72yr old patient with cirrhosis and acute kidney failure 10 minutes ago

Hello,  I was interested in your views on the management of this patient I was called to assess yesterday. This was a 72 yr. old lady with liver ci...

View Discussion

RE: Recurrent FSGS 22 minutes ago

People wonder what primary FSGS is and this is it! Classic story. Rapid transplant recurrence probably identifies it better than anything else. I a...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 5 hours ago

As I know dual RAAS is no longer recommended cause of risk of hyperkalemia, Also RAAS with spironolactone showed better anti proteinuric effect, bu...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 5 hours ago

Thank you, now it's clear why better to check the level. I just wonder why no guidline for level monitoring, obviously it's necessary! ------------...

View Discussion

Recurrent FSGS 7 hours ago

Hello, I am hoping to get some thoughts about this patient: 43 yo woman with history FSGS initially diagnosed age 8. She eventually developed ESRD ...

View Discussion

RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 14 hours ago

normal C4 makes cryoglibulinemia less likely   in non albumin proteinuria better to do serum free light chain and look for mononoclonal gammopathy ...

View Discussion

RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 15 hours ago

SCr 5.2 --> 4.5 --> 4.1 mg on steroids alone (high BUN probably from steroid effect) suggests AIN responding to steroids. If urine output is good a...

View Discussion

RE: 80 yr female, AKI, positive RF and anti RO, mildly consumed C3 18 hours ago

The RF and anti-Lo suggest an autoimmune disease. That high of a RF always makes me wonder about cryoglobulins. The anti Lo being Sjogren and that ...

View Discussion

RE: Divergence of Cystatin C and Creatinine in 2 paediatric patients 20 hours ago

Thank you very much, Dr. Leung, this is very interesting and helpful! I checked back with the paediatric oncologist and engraftment was taking plac...

View Discussion

80 yr female, AKI, positive RF and anti RO, mildly consumed C3 1 day ago

80 yr old female, hypertensive for 10 yrs on valsartan/amlodipine presented with anorexia, nausea, vomiting. Laboratory workup revealed AKI, serum ...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

Is there any added advantage of dual RAAS blockade in young  patients like above with out comorbids and not having underlying cardiovascular diseas...

View Discussion

RE: Polyuria in healthy Community pt 1 day ago

oh right...not yet. Yes, weird. Will do so. ------------------------------ Meera Bajwa MD ------------------------------

View Discussion

RE: Polyuria in healthy Community pt 1 day ago

Did you send the 24 hour urine for Na K and urea to see what is making up his very excessive 24 hour urine solute excretion?  !263 is a LOT of mosm...

View Discussion

RE: Polyuria in healthy Community pt 1 day ago

Ok, repeat urine osmolality is 482 with 24 hour urine output of 2.6 Liters for a total of 1253mosm/24 hours. Is 2.6L technically even polyuria--bar...

View Discussion

RE: ESRD on IHD needing MRI with gadolinium. 1 day ago

See Attached NKF ACR consensus position paper. Group II Gad agents should be safe Disclosure I am an author on this paper, but it was approved by N...

View Discussion

ESRD on IHD needing MRI with gadolinium. 1 day ago

I am wondering the general opinion on totally avoiding gadolinium in a recommended study for a patient due to risk of NSF.  Avoid vs dialysis follo...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

While there are no formal, controlled studies to guide target CNI levels in treating membranous nephropathy, lupus nephritis and other glomerulopat...

View Discussion

RE: Vaccination in patients with IgA nephropathy 1 day ago

Thank you Dr. Rodby for the interesting link,  I have told my patients that risk of relapse/IgA flare is also present with COVID infection (or any ...

View Discussion

RE: Vaccination in patients with IgA nephropathy 1 day ago

Thank you Dr. Amuluru, very interesting case. ------------------------------ Hamid Moradi MD, FASN Associate Clinical Professor Principal Investiga...

View Discussion

RE: COVID19/ + MPO3/ Collapsing GN 1 day ago

“Is he on hydralazine, allopurinol or cocaine (levamisole) drugs know not cause +ANCA with or without clinical vasculitis? “ None BL Creat unknown ...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

I think many people do follow levels and shoot for transplant therapeutic levels,  I stopped using CSA a while back for GN, but I always started lo...

View Discussion

RE: COVID19/ + MPO3/ Collapsing GN 1 day ago

Do we have any baseline creatinine. Overall this patient has poor prognosis based on biopsy findings. COVID and CG is well known. I had 3 patient w...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

Dr Emad, we do have CNI target levels for GN. I keep it 125-175 trough for cyclosporin. But not that you are tapering the dose , levels are not imp...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

It's necessary to monitor CsA level when treating for GN ?! There is target level in such cases? In transplant we checking for C2 level.... In GN i...

View Discussion

RE: Transplant work up in a patient with low C3 compliment 1 day ago

Low C3 can occur in dialysis but given late presentation and young age would favor genetic complement analysis prior to transplant. C3GN high recur...

View Discussion

RE: Anemia in PD patient 1 day ago

No - no bleeding.. ------------------------------ [Manisha] [Singh] [MD] [FASN] [Assistant Professor] [University of Arkansas for Medical Sciences]...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

She is currently on a very low dose of cyclosporine (25 mg BID). I don't know if you have been monitoring cyclosporine levels. I will not be surpri...

View Discussion

RE: bariatric surgery in systemic lupus 1 day ago

I have had one lupus patient undergo gastric sleeve surgery and there were no issues at all, and she successfully lost weight.  Of course weight lo...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

Thank you for nice explanation, Yea at the beginning APLA2R was positive...! --------------------------------- Emad Odeh MD Jordan ---------------...

View Discussion

RE: Cyclosporin Discontinuation In Primary Membranous 1 day ago

I assume she was PLA2R positive initially. Assuming so, As for tapering v stopping a non steroid IS agent such as a CNI, I don't know if there are ...

View Discussion

RE: bariatric surgery in systemic lupus 1 day ago

thanks dr roger this patient is off steroid she is only antihypertensives and myfortic as she had mild avascular necrosis she is on quiescent state...

View Discussion

Cyclosporin Discontinuation In Primary Membranous 2 days ago

May I ask you about this 25yrs old female who was diagnosed in other hospital with primary Membranous NP 2 yrs ago and started on CsA since then wi...

View Discussion

RE: bariatric surgery in systemic lupus 2 days ago

I can't imagine why this wouldn't be a good idea except I would want the pt in remission and yet off prednisone. Stresses can make lupus relapse bu...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Absolutely correct. Very good point. ------------------------------ Manoocher Soleimani MD Professor University of New Mexico Health Sciences Cente...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Hypokalemia can also stimulate proximal tubule ammoniagenesis by increased uptake of glutamine. Another reason to maintain normal K levels in patie...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Two more points are worth discussing: 1. In addition to its effect on impairing urea synthesis in hepatocytes, acetazolamide has a known effect on ...

View Discussion

bariatric surgery in systemic lupus 2 days ago

dear colleague and good morning to you all I would like to ask if someone has experience in doing bariatric surgery  in rheumatic diseases in parti...

View Discussion

RE: Anemia in PD patient 2 days ago

Dose she have heavy menstrual cycles? --------------------------------- Monika Aggarwal (Gupta) MD, FASN Staff Physician and Medical Director Dial...

View Discussion

RE: COVID19/ + MPO3/ Collapsing GN 2 days ago

49 y/o b male with COVID and c-FSGS most certainly will have APOL1 high risk genotypes. What to make of the ANCA?  and what about c-FSGS in vasculi...

View Discussion

COVID19/ + MPO3/ Collapsing GN 2 days ago

Hello all, I am in need to figure this situation out.  I have a 49-year-old African-American gentleman ,who was admitted on January 8, 2021 with cr...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Wow I learned a lot here.  https://www.jstor.org/stable/30156212?seq=1 We use carbonic anhydrase inhibitors all the time without hyperammonemia. So...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Fascinating!. Acetazolamide can increase blood NH3 (ammonia) levels both in patients with ESRD as well as patients with stable (compensated)  liver...

View Discussion

RE: Acetazolamide in CKD 2 days ago

I had a hemodialysis patient who developed severe hyperammonemia after acetazolamide prescription for glaucoma. There are reports on the hyperammon...

View Discussion

RE: Divergence of Cystatin C and Creatinine in 2 paediatric patients 2 days ago

This is a pattern we have noted in our stem-cell transplant patients as well.  This is particularly the case when the patient is engrafting.  This ...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Assuming that the effect on intracranial pressure is mediated by inhibition of carbonic anhydrase in the choroid plexus and not in the kidney, trea...

View Discussion

Anemia in PD patient 2 days ago

I am perplexed by anemia in a PD patient- this is a young woman in 30s ESKD from recurrent AKIs following treatment of lymphoma 7 years ago. Not on...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Acetazolamide in CKD: Acetazolamide has been used in patients with CKD with either increased intracranial hypertension or glaucoma. Since oral acet...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Replying to my own reply after rereading the OPs question and realizing that I answered a question that wasn't ask. My bad. -----------------------...

View Discussion

RE: Acetazolamide in CKD 2 days ago

Interesting question. Acetazolamide (and all other carbonic anhydrase inhibitors) decrease intracranial pressure by decreasing production of CSF vi...

View Discussion

RE: Acetazolamide in CKD 2 days ago

I recall looking at this before when it was prescribed for ocular HTN in a patient w/ advanced CKD or ESRD and came to understand that it would be ...

View Discussion