RE: Antiphospholipid Syndrome in pregnancy 1 hour ago

VEGF was send before PLEX not sFlt-1. This patient had essentially no placental blood flow during diastole which seems to be an ominous sign that u...

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RE: Antiphospholipid Syndrome in pregnancy 2 hours ago

What did you do with the Warfarin therapy during PLEX?. Vitamin K antagonists are relatively contra-indicated in Pregnancy. Tough decisions in this...

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RE: Antiphospholipid Syndrome in pregnancy 2 hours ago

Did you measure any biomarkers of pre-eclampsia, such as sFlit, before and after PLEX? How severely reduced is the placental blood flow as a % of t...

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RE: Antiphospholipid Syndrome in pregnancy 3 hours ago

Updates on this case: I started PLEX on Friday after placing a perma cath and repeated again yesterday and today. Each session involved one volume ...

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RE: C3 GN case? 10 hours ago

Excellent discussion-let’s give Dr.Naumam credit for cracking the case- well done and thanks --------------------------------- [Mark] [Lerman] [MD,...

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RE: C3 GN case? 11 hours ago

Thanks Dr. Fogo. I agree 100%. I think the point is that “C3GN” is a phenotype not a distinct disease. It can be cause by multiple disorders. Altho...

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RE: C3 GN case? 11 hours ago

I actually think that the approach is that C3GN is the morphologic lesion, and the cause may be due to CFHR5 abnormality, called CFHR5 nephropathy ...

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RE: C3 GN case? 11 hours ago

C5HR5-nephropathy  causing C3GN is due to a variant causing internal duplication of exin 2  two in the gene, leading to complement dysregulation. D...

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RE: C3 GN case? 11 hours ago

Dr Glassock is as usual correct-The kidney biopsy shows deposition of C3 in these Cypriotic kindreds, originally recognized by Terry Cook and Matth...

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RE: C3 GN case? 1 day ago

Thanks- this was also my conclusion from a survey of the relevant literature. One should conclude that when a biopsy report lists a “diagnosis” of ...

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RE: C3 GN case? 1 day ago

To my knowledge, based on the series published (I have not personally seen any cases), there aren't any morphological features that would allow us ...

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RE: C3 GN case? 1 day ago

Thanks so much for all the helpful information! I will try to get the genetic testing but sounds like no need to pursue any staining of the renal b...

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RE: C3 GN case? 1 day ago

Thanks Dr. Cassol for your help in this very interesting case. Are there any pathological features that would allow one to suspect CFHR-5 Nephropat...

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RE: C3 GN case? 1 day ago

The CFHR5 antibody is not specific to mutated CFHR5, it just co-localizes with C3, where it is deposited, so it wouldn't be of help in this case...

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RE: Antiphospholipid Syndrome in pregnancy 1 day ago

Fascinating case. Use of PLEX and IVIg to improve placental blood flow in an otherwise asymptomatic pregnancy complicated by “triple positive”=anti...

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RE: Antiphospholipid Syndrome in pregnancy 1 day ago

To update you on this case that Dr @Ahlim Al sanani posted several weeks ago. Patient developed features of placental insufficiency with impaired ...

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RE: Could this be TMA? 1 day ago

Thank you Dr. Anand for sharing this interesting case. Having all the risk factors, low platelet counts and very poor prognosis!! is there any poss...

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RE: Mixed connective tissue disease and gn 1 day ago

I would agree with Professor Glassock, I would not automatically treat patients with advanced CKD placed on a course of steroids without other indi...

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RE: It´s not LUPUS (?) 1 day ago

Got results, HCV negative and NO VIRAL LOAD, curiously  erythrocyte sedimentation rate WESTERGREEN 120mm/h, and keep calling my attention that hepa...

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RE: exit site peritoneal catheter 1 day ago

really close to exit site, looks like granuloma? ------------------------------ Juan C Santacruz Clínica de los Riñones Menydial Quito-Ecuador M.D ...

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RE: IgA, with CS toxicity, 2.2 gm proteinuria 1 day ago

Dr. Glassock, I chose my words carefully (with you on my mind...) saying I was a minor advocate, I would hardly classify that as an "enthusiast". B...

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RE: IgA, with CS toxicity, 2.2 gm proteinuria 2 days ago

Unlike Dr. Rodby, I am not an enthusiast for MMF in non-Asians with IgAN. The evidence for efficacy (from RCT) is just too weak . The treatment of ...

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RE: Stone 2 days ago

Kidney stones are not a part of CKDu, to my knowledge. Sent from my iPad

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RE: C3 GN case? 2 days ago

I do not think that staying the kidney biopsy for CFHR-5 will help you manage this case. I would not bother trying. A genetic study for CFHR- 5 mut...

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RE: ADPKD pt. 2 days ago

She does seem aro have good prognosis and not a candidate for Tolvaptan. For additional prognostic information one could do a genetic analysis and ...

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RE: ADPKD pt. 2 days ago

① Here's info that can help predict progression (pics below). ② You've already used the Mayo image classification and that is pretty good (it's wha...

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ADPKD pt. 2 days ago

​Wanted to post this case for your expert opinion. Patient is a 46 y.o. Caucasian female who is a labor and delivery nurse, otherwise very health...

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RE: exit site peritoneal catheter 2 days ago

If I understood your acronyms correctly, then all sounds good to me.  Is there something specific about the exit-site that concerns you? ----------...

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RE: C3 GN case? 2 days ago

Thank you Dr. Rubin and Dr. Nauman and everyone for your ​help on this case! It may be difficult to stain for the CFHR5 on the biopsy as it was don...

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RE: ANCA+ 2 days ago

Agree with Dr. Glassock that this is most likely infravesical obstructive uropathy. THe distended/thickened/heavily trabeculated bladder wall, nega...

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RE: exit site peritoneal catheter 2 days ago

- Daily UF 1,2-1,7 Liters, residual diuresis 500cc, actual DPA 5 exchanges of 2 liters with 2 hour permanency, last ktv 2,4, no incidence with sess...

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RE: AKI with jugular vein thrombosis 2 days ago

"Urine analysis normal, specific gravity 1.010. Low blood pressure about 90/50 on presentation." Agree that ICD placement most likely  triggered ju...

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RE: It´s not LUPUS (?) 2 days ago

Denies NSAIDs ingestion, but pantoprazole was in her medication list. If so, we have another problem, what is the inmunological reason of all those...

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RE: It´s not LUPUS (?) 2 days ago

this patient has history of methotrexate use for more than 30 years ------------------------------ Juan C Santacruz Clínica de los Riñones Menydial...

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RE: exit site peritoneal catheter 2 days ago

how are the flows and ultrafiltration and weekly kt/V? ------------------------------ Tejas Desai, MD Founder, NOD Analytics Charlotte, NC, USA Web...

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exit site peritoneal catheter 2 days ago

What do you think about this exit site place.  Catheter placement 8 month ago, cuff extrusion 6 months then recolocated, now like this   ------...

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RE: AKI with jugular vein thrombosis 2 days ago

I would also be concerned that the thrombus is related to the ICD placement if the timing fits the scenario. Transient hypotension of a concern. Di...

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RE: C3 GN case? 2 days ago

@Kelly Liang Thank you for the information. Please see the attached link for the University of Iowa Complement Lab headed by Dr. Richard Smith. Its...

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RE: AKI with jugular vein thrombosis 2 days ago

He has an ICD so that could be the inciting event for the internal jugular vein clot. If you're worried about renal vessel thrombosis, and if his b...

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RE: AKI with jugular vein thrombosis 2 days ago

What side is the ICD on? Any prior instrumentation of the left IJ? ------------------------------ Monnie Wasse MD, MPH, FASN Professor of Medicine ...

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RE: ANCA+ 2 days ago

I think this is mainly a case of bladder outlet obstruction (? BPH vs Prostatic Cancer). I too would ignore for now) the serologies if renal functi...

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RE: Migraine headaches and hyponatremia 2 days ago

I missed “over 5 days” part, and was perplexed by Dr Glassock and Dr Friedman calculation. --------------------------------- Awais Nauman HMC Doha ...

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RE: C3 GN case? 2 days ago

Dr Liang, for us our genetics department does all the liaison with testing centers. Prior to that, for rare diseases, I have contacted prominent au...

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RE: Stone 2 days ago

Sugarcane aficionado perhaps? Does this patient come from an area that is high for CKDu?  Seems like a lot of silica is found in the water in such ...

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RE: ANCA+ 2 days ago

Do you have an etiology for the obstruction? Seems like he had a post obstructive diuresis and the creatinine is also coming down from this.  i wou...

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RE: C3 GN case? 2 days ago

Can you stain the glomerulus for  CFHR5? Would that help confirm the diagnosis? Ref:  https://datastudio.google.com/s/t9c9f4BmmvA -----------------...

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RE: IgA, with CS toxicity, 2.2 gm proteinuria 2 days ago

well summarized, and as a minor advocate for MMF I would still give this all 6-12 months before even thinking about adding MMF. And during that tim...

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RE: IgA, with CS toxicity, 2.2 gm proteinuria 2 days ago

I am really thankful to  respected professors in helping out the above scenario. Here is the summary of your valuable suggestions.  1.will taper cs...

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RE: C3 GN case? 2 days ago

His maternal grandfather had kidney stones and kidney disease (not sure what kind of kidney disease). His father has HTN. Is the CFHR5 mutation e...

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RE: ANCA+ 2 days ago

Thanks for the replies Cr improved to 2.7 No ureteral obstruction on nephrogram Free K/L ratio is 2.37 Kappa free light chain 119.47 Lambda Free li...

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