank you. Already we added tacrolimus And I think metolazone is a good choice to improve edema --------------------------------- Mohamed Mahmoud M...

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RE: Minimal Change Frequent Relapse 3 hours ago

I would not be surprised at all if a repeat biopsy shows FSGS lesions, and I am unsure how this finding will influence therapy going forward. -----...

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RE: Steal syndrome just a cool picture…. 3 hours ago

Thanks for sharing this cool picture. Never heard about this thermal nail polish before. ------------------------------ Kavee Limbutara MD Nephrolo...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 4 hours ago

--IR uses smaller needles than we used to, in the interests of safety, and maybe they get fewer glomeruli on that basis, but I have been involved i...

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RE: Nephrotic Syndrome and Arterial Thrombosis 4 hours ago

"Currently on Lasix and albumin urine out put about 1.5. Liter/d This patient to continue on steroid or shift hime to other IS. Line ?" From what I...

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RE: ESA in CKD patients with cancer 4 hours ago

We usually get "permission" to use an ESA from oncology if a patient has an active cancer. More often than not they give it unless it is aggressive...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 4 hours ago

IR is used to getting small samples for cancer diagnoses, they dont often understand that glomerular diseases dan be focal and you really need a go...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 4 hours ago

" IR has more inadequate samples and more complications" I spoke with the chief of radiology and head of IR about inadequate sample size of kidney ...

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RE: ESA in CKD patients with cancer 4 hours ago

Thanks Mike. Yes it is a great paper written by Dr. Fishbane et al. ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ----...

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Active Lupus With Normal Comlement 5 hours ago

How frequent you see patients with active lupus and LN with normal complement and negative antidsDNA ? And if so , is there any explanation? @Rich...

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RE: Nephrotic Syndrome and Arterial Thrombosis 5 hours ago

From a pure probability perspective this is more likely arterial thrombosis due to severe NS and MCD in relapse. It possible that the COVID vaccina...

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RE: Minimal Change Frequent Relapse 6 hours ago

Thanks Dr. Leung, for the great suggestions. Will offer repeat biopsy, lymphoma check.

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RE: Nephrotic Syndrome and Arterial Thrombosis 6 hours ago

Hi I have update for this patient. Albumin now less than 10. On predispose 80 mg od . Recently has massive socrotal odema. Seen by urologist if pre...

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RE: Minimal Change Frequent Relapse 6 hours ago

Agree with Dr. Glassock.  It would be very helpful to know if the patient progressed to FSGS.  Also, could this patient have a lymphoma?  If these ...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 6 hours ago

Agree 100%.  We as a community need to do better at helping young graduates that want to start their own private practice and not expect them to be...

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RE: ESA in CKD patients with cancer 6 hours ago

This review on this topic by Fishman is very informative ------------------------------ Michael Rudnick MD University of Pennsylvania Philadelphia ...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 6 hours ago

I was rather astonished to read the views of Dr Nuristani. I thought that these problems were peculiar to my country. Group practice has its good a...

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RE: ESA in CKD patients with cancer 6 hours ago

Excellent responses from Richard and Tejas. Most patients, following appropriate education on the risk-benefit analysis, often prefer the continu...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 7 hours ago

I’m sorry you have to go through this. --------------------------------- Tejas Desai, MD Founder, NOD Analytics Charlotte, NC, USA Web: https://goo...

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RE: ESA in CKD patients with cancer 13 hours ago

Thank you Dr.Glassock and Dr.Desai.Really appreciate your input. ------------------------------ Chathurika Beligaswatta ---------------------------...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 16 hours ago

Excellent discussion. As a relatively new graduate, with my own private practice, let me share my 2 cents. I have expressed my frustration multiple...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 17 hours ago

EXACTLY!!! ------------------------------ Mario Rubin, M.D. Houston TX (713) 252-5539 ------------------------------

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 17 hours ago

To me being a nephrologist is about reasoning, data analysis, understanding physiology and weaving that into a meaningful patient interaction , not...

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RE: Steal syndrome just a cool picture…. 17 hours ago

Yes (I learned that after a giggle search) but does cool make it darker or lighter? --------------------------------- Roger Rodby MD, FASN Professo...

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RE: Steal syndrome just a cool picture…. 19 hours ago

The thermal nail polish will have different colors for different temperatures ------------------------------ Radu Raducu MD MD St. Alexius Hospital...

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RE: Steal syndrome just a cool picture…. 20 hours ago

If you look at the finger nails from the right hand you can see that the tips of the fingernails are starting to change color from blue to violet. ...

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RE: ESA in CKD patients with cancer 21 hours ago

Thanks- Dr. Desai. Interesting information. It is my impression that very of these trials were conducted to directly assess the safety (and efficac...

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RE: ESA in CKD patients with cancer 23 hours ago

Here is some data from a large number of trials.  It shows that the fear we use to have with ESA therapy and cancers may not be true, except for pe...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 23 hours ago

I agree with Dr. Rodby. Learning how to do kidney biopsies is a variable and a 6 biopsy supervised training sessions is often not enough. Trainees ...

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RE: ESA in CKD patients with cancer 23 hours ago

In my opinion, use of Epo should be based on patients desires, wishes and understanding of potential benefits and risks, including aggravation of t...

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RE: Minimal Change Frequent Relapse 23 hours ago

By the way, he does not meet the definition of either Frequently Relapsing or Steroid- dependent MCD. --------------------------------- Richard Gla...

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RE: Minimal Change Frequent Relapse 23 hours ago

In light of AKI with preceding therapy with CNI and mildly impaired GFR now, I would avoid a CNI, and if blown Nephrotic relapse develops he can al...

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RE: Minimal Change Frequent Relapse 23 hours ago

Thank you Dr. Glassock, I think I can observe him for a month. If he worsens with hypoalbuminemia, and worsening proteinuria, what should the cour...

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ESA in CKD patients with cancer 1 day ago

I would like to know your views on the following- 1.Continuation of ESA in a patient who is already on hemodialysis, but recently diagnosed to have...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

We are very active in renal biopsy training, very inactive in acute access placement, and I dont find that they care one way or the other. I also k...

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RE: Steal syndrome just a cool picture…. 1 day ago

Can you provide a more objective bedside finding re: dialysis access associated steal syndrome (i.e. oxygen saturation of each hand)? Or digital pr...

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RE: Minimal Change Frequent Relapse 1 day ago

My guess is that this is really Primary FSGS, that was initially steroid and RTX responsive. The most recent relapse does not resemble relapses of ...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

Thank you for your thoughts. I fully agree with the reasons why you went into nephrology which apply to me as well I can only say what drew me into...

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RE: Steal syndrome just a cool picture…. 1 day ago

I posted my answer before seeing yours BTW, so great minds think alike! Also agree w/the prior post that her politics may be more evident than her ...

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RE: Steal syndrome just a cool picture…. 1 day ago

Although ischemic changes are not obvious on either hand, IMO, I'm voting for the left hand because there is a BP cuff on the right! Also to be pro...

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RE: Resistant Chronic Activev Antibody Mediated Rejection 1 day ago

I would also add that unless your program performs protocol biopsies to monitor sub clinical rejection IMO using serum creatinine and new onset pro...

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RE: Steal syndrome just a cool picture…. 1 day ago

Left hand as she has a BP cuff on the right. ------------------------------ Karn Gupta MD, FASN North Carolina Nephrology, P.A. Morrisville NC (216...

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RE: Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

Great and very important post. I read both articles and am relieved that most fellowship training programs continue to require learning basic nephr...

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RE: Resistant Chronic Activev Antibody Mediated Rejection 1 day ago

I would agree with Dr Lerman and Dr Rubin in that no treatment is effective and possibly treatment further may be harmful in terms of worsening imm...

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Does the number of procedures performed by nephrologists affect the recruitment of trainees to nephrology fellowship programs? 1 day ago

Yesterday one of the graduating fellows at a local (Houston) medical school, presented a very nice summary of the factors which have been identifie...

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