Steal syndrome just a cool picture…. 1 hour ago

rounding in Dialysis unit this lady has thermal nail polish, has AVF one one of the hands and steal syndrome, which hand is ischemic? -------------...

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RE: Steroid resistant Lupus podocytopathy 2 hours ago

------------------------------ Arjun Sharma MD Timnath CO (203) 816-1117 ------------------------------

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RE: PD in Liver failure 6 hours ago

Here are some tips: ------------------------------ Tejas Desai, MD Founder, NOD Analytics Charlotte, NC, USA Web: https://goo.gl/mfziXG Contact: tw...

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RE: Water and Dialysate flow rate 6 hours ago

Thank you for this water consumption analysis. To add some good news, current RO water systems in large in-center dialysis facilities have about a ...

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RE: PD in Liver failure 7 hours ago

Sounds like a good idea--"make her symptoms better", attend daughter's wedding, and she won't need paracentesis anymore, all very good things. For ...

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PD in Liver failure 8 hours ago

I have a patient with liver failure and kidney failure who needs to start dialysis. She runs low BPs because of portal hypertension and is often sy...

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RE: Steroid resistant Lupus podocytopathy 8 hours ago

Do you have any other serologic/immunologic marker results?  The linear deposition of IgG has me wondering a diagnosis other than lupus: I wonder i...

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RE: Water and Dialysate flow rate 9 hours ago

Thanks for doing these useful calculations.  I'd add one other thoughts: -that's the rate of use of dialysis-quality water. However, I understand t...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 13 hours ago

Thanks for the question.  Of course, we are dealing with steroud-resistant  FSGS, not MCD in this case.in fact mist cases of steroid resistant MCD ...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 16 hours ago

Professor Glassock, What is in your opinion on the role of cytoxan in MCD-SRNS? There are some suggestions that it might help. Certainly, not an id...

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RE: Steroid resistant Lupus podocytopathy 19 hours ago

Can you upload the de-identified full pathology report including IF and EM? --------------------------------- Richard Glassock MD, FASN Emeritus P...

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RE: Steroid resistant Lupus podocytopathy 1 day ago

This picture does not entirely fit the classic description of lupus podocytopathy.  I have seen a few elderly women with what looked like MCD turn ...

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RE: Steroid resistant Lupus podocytopathy 1 day ago

She is not a diabetic, she has had RA in the past, hyperlipidemia but no other major medical history ------------------------------ Arjun Sharma MD...

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RE: Steroid resistant Lupus podocytopathy 1 day ago

Is she diabetic?  The IF is reminiscent of diabetic Nephropathy.  No immune complex deposits  by EM in mesangium makes Lupus a little less likely. ...

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Steroid resistant Lupus podocytopathy 1 day ago

I have a patient I could use some help with. The patient is a 60 yo white female with PMH lupus (without previous renal involvement) who had been o...

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RE: Water and Dialysate flow rate 1 day ago

The original Michaels paper has a formula for the case where Qb = Qd with countercurrent flow -  K = Qb (R/R+1) where R = KoA/Qb ------------------...

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RE: Water and Dialysate flow rate 1 day ago

My hope is to have nephrologists question the tools that are currently available and to push manufacturers of Dialysis machines and dialyzers to ma...

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RE: What might my patient be taking? 1 day ago

Interesting case! Calculated anion gap is 20 indicating this is likely a mixed acid base disorder. Delta anion gap is around 8 (from ESKD presumabl...

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RE: Non-Proteinuric CKD and Bilateral Renal Cysts in a Young Man 1 day ago

Just thinking loud.... Am I seeing a Young hypertensive with Hypokalemia and Alkalosis.... Could this be Liddle's syndrome... Or Am I just imaginin...

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RE: Water and Dialysate flow rate 1 day ago

Dr. Segal. Many thanks. Your calculations surely help to put the issue in a societal perspective. --------------------------------- Richard Glassoc...

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RE: Water and Dialysate flow rate 1 day ago

Is reducing DFR in HD patients generally to achieve a societal goal (reduction of population based water consumption) reasonable while we do not fu...

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RE: Water and Dialysate flow rate 1 day ago

I am not sure if anyone answered Professor Glassock's question yet, but here is what I calculated: If the average dialysate flow rate is 600 mL per...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

For Primary FSGS, if the patient cannot tolerate the high dose steroid regimen, many experts advocate switching to CNI + low dose steroid ( or no s...

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RE: Water and Dialysate flow rate 1 day ago

Robert,  Thank you for your reply. I completely agree that there is a minimum amount of clearance that positively impacts mortality. I also agree t...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

On review of your original post, I may have been a bit premature in concluding that the patient has a Primary form of FSGS. It is always important ...

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RE: Water and Dialysate flow rate 1 day ago

We used Tablo in 8 patients in one of our facilities and after a month only one required additional time. The other 7 had no change in Kt/V. Intere...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

The definition of steroid resistant nephrotic syndrome is lack of response to 4 months of full dose of steroids. I often find that patients( and my...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

Does she have any ancestors from West Africa? if not, the likelihood of APOL1 risk alleles is quite low, but not zero. ----------------------------...

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RE: AVACOPAN in ANCA vasculitis 1 day ago

Not yet FDA approved , However results of CLEAR, CLASSIC and advocate trials are promise as a steroid sparing or at least decrease steroid dose. --...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

She is mediterranian actually. --------------------------------- Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ---------------------------------

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RE: Obstructive Uropthy Without Back Pressure Or Hydronephrosis 1 day ago

I think we have collectively  answered the question in the original post.  Bilateral urinary tract obstruction is extremely unlikely in this  case ...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

Thanks   -  this us all quite compatible with Primary (permeability factor related ) FSGS.  I think you can disregard the patterns by LM- they will...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

Initially her 24 hour proteinuria was 10 grams..serum Albumin 2.1 creatinine was always below 1 mg/dl. ------------------------------ Wael Jebur MD...

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

------------------------------ Wael Jebur MD, FASN drwaellatif@hotmail.com Dubai ------------------------------

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RE: Steroid And CNi Resistant Minimal Change Nephrotic Syndrom 1 day ago

I am sorry for the incorrect information about the biopsy report I shared earlier . actually its FSGS, consistent with behaviour of the disease. I ...

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RE: Obstructive Uropthy Without Back Pressure Or Hydronephrosis 1 day ago

HI. I have questions is hydronephrosis In volume depletion patient Without suspicious of retroperitoneal fibrosis risk, without active urological i...

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RE: Atheroembolic Plaque? 1 day ago

@Shahzad Safdar mentioned about C4 being often present in % of 0,25,50 ..  when initially C4 came low, we were all perplexed. 2+ rbc and 2+ prt on ...

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RE: Derms on HD II 1 day ago

Thank you all for your thoughts, wise advises and help, we will continue follow-up and let you know more info Greetings to all!! ------------------...

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RE: Obstructive Uropthy Without Back Pressure Or Hydronephrosis 1 day ago

Excellent Dr Venkat, many thanks, that is great But if I read it correctly it seems to apply to all causes of obstruction, not preferentially to re...

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RE: Atheroembolic Plaque? 1 day ago

The initial C4 must have been a lab error. I am more impressed by the serum albumin of 2.5 several weeks post op in a patient without proteinuria (...

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RE: Atheroembolic Plaque? 1 day ago

"i rechecked complement - C4  was 15 (it was 0.1 before)" It appears that you have only two C4 measurements. Thus, the possibility of the initial v...

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RE: Water and Dialysate flow rate 1 day ago

I had the program use the equation for a fixed KoA and then ran the range of Qb and Qd for 0 to 1000. So this was years ago so I will re-run but so...

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RE: Water and Dialysate flow rate 1 day ago

I corrected myself in that the eq’n only doesn’t work when Qb = Qd. In that instance, alpha = 0, e^alpha = 1 & therefore, both the numerator & deno...

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RE: Water and Dialysate flow rate 1 day ago

Michael Your points are well taken and obviously, there are many good articles about the short-frequent vs longer less frequent dialysis treatment ...

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RE: Obstructive Uropthy Without Back Pressure Or Hydronephrosis 1 day ago

Regarding Dr. Hirsch's question: Experimental obstructive uropathy causes initial/transient preglomerular vasodilatation followed by more prolonged...

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RE: Water and Dialysate flow rate 1 day ago

I have looked back into the equations used from Michael's equation in my program within Mathematica and it works for Qb Qd. (exp to the power of 0...

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RE: Water and Dialysate flow rate 2 days ago

You make a valid point in that "in-series" i did add the dialyzer KoA but as you pointed out (1-Qb/Qd) cannot be negative (or 1) so it does generat...

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RE: Water and Dialysate flow rate 2 days ago

@Robert Hootkins Tangential to this post but in your article, just curious re: your calculation of theoretical K in Table II using 1 or 2 dialyzers...

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RE: Atheroembolic Plaque? 2 days ago

Hello all! i will try to present the entire picture to the best of my knowledge... i was called in to see the pt again.. and his Cr was definitely ...

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RE: Water and Dialysate flow rate 2 days ago

I think there are really two discussions here relative to clearance. 1) what Qd achieves optimal clearance per unit time - I agree with the prior c...

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