RE: complex case of nephrotic syndrome in liver transplant patients 5 hours ago

I have no idea about the clinical relevance of the "equivocal " IF findings for C3, C1q and Lambda. Please discuss this with your renal pathologist...

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RE: IgA nephropathy with crescents 6 hours ago

Dear Colleagues, I appreciated your discussion regarding therapy in patients with IgA nephropathy (IgAN) presenting with crescents on kidney biops...

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RE: SIADH conundrum 7 hours ago

This is SIADH. I would use low dose tolvaptan and adjust accordingly. You cannot continue with HTS indefinitely. ------------------------------ J...

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RE: complex case of nephrotic syndrome in liver transplant patients 7 hours ago

Please see the following from AI: "Campath is a monoclonal antibody designed to target the CD52 protein. Because CD52 is found on the surface of ...

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RE: SIADH conundrum 7 hours ago

Personally I don't believe there is a renal salt wasting syndrome (see attached). The literature on the subject is very weak. Most likely this case...

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RE: complex case of nephrotic syndrome in liver transplant patients 8 hours ago

@ prof glassock what is the relevance of c3 granular glomerular staining . And c1q ig k lambda? If this is diffuse podocytopathy due to sirolimus ...

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Total Hip Replacement in ESRD 8 hours ago

I have a 30 yo SLE ESRD with severe avascular necrosis of the hip; she's mostly in a wheelchair, hardly walks ("I hop") and requires daily narcotic...

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RE: Dual Vascultis / Sle 9 hours ago

If Elisa +ve and crithidea negative and symptoms not In keeping with lupus /ctd? Then maybe can rule it out as false positive ds dna? What are yo...

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RE: SIADH conundrum 10 hours ago

Thank you for the feedback.. would be interesting to see what happens to her volume status, once the IV acyclovir is stopped ---------------------...

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RE: SIADH conundrum 10 hours ago

Her initial urine studies were, in fact, done prior to fluids and prior to acyclovir initiation. As stated above, no evidence clinically of a salt ...

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RE: SIADH conundrum 10 hours ago

Thanks for the response. I have used all of these options before though in this particular case was unsure about the potential increase in risk of ...

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RE: SIADH conundrum 10 hours ago

Baseline renal function is normal and remains normal now. She is receiving IV acyclovir 650 mg (13 mL volume) in 100 mL NS run at 100 mL/hr. The on...

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RE: SIADH conundrum 10 hours ago

Thanks for the response. She clinically appears euvolemic. BP has actually been high. There is nothing to suggest presence of salt wasting. Her uri...

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RE: IgA nephropathy with crescents 11 hours ago

Thank you all. Thank you Dr. Glassock. Looking at all data, I will start him MMF, switch to moderate dose steroids and over next few weeks come dow...

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RE: Dual Vascultis / Sle 13 hours ago

If the ELISA anti-dsDNA is positive, what additional information will be provided by an Crithida anti -ds DNA assay. ----------------------------...

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RE: SIADH conundrum 15 hours ago

Assuming this patient has the folllowing : Pna 120 , weight 70kg, then TBW = 35 l and TBna = 35x120=4200 meq. If shes getting 3 liters of fluid and...

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RE: AKI - 3 weeks post normal vaginal delivery 17 hours ago

Thanks dr kaur What does cva pain mean ? What range was her tacrolimus levels? Are there any features of PRES? Eye changes because of HTN? Any p...

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RE: complex case of nephrotic syndrome in liver transplant patients 17 hours ago

The liver team feels patient would need new liver transplant and asking us whether they can use campath ? Any thought? @ prof mark lerman apprecia...

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RE: Dual Vascultis / Sle 17 hours ago

This case was discussed with rheumatologists/ mdt and they advised that they felt it was Anca and sle was less likely ( clinical +age) so no biopsy...

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RE: SIADH conundrum 19 hours ago

With the high U osm I would consider this an ADH-mediated problem and with the high U Na (and no mention of low BP or high bun to cr ratio) I would...

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RE: IgA nephropathy with crescents 22 hours ago

Cyclophosphamide is great for severe LN and ANCA vasculitis but this may not translate to crescentic IgAN (C1) without RPGN. The only RCT of CYC th...

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RE: Pd Patient And Lipid Lowering Agent 23 hours ago

@prof bargman what is your approach to lipid management in your cohort ? Many thanks --------------------------------- Muhammad Soobadar MBChB ...

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RE: IgA nephropathy with crescents 23 hours ago

Thanks I would agree with prof glassock and dr dastoor . The conundrum in this case is if use Sparsentan first and proteinuria drops after 4 weeks...

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RE: yeast peritonitis and return to PD. 23 hours ago

Thanks really helpful Bw Belal --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: yeast peritonitis and return to PD. 23 hours ago

All except the patient with the pessary and repeat yeast peritonitis. You can look up the absolute numbers in our paper that I attached. Get Outl...

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RE: low phosphate and smoldering myeloma 1 day ago

Hi dr dastoor, Interested to know how you get the figure of 40 mmol of phosphate in urine daily? And what is the expected range for potasssium and...

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RE: yeast peritonitis and return to PD. 1 day ago

Thanks dr Mariam @ prof bargman. What number of patients restarted pd after yeast peritonitis and what number managed to maintain on it ( expect 2 ...

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RE: Pd Patient And Lipid Lowering Agent 1 day ago

Thanks prof glassock I was not aware of lipid oil but from the trial Seems promising . I will discuss with colleagues in my unit and consider imp...

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RE: SIADH conundrum 1 day ago

Vasopressin Storm - Vasopressin Surge - Vasopressin Spray Here I propose a name change to SIADH. "Vasopressin Storm!" We no longer call this wa...

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RE: SIADH conundrum 1 day ago

in regard to potential nephrotoxicity of iv acyclovir, i assume baseline renal function was normal? how fast is acyclovir being infused and at what...

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RE: SIADH conundrum 1 day ago

The Uosm is high , which can mean 2 things 1. The patient is volume depleted , or 2. The patient has an inappropriate ADH excretion in the face o...

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RE: C3 or MGRS 1 day ago

No , this is another case . The previous case had a bone marrow and no evidence of a monoclonal disorder . This case also has a gamma spike on SPEP...

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SIADH conundrum 1 day ago

Hello everyone, I have an interesting case of SIADH management in the hospital. 69 y.o. female with altered mental status found to have encepha...

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RE: C3 or MGRS 1 day ago

Was this the case you were going to do the IgG3 on?? ------------------------------ Michael Hughson MD Univeristy of Mississippi Medical Center (...

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RE: IgA nephropathy with crescents 1 day ago

Thank you all for your input. I read in the supplementary material of Applause trial that patients who received any immunosuppression within 90 day...

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RE: C3 or MGRS 1 day ago

Thanks Dr. Dastoor. The fact that she was treated with immunosuppression and did not develop any clinically apparent infection makes IRGN unlikely....

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RE: AKI - 3 weeks post normal vaginal delivery 1 day ago

I can only see partial notes from the outside system. It still says "ATN resolving preliminary results". No mention of glomeruli. But does not se...

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RE: AKI - 3 weeks post normal vaginal delivery 1 day ago

Did the biopsy show patchy cortical necrosis is or acute tubular necrosis?. ------------------------------ Richard Glassock MD, FASN Emeritus Pr...

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RE: AKI - 3 weeks post normal vaginal delivery 1 day ago

What did the kidney biopsy show? ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of Medicine at UCLA La...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 1 day ago

Does your patient have diarrhea or aType 1 DM? Has the skin lesion been biopsied? Is it Psoriasis or Eczema.?I am thinking of IPEX syndrome - a ver...

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RE: C3 or MGRS 1 day ago

I agree that this might be a C3GN pattern of injury due to a PGNMID. Temporary therapy with Pegcetacoplan might be effective, but for the long term...

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RE: IgA nephropathy with crescents 1 day ago

I agree with Dr.Dastoor, but I would use MMF as well. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School o...

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RE: C3 or MGRS 1 day ago

Thank you. As of now there has been no infections detected . She has been on high dose steroids and MMF and that would have activated an occult inf...

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RE: C3 or MGRS 2 days ago

Hi Dr. Dastoor, this is my opinion only I think there's definitely too much IgM to call it C3G and that this patients should be carefully evalua...

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C3 or MGRS 2 days ago

I would like to reintroduce the case presented here 4 weeks ago . 39 year old female , who presented with sudden onset of nephrotic syndrome. He...

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RE: IgA nephropathy with crescents 2 days ago

Pulse steroids , followed by a course of 2. oral steroids and 3. Iptacopan , if insurance permits . Hit hard and hit fast , would be the way to go....

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RE: Tumoral calcinosis in a PD patient 2 days ago

Sounds like the phos is getting under control, how high was it. Not sure you need to add tenepanor, though it may be helpful. would definitely chec...

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RE: Tumoral calcinosis in a PD patient 2 days ago

Thank you all for the excellent comments, especially regarding the adynamic bone possibility and due precautions: avoiding bisphosphonate and alumi...

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RE: Tumoral calcinosis in a PD patient 2 days ago

Is a pth of 230 really a concern for adynamic bone disease? I would however stop the vit D for that reason and also especially in the setting of tu...

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RE: Challenging overlap case: psoriasis, relapsing nephrotic syndrome, and planned guselkumab therapy 2 days ago

i think the psoriasis treatment can wait until the nephrotic syndrome is in remission, even if by chance rituximab exacerbates it (?). As frequen...

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