ESRD on IHD needing MRI with gadolinium. 36 minutes 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...

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RE: Cyclosporin Discontinuation In Primary Membranous 45 minutes ago

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

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RE: Vaccination in patients with IgA nephropathy 1 hour 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 ...

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RE: Vaccination in patients with IgA nephropathy 1 hour ago

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

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RE: COVID19/ + MPO3/ Collapsing GN 3 hours ago

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

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RE: Cyclosporin Discontinuation In Primary Membranous 6 hours 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...

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RE: COVID19/ + MPO3/ Collapsing GN 8 hours 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...

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RE: Cyclosporin Discontinuation In Primary Membranous 9 hours 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...

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RE: Cyclosporin Discontinuation In Primary Membranous 9 hours 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...

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RE: Transplant work up in a patient with low C3 compliment 9 hours 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...

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RE: Anemia in PD patient 9 hours ago

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

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RE: Cyclosporin Discontinuation In Primary Membranous 9 hours 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...

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RE: bariatric surgery in systemic lupus 10 hours 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...

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RE: Cyclosporin Discontinuation In Primary Membranous 11 hours ago

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

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RE: Cyclosporin Discontinuation In Primary Membranous 11 hours 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 ...

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RE: bariatric surgery in systemic lupus 13 hours 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...

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Cyclosporin Discontinuation In Primary Membranous 15 hours 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...

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RE: bariatric surgery in systemic lupus 18 hours 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...

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RE: Acetazolamide in CKD 18 hours ago

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

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RE: Acetazolamide in CKD 18 hours ago

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

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RE: Acetazolamide in CKD 19 hours 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 ...

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bariatric surgery in systemic lupus 19 hours 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...

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RE: Anemia in PD patient 20 hours ago

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

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RE: COVID19/ + MPO3/ Collapsing GN 21 hours 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...

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COVID19/ + MPO3/ Collapsing GN 21 hours 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...

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RE: Acetazolamide in CKD 21 hours 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...

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RE: Acetazolamide in CKD 22 hours ago

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

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RE: Acetazolamide in CKD 23 hours ago

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

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RE: Divergence of Cystatin C and Creatinine in 2 paediatric patients 1 day 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 ...

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RE: Acetazolamide in CKD 1 day 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...

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Anemia in PD patient 1 day 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...

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RE: Acetazolamide in CKD 1 day ago

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

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RE: Acetazolamide in CKD 1 day ago

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

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RE: Acetazolamide in CKD 1 day ago

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

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RE: Acetazolamide in CKD 1 day 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 ...

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RE: Vaccination in patients with IgA nephropathy 2 days ago

Intersting question but read this, it strongly suggests the answer is no.  https://apnews.com/article/fact-checking-afs:Content:9889529642 --------...

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RE: Acetazolamide in CKD 2 days ago

interesting question.  I have seen it used in CKD and I have given NaHCO3 if the [HCO3]  gets too low. Realize that carbonic anhydrase inhibitors e...

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Acetazolamide in CKD 2 days ago

Dear all,  I was wondering whether anyone had experience of use of acetazolamide in CKD (recommend by neurologists as a treatment for benign intrac...

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RE: Vaccination in patients with IgA nephropathy 2 days ago

Dr. Hamid Very interesting question! I do not have any relevant literature to share, however, had a 60 yo patient with newly diagnosed hemochromato...

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Vaccination in patients with IgA nephropathy 2 days ago

Dear colleagues,  I was recently asked by one of my neurosurgical colleagues whether there is any evidence/concern about COVID vaccination in patie...

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RE: HyperCa plus few unexpected findings 2 days ago

I realize your case does not have all the features reported with HHRH, but i thought may be worth exploring. It reminded of a patient i saw who had...

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Transplant work up in a patient with low C3 compliment 2 days ago

I would like to get the opinion of members regarding one patient being worked up renal transplant.  Patient is 18 year old who presented with advan...

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RE: A puzzling case of hypercalcemia 2 days ago

No 24 hr urine collection done. She was NPO during hospitalization for dysphagia and did require PEG. Considering her dementia and other medical pr...

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

Hello,  I have been consulted on two paediatric cases, one 18 yrs. and one 1 yr. old, both after allogeneic stem cell transplant. Both have had a m...

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RE: HyperCa plus few unexpected findings 2 days ago

Agree with searching for granulomatous infection/inflammation. I have a patient who had undergone buttock lift cosmetic surgery in the past which r...

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RE: CKD MBD Algorithm 2 days ago

Agree that the management of mbd in dialysis is best done on a case by case basis and is not really amenable to protocol, esp now that sensipar and...

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RE: HyperCalcemia In HD 2 days ago

Obviously i am a bit late for this discussion, but we have a few cases like this and palmidronate did the trick. We write up 2 cases and recently a...

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RE: HyperCa plus few unexpected findings 2 days ago

Interesting, would then further search for granulomas ------------------------------ Stuart Sprague DO, FASN Chief, Division of Nephrology and Hype...

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RE: HyperCa plus few unexpected findings 2 days ago

Dr. Sprague, CYP24A1 was negative ------------------------------ Mark Vishnepolsky MD, FASN ------------------------------

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RE: HyperCa plus few unexpected findings 2 days ago

It is a telemedicine world and I have not physically examined this patient. Aside for UTI no infections, ACE level was normal but i realize it does...

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