RE: PD In Patients Who Make Up Their Weights 8 hours ago

I think you are all being very considerate. Im very skeptical. I would cut a deal with her and until she can go to HD with no shenanigans, for say ...

View Discussion

RE: PD In Patients Who Make Up Their Weights 8 hours ago

In addition to time-limited PD trial, do you have the capacity for assisted PD (as close to supervised as you’ll get in home setting without coinha...

View Discussion

RE: PD In Patients Who Make Up Their Weights 11 hours ago

This is a tricky one. As an adult she should have some autonomy in decision-making, so her desire to try PD is difficult to overrule. She has a PD ...

View Discussion

RE: PD In Patients Who Make Up Their Weights 13 hours ago

Thanks a lot Dr Glassock for your details about management that's exactly what I did with my patient and get good results and till now continue on ...

View Discussion

RE: Fibrillary GN with IgG lambda 14 hours ago

Mayo Clinic is using rituximab and presented a poster of 11 patients who received it:  https://datastudio.google.com/s/tLPA3pe6jY8 ----------------...

View Discussion

RE: PD In Patients Who Make Up Their Weights 14 hours ago

Dr. Krediet's plan has many merits. Many thanks. -- Dick Glassock Please note and save my new email address: rjglassock@gmail.com

View Discussion

RE: PD In Patients Who Make Up Their Weights 14 hours ago

​I think patient motivation is a strong predictor for sucessful PD. This is certainly not an easy patient because of her obsession with her body we...

View Discussion

RE: another membranous case :( 15 hours ago

Thanks again everyone Both of his biopsies stained equally for kappa and lambda, and strongly positive for PLA2R with IgG4 subclass. There is no ev...

View Discussion

RE: Fibrillary GN with IgG lambda 16 hours ago

Thank you Dr Desai and Dr Glassock. DNAJB9 staining was not reported on the biopsy results. From treatment perspective, Rituximab first and if no r...

View Discussion

RE: Fibrillary GN with IgG lambda 16 hours ago

This would be classified as a MGRS lesion, even if all efforts to find a clone are unrewarding. Many experts advise an initial treatment with anti-...

View Discussion

RE: Fibrillary GN with IgG lambda 17 hours ago

I'm not sure a search for a plasma cell clone is absolutely needed if the diagnosis of fibrillary GN is confirmed (with DNAJB9 staining). I'm sure ...

View Discussion

RE: PD In Patients Who Make Up Their Weights 17 hours ago

The patient has been off steroids for some time and has been receiving rituximab. My approach has been to: 1. educate patients about risk for weigh...

View Discussion

Fibrillary GN with IgG lambda 17 hours ago

I would appreciate the input on the management of this 62 yr patient with h/o DM, HTN who was referred for proteinuria Pt was noted to have nephro...

View Discussion

RE: another membranous case :( 18 hours ago

This is an interesting case of MN, resistant to multiple drugs, as underlined by Pr. Glassock and others. A few questions: 1. Did you stain for IgG...

View Discussion

RE: another membranous case :( 18 hours ago

Yup, just a “pipe dream” for now. --------------------------------- Oded Friedman ---------------------------------

View Discussion

RE: another membranous case :( 18 hours ago

To my knowledge, immunoadsorption fir anti-PLA2R mediated MN is not clinically available yet (although research on this therapy is continuing ).PLE...

View Discussion

RE: Daily dialysis in nursing home settings with ternal catheters 18 hours ago

I am not aware of any such study, but I would presume that frequent catheter manipulation would increase the risk of infection merely because it is...

View Discussion

RE: PD In Patients Who Make Up Their Weights 18 hours ago

In fact with hypotension attacks with HD may be difficult to be shifting her again for HD and she was young so long term dialysis may be better wit...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 18 hours ago

Might be advisable to check 24-hr UCa/FECa re: PHPT vs FHH only after vitamin D repletion. --------------------------------- Oded Friedman --------...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 18 hours ago

May I seek some clarification: The starting point of concern in this otherwise healthy potential donor is persistent hypercalcemia. With persistent...

View Discussion

RE: another membranous case :( 18 hours ago

Am curiously awaiting more evidence for immunoadsorption; compared to PLEX (although I’ll admit I have no personal experience with PLEX-treated MN)...

View Discussion

RE: another membranous case :( 18 hours ago

thanks Dr. Glassock for this reference. this is a very interesting proposition Plex and anti-CD 20 they seem to prefer to do the the plex after the...

View Discussion

RE: PD In Patients Who Make Up Their Weights 19 hours ago

It us so difficult to “deny” or even dissuade a pt from PD. They “all” think they can still lose weight but with the sugar load it is very unusual ...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 19 hours ago

Like Dr Lucca said, these is not uncommon, and at least in two case of donor with light hypercalcemia  and positive sestamibi  we discard donation ...

View Discussion

RE: another membranous case :( 19 hours ago

See Podesta MA, et al. Nephron 2020;144:30-35 for a study of PLEX + Ofatumumab in Resistant PLA2R MN. Sent from my iPad

View Discussion

RE: Potential kidney donor w parathyroid adenoma 19 hours ago

Thanks for sharing your valuable advice. It looks like caution is advisable and additional studies needed to confirm PHPTH before an operation. Sen...

View Discussion

RE: Peritoneal Dialysis in ESRD with Liver cIrrhosis and ascites 19 hours ago

Based upon my experience of having managed few such patients, I thought the fear of higher morbidity resulting from PD was grossly overstated espec...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 19 hours ago

It is a bit high for FHH. However there are enormous errors and variability with PTH assays  this without several measurements I am skeptical. Also...

View Discussion

RE: another membranous case :( 20 hours ago

thanks everyone. Dr. Desai, thanks for the links and comments. yes, with his current gfr (20ish ml/mi) I am currently a little hesitant for a CNI, ...

View Discussion

RE: PD In Patients Who Make Up Their Weights 20 hours ago

Thank you! These were my thoughts as well and I guess I just needed some validation 😂 before the PD catheter is removed. -------------------------...

View Discussion

RE: significance of low C3? biopsy? 20 hours ago

With this lower level of proteinuria despite advanced ckd, i woukd get simultaneous ACR And PCR to see if proteinuria is glomerular. But agree with...

View Discussion

RE: PD In Patients Who Make Up Their Weights 20 hours ago

“Everybody” gains weight on PD, unless this is still steroid related and if so maybe getting her off and using azathioprine or rituxan as maintenan...

View Discussion

RE: Peritoneal Dialysis in ESRD with Liver cIrrhosis and ascites 20 hours ago

I agree 100% with all these important points about the role of albumin and intravascular volume and albumin and what it means from loss v nutrition...

View Discussion

RE: another membranous case :( 20 hours ago

Im not optimistic about CNI MMF etc. i think if you have any hope it is to get rid of that PLA2R antibody. “I would consider therapy with Ofatumuma...

View Discussion

RE: IgA Nephropathy Without Hematuria 21 hours ago

I think that us a reasonable hypothesis. Woukd expect other signs of micro angiopathic hemolytic anemia, but you never Know. Usually we dint specul...

View Discussion

RE: IgA Nephropathy Without Hematuria 21 hours ago

Just a thought could we explain all this without LM as consequence of Malignant hypertention . C3 deposition has been reported as part of IF findin...

View Discussion

RE: another membranous case :( 21 hours ago

Honestly it sounds like you've done a great job trying to abate the inflammatory response in the kidneys.  It's really hard to care for membranous ...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 1 day ago

Dr. Sprague. Is the iPTH “too high” for FHH and how you use the positive Sestamibi scan in this case. Sent from my iPadj

View Discussion

RE: Potential kidney donor w parathyroid adenoma 1 day ago

I mostly agree with all the comments made and with Dr. Goldfarb's comments about vit D deficiency and primary HPTH.  I also know and greatly respec...

View Discussion

RE: Peritoneal Dialysis in ESRD with Liver cIrrhosis and ascites 1 day ago

Pondering the nature of albumin: I would caution about too much of a concern about removing albumin from the cirrhotic belly with PD and lowering s...

View Discussion

PD In Patients Who Make Up Their Weights 1 day ago

Young women with AKI from ANCA vasculitis on IHD via permacath learns that she will need dialysis long term. She has gained weight from prednisone....

View Discussion

RE: another membranous case :( 1 day ago

These kind of multi-drug resistant high anti-PLA2R antibody cases of MN are fortunately uncommon, so there is no consensus on therapy. Be sure that...

View Discussion

another membranous case :( 1 day ago

Hello again, I have another membranous case. My apologies for the long post. A 46 year old caucasian man who i initially met in 2018 with nephrotic...

View Discussion

RE: significance of low C3? biopsy? 1 day ago

Apology for this abbreviation, SIFE stand for serum immunofixation essay. --------------------------------- Hayder Aledan MD, FASN Assistant Profes...

View Discussion

RE: Peritoneal Dialysis in ESRD with Liver cIrrhosis and ascites 1 day ago

Thank you all for your helpful input and comments. ------------------------------ Ashutosh Singh MD, FASN Knoxville TN (865) 483-7511 -------------...

View Discussion

RE: unclear hyponatremia 1 day ago

Do not know. Looking at the facts. Assume Body weight 60 - 70 kg, Average U osm 450, delta [Na] 17 meq/L in 5 days. Water retention necessary to lo...

View Discussion

RE: IgA Nephropathy Without Hematuria 1 day ago

" Interesting that you suggest MMF not cyclophosphamide !!!" I am of the opinion that crescents are just an advanced, later or more severe form of ...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 1 day ago

The issue of vitamin D and primary hyperparathyroidism has been thoroughly studied by (New Yorker) Shonni Silverberg; she is always my go-to consul...

View Discussion

RE: Potential kidney donor w parathyroid adenoma 1 day ago

Illustrates a very common dilemma faced by transplant physicians. From the recipient's point of view, a younger donor is preferable because donor o...

View Discussion

RE: unclear hyponatremia 1 day ago

Malignancy-related erratic, autonomous ADH secretion but what acutely changed from 5 days earlier to go from normo- to severe hyponatremia? Is the ...

View Discussion