RE: kidney biopsy sampling error 2 hours ago

@Alton Farris @Kim Solez Another major problem with quantifying IFTA is the significant variation of the reading among pathologists. Dr. Farris and...

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RE: kidney biopsy sampling error 2 hours ago

Interstitial Fibrosis and Tubular Atrophy (scarring ) is almost by definition a “focal” process, affecting some but all areas of the kidney cortex ...

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RE: MAP or BP goals for renal perfusion 3 hours ago

Agree!!! ------------------------------ Mario Rubin, M.D. Houston TX ------------------------------

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RE: MAP or BP goals for renal perfusion 3 hours ago

A related point: Abuelo's "Normotensive Ischemic ARF" is classic, must read; even better, IMO, when read in conjunction with Biff Palmer's (https:/...

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RE: Early A V Fistula creation as a strategy for Retarding the progression 3 hours ago

Hi we published a study that looked At bp changes after avf creation vs not in patients 1 yr out from starting dialysis (pmid 31150056) for two rea...

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RE: MAP or BP goals for renal perfusion 4 hours ago

In addition this may be the area of utility of bio markers especially those with good early discrimination of AKI risk. The question in hemodynamic...

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RE: MAP or BP goals for renal perfusion 4 hours ago

There are no diseases but sick people (1700's). We have finally come to terms with this ancient statement (see attached) by attempting to implement...

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RE: MAP or BP goals for renal perfusion 4 hours ago

Each person has a different autoregulatory curve based not their day to day BP. 120/80 cold lead to hypo perfusion in a person used to 200/120. We ...

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RE: kidney biopsy sampling error 4 hours ago

I dont know of any data on IFTA confidence based on sample size or position from the kidney. Fibrosis CAN be patchy. for instance we had a case in ...

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RE: kidney biopsy sampling error 5 hours ago

Thank you Dr. Glassock and Dr. Rodby. These are wonderful references indeed and should be must-read for all nephrologists. I have to say though tha...

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RE: kidney biopsy sampling error 5 hours ago

Howard Corwin (my Attending when I was a Fellow) wrote on this in 1988 and then it was expanded on in 1990 in KI.  This is an important question so...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 5 hours ago

Very sad story, indeed! Are you sure the previous episodes hadn`t been suicidal? e.g. ethylene glycol ingestions… Recently, we've had a case of gla...

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RE: kidney biopsy sampling error 5 hours ago

See Sethi S, et all Kidney Int 2017. --------------------------------- Richard Glassock MD, FASN Emeritus Professor David Geffen School of Medici...

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MAP or BP goals for renal perfusion 5 hours ago

Hello everyone, Currently on a cardiology rotation, and the fellow asked me to show him a paper that a MAP goal of 65 is sufficient for patients re...

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RE: Atheroembolic Plaque? 7 hours ago

Hello everyone. Thank you for your amazing contribution. I am updating - My patient got discharged to a NH yesterday with improving Cr - came down ...

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RE: Kidney injury with olaparib? 8 hours ago

Hello, Dr. Deshpande had a nice summary about elevated creatinine (not AKI per se) in a review which may be helpful. https://journals.sagepub.com/d...

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RE: Diet and Fluid Regulation on KRT 8 hours ago

Zach, While dialysis is a lifesaver, it is totally inadequate compared to a transplant, and its that are well dialyzed are hardly healthy, no matte...

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RE: Metabolic Acidosis after transplant 9 hours ago

Some of the studies are a little tricky because they hold eGFR constant ("correct" for it) and find MA predicts graft failure. But eGFRs are estima...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 9 hours ago

so sad, I am so sorry to hear that. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicag...

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RE: Metabolic Acidosis after transplant 9 hours ago

I was not sure if this was the article you were referring to: Effect of Sodium Bicarbonate in Kidney Transplant Recipients With Chronic Metabolic A...

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RE: Metabolic Acidosis after transplant 9 hours ago

Sorry My query was about Metabolic acidosis  in well functioning graft. I have recently seen a paper in transplantation  which mentioned that sodiu...

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RE: Diet and Fluid Regulation on KRT 10 hours ago

This question should be directly addressed to Kam Kalantar-Zadeh, MD, PhD of UC Irvine. He has written extensively on this topic and may want to ex...

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kidney biopsy sampling error 10 hours ago

As Nephrologists, we have been taught to be aware of the potential for sampling error when interpreting kidney biopsy - especially in conditions li...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 10 hours ago

A sad story actually. Despite doing everything possible - including a PET scan to rule out occult malignancies - we were unable to find the cause f...

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Diet and Fluid Regulation on KRT 10 hours ago

An important aspect of improved quality of life for people with kidney failure is liberalized diet and fluid regulation. The KHI KRT Roadmap reads ...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 11 hours ago

HD is fine but it last for a few hours, a bad lactic acidosis can last for days. This case was from 9/20. What is the follow-up? Was a diagnosis ma...

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RE: Metabolic Acidosis after transplant 11 hours ago

MA is not uncommon even in "well functioning" kidney transplants. Not surprising given solitary functioning kidney in the setting of chronic nephro...

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RE: Metabolic Acidosis after transplant 11 hours ago

MA has been associated with graft failure even after correcting for eGFR https://doi.org/10.1681/ASN.2016070793 --------------------------------- [...

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RE: Early A V Fistula creation as a strategy for Retarding the progression 11 hours ago

Nothing like surgery to make the concept of impending dialysis real. I believe that if there is some reduction in progression, some portion of it i...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 11 hours ago

The patient concerned had normal blood pressure - in fact the BP was on the high side - therefore we were able to perform bedside HD rather than CR...

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RE: How much do we know? 11 hours ago

quite frankly filtration to clean the blood is very inefficient. You have to filter so much blood to get rid of the daily production of urea and ke...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 11 hours ago

I recently had a 19 yo female with this and she turned out to have a genetic mitochondrial disorder You can get the testing with Invitae ----------...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 11 hours ago

"With CRRT (and I suspect that individual in the ICU received CRRT) at a usual dialysate flow rate of 2000 ml/hr, the rate of bicarbonate is only 3...

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RE: crescntric lupus nephritis in transplant kidney 11 hours ago

sir , his C3 also is low with a normal C4 . any new advice?. though his creat remains stable at 1.4 ------------------------------ Sudeep Prakash M...

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RE: crescntric lupus nephritis in transplant kidney 12 hours ago

sir both kappa , lambda were 3+. I am also considering C1q neprhopathy ------------------------------ Sudeep Prakash MD Rutgers Health/New Jersey M...

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RE: Metabolic Acidosis after transplant 12 hours ago

As indicated we need a more complete set of data including serum creatinine (is he rejecting?), serum bicarb (is he on calcineurin inhibitors), ani...

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RE: How much do we know? 12 hours ago

Glomerulo-Philes  may be chagrined to learn that 3 times in the  evolutionary history of fishes that species without glomeruli have arisen and some...

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RE: Unusual Sensory Symptoms In A Dialysis Patient 12 hours ago

Dr. Glassock, thank you.  The psychiatrist who weighed in thought it was delusions or hallucinations as did I.  His medication list is otherwise ...

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RE: Metabolic Acidosis after transplant 13 hours ago

Not so simple enquiry-  what kind of MA?  How severe a MA? When in the  course of JT ------------------------------ Richard Glassock MD, FASN Emeri...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 13 hours ago

I agree with your statement that we treat severe acidosis even if there is a lack of good evidence simply because we feel we "must", and I also fee...

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Metabolic Acidosis after transplant 15 hours ago

Hello and Eid greetings I have a simple query Do we really need to treat metabolic acidosis after kidney transplant? ------------------------------...

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RE: Relapae/Flare in Lupus Nephritis 16 hours ago

"What is the best available evidence that following serologies adds to following clinical criteria (hematuria, proteinuria, BP, Cr)? Specifically, ...

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RE: Relapae/Flare in Lupus Nephritis 16 hours ago

Dear Professor Glassock, Thank you for your detailed reply. My doubts are : you mentioned 'Hematuria -Nephritic flare  ' and 'Proteinuric' flares W...

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RE: Relapae/Flare in Lupus Nephritis 17 hours ago

Fair enough.  I was not intending to annoy, but rather to inject a dose of pragmatism into a discussion of "guidelines" or plans.  Lupus Nephritis ...

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RE: Kidney injury with olaparib? 18 hours ago

I don't see oncology patient so much but had one lady with deranged kidney function taking Olaparib. I checked PubMed and found studies suggesting ...

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RE: Relapae/Flare in Lupus Nephritis 19 hours ago

Dear Professor Glassock , Thank you for your honest opinion . Thank you for your honest opinion. I did not post this topic to annoy the audience....

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RE: Relapae/Flare in Lupus Nephritis 21 hours ago

I think you are trying to introduce too much precision into what is fundamentally a very imprecise disease.  Guidelines will be rather useless, as ...

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RE: Early A V Fistula creation as a strategy for Retarding the progression 22 hours ago

Actually we have some anecdotal cases that it seemed to delay progression.  In fact Tom Golper has been trying to get a study started, which we wil...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 22 hours ago

The reason for RRT in lactic acidosis is not removal of lactate, (and you really don’t want to remove lactate bc it is a source of HCO3) but to sup...

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RE: Recurrent Severe Lactic Acidosis In A Young Male 23 hours ago

Lactic acidosis per se should not be an indication for RRT. Very little lactate is removed (and it's the base, "lactate", not lactic acid - HCO3 ha...

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