RE: Calciphylaxis conundrum 2 hours ago

This is a very difficult case, it is a very unusual location for calciphylaxis and his labs/risk factors are relatively low. Though I agree with Dr...

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RE: Calciphylaxis conundrum 3 hours ago

The argument by @Michael Linsey is not without merit. 90 days out).​ What is the risk to this patient with calciphylaxis if he remains on warfar...

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RE: Dialysis dependent lupus nephritis 3 hours ago

I understand the repeat biopsy, But the pathology is hard to interpret. I think MMF and fingers crossed it the right approach. I like PD, less he...

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RE: Renal limited TMA in young patient 3 hours ago

there are two obvious possibilities here, TMA from "(essential") HTN or HTN from a primary TMA The former is unusual at that age unless as Dr Venka...

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RE: Renal limited TMA in young patient 4 hours ago

Is she African American? Family history of hypertension? Malignant (probably "essential") hypertension at such a young age is much more likely in A...

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RE: Dialysis dependent lupus nephritis 5 hours ago

Repeat kidney biopsies at 3 and 6 months in LN, even of a dialysis - dependent form, are very early to use any information provided from the morpho...

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RE: Renal limited TMA in young patient 5 hours ago

These features suggest that malignant hypertension is driving the pathology. I would continue to follow the patient with aggressive control of BP r...

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RE: Calciphylaxis conundrum 5 hours ago

With very carefully documented informed consent, I would likely try Apixaban in this very difficult situation. Obviously, a full court press of eve...

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RE: Dialysis dependent lupus nephritis 6 hours ago

Thanks for the input! In this gentleman, there was an initial improvement in urine output and resolution of extra renal manifestations. However, ...

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RE: Biopsy In Anti Gbm Disease 6 hours ago

Insufficient information is provided to judge the value of kidney biopsy in this situation. False Positive anti-GBM assays are very very uncommon ...

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RE: Biopsy In Anti Gbm Disease 7 hours ago

Hi thanks for reply . patient is Anca negative and does not have pulmonary haemorrhage . What would a biopsy show? Dual pathology ? Like atn, tin? ...

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Renal limited TMA in young patient 7 hours ago

Hello everyone, I would appreciate your input on this case. 22 year old woman initially presenting to ER for severe hypertension (227/156) with...

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RE: Biopsy In Anti Gbm Disease 8 hours ago

To biopsy or not when you seem to have a diagnosis clinically supported by some serologic finding (AKI with hematuria and a positive ANCA Elisa, PL...

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Biopsy In Anti Gbm Disease 10 hours ago

Hi I would like to know if a patient presenting with rpgn picture previously normal kidney function. and anti Gbm positive and started on methyl pr...

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RE: Calciphylaxis conundrum 11 hours ago

NOAC should be approved as an off label alternative to patients with biopsy proven or highly suspected calciphylaxis. I agree with Dr Mellas. ----...

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RE: Calciphylaxis conundrum 12 hours ago

The mechanical valve pre dated dialysis. I have been dreading this day for some time. I have decided on going with apixaban. ---------------------...

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RE: Calciphylaxis conundrum 12 hours ago

Reading this ; The trial was discontinued after the enrollment of 252 patients (199 in population A and 53 in population B) because of an excess of...

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RE: Calciphylaxis conundrum 13 hours ago

"The non–vitamin K antagonist oral anticoagulants (NOACs) are replacing vitamin K antagonists in many settings, including bioprostheses, because of...

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RE: covid, masks, dialysis 14 hours ago

I know many people are tired of masks, including myself. I cannot remember some of our new patients faces, as there are mainly hidden by masks. Unf...

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RE: covid, masks, dialysis 16 hours ago

Thank you for raising this topic which is of great importance to our patients and staff in dialysis facilities across the US and around the World. ...

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RE: hypercalciuria 1 day ago

Not that I know of. But the degree of hypercalciuria is consistent with it ------------------------------ Stuart Sprague DO, FASN Chief, Division ...

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RE: hypercalciuria 1 day ago

Are peri-articulation calcifications seen in CYP24 defects? --------------------------------- Richard Glassock MD, FASN Emeritus Professor David...

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RE: Calciphylaxis conundrum 1 day ago

If it is a mechanical valve, is Apixaban an accepted and safe alternative to Warfarin (even if it is not approved by the FDA for this indication? H...

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RE: covid, masks, dialysis 1 day ago

Thanks Roger, yes, lot of variables, lot of background infections, hard to sort out, but...have you heard of any--any!-- instances where a patient ...

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RE: covid, masks, dialysis 1 day ago

Sheldon, “Then we have the covid-dedicated units where by selection, every patient is infectious, and the nurse/technician spends all day, every d...

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RE: Calciphylaxis conundrum 1 day ago

Can we assume that this was a mechanical and not a bio prosthetic aortic valve replacement?. It will make a big difference. ----------------------...

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RE: Calciphylaxis conundrum 1 day ago

Dr. Rodby- is there a non-Warfarin protocol to prevent thromboembolism with prosthetic. cardiac valves? If there is, what is its efficacy?This need...

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RE: Calciphylaxis conundrum 1 day ago

My experiences. Generally. If calciphylaxis comes up in the discussion, it's probably calciphylaxis. It is an odd place for it however. For this su...

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RE: Dialysis dependent lupus nephritis 1 day ago

Thanks Dr. Glassock. I wanted to use this case to initiate a discussion on the role and timing of rebiopsy in lupus nephritis. -------------------...

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RE: Dialysis dependent lupus nephritis 1 day ago

I have significant doubts that the repeat biopsies only after a short duration of treatment (6 months) contributed significantly management, in thi...

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covid, masks, dialysis 1 day ago

This is just a curiosity question, not really a renal question but maybe of interest (I hope) One of the debated points in Covid--at least in some ...

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RE: Dialysis dependent lupus nephritis 1 day ago

This patient had 3 renal biopsies over a ~ 6 month period. Follow-up biopsies were done in the setting of increasing urine output, decreasing SCr l...

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RE: Dialysis dependent lupus nephritis 1 day ago

The difference in path could be sampling variation. I agree with above recommendations. At his creatinine he might be able to stop dialysis, you c...

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RE: hypercalciuria 1 day ago

I agree with Dr Safdar, I would check a 1,25 D and if inappropriate need to look for an occult cause or a CYP24 defect ---------------------------...

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Calciphylaxis conundrum 1 day ago

75 yo male with ESKD on hemodialysis for several years, not diabetic, on coumadin for a prosthetic aortic valve. He experienced pain behind his lef...

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RE: Dialysis dependent lupus nephritis 1 day ago

There is very little experience with induction regimens for severe LN in males with kidney failure at presentation. So any suggestions are not "evi...

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RE: Dialysis dependent lupus nephritis 1 day ago

I think in a case like this i too would prefer cyclophosphamide over MMF. With rapidly deteriorating renal function, cyclophosphamide would be a be...

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RE: anca vasculitis 2 days ago

Tough decision. I hope this works out for the best. --------------------------------- Richard Glassock MD, FASN Emeritus Professor David Geffe...

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RE: hypercalciuria 2 days ago

Interesting idea. A lateral X-ray of the intervertebral discs and a urine test for Homogentisic acid would be diagnostic. I do not think that hyper...

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RE: anca vasculitis 2 days ago

Given his young age and severe clinical picture, I wanted to "maximize" his initial therapy. I definitely went back and forth on the PLEX question....

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RE: Membranous x Class V NL 2 days ago

No real reason to start Hydroxychloroquine , in my opinion. I would probably use RTX and follow antiPLA2R levels by ELiSA. -----------------------...

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RE: hypercalciuria 2 days ago

Ochronotic arthropathy can present with periarticular calcification though cartilagenous calcification of intervertebral discs are typical. simple ...

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RE: Membranous x Class V NL 2 days ago

Hello again, One last question regarding this case: would you start her on hydroxychloroquine? ------------------------------ Tiago Cerqueira, MD...

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RE: PR3 disease 2 days ago

Why do cardiologist love hydralazine? Other than the combination of hydra/spiro that showed some benefit in black individuals with heart failure, i...

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RE: anca vasculitis 2 days ago

As stated earlier, the utility of PLEX is unknown in cases like this and PLEX seems to add a risk of serious adverse events, and possibly greater m...

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RE: anca vasculitis 2 days ago

HI, I would recommend plex, I was also in mind going back and forth, but 100% crescent, and young ,and would take a chance. I wish I can tell you ...

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RE: Dialysis dependent lupus nephritis 2 days ago

I don’t see anything on this case that would sway me to one over the other MMF v IV CYC v po CYC , NIH IV CYC v EuroLupus IV CYC. His renal funct...

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RE: Dialysis dependent lupus nephritis 2 days ago

Thanks @Roger Rodby @Richard Glassock @Satish Balan C3 is 0.75 g/L latest and hasn't changed since the onset of the disease. It remained that rage ...

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RE: anca vasculitis 3 days ago

Thank you both! I'm going with modifed version of the Gulati et al treatment protocol with low dose IV CYC + RTX. Will hold off on PLEX-- his pulm...

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RE: immunotactoid gn 3 days ago

Paraffin IF-IgG kappa positive, lambda negative. This is a typical ITG with monoclonal deposits and MN by LM. Treat accordingly ------------------...

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