RE: smoldering myeloma in a patient with diabetic nephrolpathy 2 hours ago

Hi, Dr. Leung, thanks again. Her last BM biopsy was done in 10/2019, which showed plasma cell around 10%, normal cellular bone marrow, that's why I...

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RE: Kidney biopsy 3 hours ago

That is correct.  A renal biopsy is not a benign procedure no matter what the reported complication rates are (and we have reported a lot on this)....

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 3 hours ago

I agree with @Roger Rodby , two biopsies is a lot, even for me.  I do not think he is going to make the diagnosis of multiple myeloma by the kidney...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 4 hours ago

Hi, Dr. Leung, Thank you so much for the reply. This is a complicated case. I am not sure why she had AKI. I am wondering this is faster progressio...

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RE: Crescentic GN from MGRS? 5 hours ago

That makes sense Dr. Leung.  What would you say will make a strong case towards either MGRS or Bartonella infection associated crescentic GN in our...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 5 hours ago

what is the AKI due to?​ ------------------------------ Nelson Leung MD Mayo Clinic Rochester MN (507) 266-7083 ------------------------------

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RE: Crescentic GN from MGRS? 5 hours ago

​A rheumatoid factor does not rule out a monoclonal protein since it can be a monoclonal IgM against a polyclonal IgG.  The monoclonal IgM can be s...

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RE: Crescentic GN from MGRS? 6 hours ago

Thank you for sharing your thoughts.  Looking back at the case, the cryoglobulin immunofixation was IgM kappa which made us believe it was monoclon...

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RE: PPI use in dialysis patients with hyperparathyroidism 7 hours ago

Famotidine or cimetidine can be used instead of ranitidine, if they are available and not subject to the same contamination problems. What are the ...

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RE: PPI use in dialysis patients with hyperparathyroidism 7 hours ago

Thank you. Are there other alternatives to ranitidine or PPI? ------------------------------ Asmaa Al- Chidadi MBChB, MD, MS North West Anglia NHS ...

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RE: PPI use in dialysis patients with hyperparathyroidism 7 hours ago

Whats the opinion on using TUMS as a binder and an antiacid at the same time ​, maybe that would be an option ?! ​ ------------------------------ M...

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RE: Crescentic GN from MGRS? 7 hours ago

Thank you for sharing. this looks like it has an infectious etiology after those details shared from your pathology team with similar cases , altho...

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RE: PPI use in dialysis patients with hyperparathyroidism 9 hours ago

Because Sucralfate contains a large amount of Aluminum that can potentially be absorbed, it should only be used for short periods of time in dialys...

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RE: PPI use in dialysis patients with hyperparathyroidism 10 hours ago

​Thanks Professor Glassock. The patient in question had been on Ranitidin and we are not planning to restart PPIs. There is now a national shortage...

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RE: PPI use in dialysis patients with hyperparathyroidism 10 hours ago

To my knowledge, PPI have no demonstrated effect on GI Ca++ absorption, but they do reduce GI Mg++ absorption and will lead to lower serum Mg++ lev...

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RE: Kidney biopsy 10 hours ago

Totally agree- every case needs to be evaluated individually. Patient expectations need to be included in decision making. Some patients have an in...

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RE: PPI use in dialysis patients with hyperparathyroidism 11 hours ago

Agree. seems that calcium-based phosphate binders are limited in effect when used concomitantly with proton pump inhibitors. References:   https://...

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RE: Unexplained deaths related to dialysis 11 hours ago

@Anatole Besarab , good thought about the mortality associated with his concentration of Na tri citrate solution. I remember when that literature c...

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RE: Kidney biopsy 11 hours ago

I agree, this IS an important discussion. Even though I am a strong advocate of biopsy in this case (just an opinion), each case needs to be very s...

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RE: PPI use in dialysis patients with hyperparathyroidism 11 hours ago

@Stuart Sprague ​ ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL (312) 850-843...

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RE: PPI use in dialysis patients with hyperparathyroidism 11 hours ago

PPI use interferes with the phosphate binding ability of Calckum Carbonate and Sevelamer so they should not be used together. In advanced kidney fa...

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PPI use in dialysis patients with hyperparathyroidism 12 hours ago

​A primary care colleague asked me if she can use PPI in a haemodialysis patient with hyperparathyroidism. I know PPI is associated with fracture r...

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RE: Kidney biopsy 14 hours ago

I think the main point of this discussion thread is to analyze the circumstances where a kidney biopsy is not needed to make treatment decisions ( ...

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RE: Kidney biopsy 16 hours ago

Dear all very nice & academic discussion.To me it seems to undergo renal biopsy in order to know the histological pic., which will guide management...

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RE: IgAN relapse 19 hours ago

C4d was not done. I had the same scepticism that degree of uPCR did not go by the Biopsy finding. EM did not show any other pathology. Agree double...

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RE: IgAN relapse 23 hours ago

Before Cooperate was rescinded i put a number of igan pts on arb ace combo. Even after the paper’s integrity was questioned, i kept them on it. Coo...

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RE: Covid and kidney transplant 1 day ago

Certainly I would start to stop MMF --------------------------------- ---------------------------------------------------------------------- Carlo ...

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RE: Dermatomyositis with calcinosis cutis 1 day ago

Thanks a lot very helpful Really appreciate --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology, Inc. Cincinnati OH 0222 -...

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RE: IgAN relapse 1 day ago

Dr. Desai- You are quite correct the the COOPERATE trial report was rescinded due to "data irregularities " and there is no RCT evidence that dual...

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RE: Dermatomyositis with calcinosis cutis 1 day ago

Here are the promised References- Smith S and Hanson J. J Clin Rheum. 2017; 23:445- Martin D, et al. J Clin Rheum 2019; 25: e35. I hope this helps....

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RE: Unexplained deaths related to dialysis 1 day ago

The FDA took the~40% Citrate soultion initially developed in Europe off the market in USA. Only 4% NaCitrate allowed. Even if pushed into the patie...

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RE: Kidney biopsy 1 day ago

Thank you for all the input. I ended up biopsying the kidney. My rationale for going ahead with the biospy: 1) The patient "promised" that he is go...

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RE: IgAN relapse 1 day ago

This degree of proteinuria with normal Albumin and M0,S1, T1 lesion is very unusual. Was there an EM performed? Foot process effacement? GBM thickn...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

Dear Dr. Jhaveri, thanks for the reply. below is the free light chain ratio with cr level.   Ref. Range 11/14/2016 12:18 ...

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RE: IgAN relapse 1 day ago

I'm not sure she needs dual RAS blockade with both the ACE inhibitor and the ARB.  I wasn't aware of any data that showed that (I believe the COOPE...

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RE: Crescentic GN from MGRS? 1 day ago

​According to our renal pathologist, strong IgM and crescents are common in Bartonella-glomerulonephritis and doesn't necessarily have to be cryo o...

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RE: Kidney biopsy 1 day ago

Very interesting discussion which again make this forum so valuable IMO- I think in the end only a careful discussion of benefit and risks between ...

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RE: Kidney biopsy 1 day ago

One way we could think about this is from the patient's viewpoint. He may be less interested in just having the information than we are. Is he will...

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RE: IgAN relapse 1 day ago

The “response” to CNI was likely not due to an immunologic remission but rather to a non-specific effect on glomerular proteinuria that was not lon...

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RE: Crescentic GN from MGRS? 1 day ago

Thank you Dr. Abu-Minshar. Yes, Patient was initially discharged from hospital as preliminary work up performed by ID and cardiology after renal bi...

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RE: Kidney biopsy 1 day ago

I agree with Drs. Lerman and Mellas that prognostic information and an assessment of risk of recurrent disease in the transplant kidney can be obta...

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RE: Crescentic GN from MGRS? 1 day ago

Thank you Dr. Leung​ ------------------------------ Chintan V. Shah M.D. Assistant Professor of Medicine University of Florida Gainesville, FL shah...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

Some good references here about treatment and renal prognosis: https://datastudio.google.com/s/kTc3TmYjAMg --------------------------------- Tejas ...

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IgAN relapse 1 day ago

I would appreciate your opinion on my following case. 39y old female. Presenter with urine PCR of ~700 mg/mmol. Normal creatinine, and albumin. Kid...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

Dear Dr. Desai, thanks for the reply. do you mean do mass spectrometry in biopsy tissue to find amyloid? Congo red staining in the past were both n...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

There is patient-specific info here. Needs to be erased. Update:  thanks for erasing the patient specific info.  Turns out that when you click "EDI...

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RE: Kidney biopsy 1 day ago

Personal opinion on kidney biopsies: 1 Make diagnosis; especially when uncertain 2 Assist with establishing prognosis depending on histopathology, ...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

Thank you very much for the reply, Dr. Rodby. I feel the same, will explain to oncologist. ------------------------------ JingJing Zhang MD, PhD As...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

How about mass spectrometry in this case? Heard it may be more accurate that serum FLCs. --------------------------------- Tejas Desai, MD Founder,...

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RE: smoldering myeloma in a patient with diabetic nephrolpathy 1 day ago

Two biopsies is plenty, if this renal disease were related to the paraproteinemia you should have had no trouble showing that since the plasma Cell...

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