RE: Lupus nephritis with Ramsay Hunt Syndrome 1 hour ago

Nephrotic range y (but no data on serum albumin) at initial presentation . The kidney biopsy was delayed for 3 months after introducing Intensive t...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 1 hour ago

I share Dr Abdalla assumption about Podocytopathy as both Nephrotic Syndrome is uncommon in Class II LN and Class switch from III/IV/V to Class II ...

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RE: Cause of Disproportionally High Urea 2 hours ago

Thanks Dr Friedman I agree with high FeUrea. But how did your calculation come out for protein out of 103, as when I calculated it comes at 47 In...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 2 hours ago

The patient presented with nephrotic proteinuria and achieved complete remission in a short time on steroids and MMF. Kidney biopsy showed Class II...

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RE: Cause of Disproportionally High Urea 3 hours ago

Here are a couple of articles looking at creatinine (1945) and cystatin-C (2021) in neuromuscular disease. Creatinine is a poor maker of eGFR, but ...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 3 hours ago

I would just give acyclovir in full dose for 2 weeks while monitoring renal function and ensuring adequate fluid intake. I see no reason to stop im...

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RE: Cause of Disproportionally High Urea 3 hours ago

The low creat may be the dominant driver of the high BUN/creat but there is a contribution from high urea generation as evident from the high FEure...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 4 hours ago

The biopsy was done 3 months after therapy initiated . How can you make a diagnosis of "lupus podocytopathy" under these circumstances?. Why stop B...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 7 hours ago

In my opinion, the patient was likely suffering from lupus podocytopathy due to the presence of nephrotic syndrome, which resolved with the use of ...

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RE: Cause of Disproportionally High Urea 13 hours ago

I can't see any rationale for reducing protein intake below 0.8gms/kg/d, but I might favor plant over meat or dairy protein. Just an opinion. --...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 14 hours ago

Interesting suggestion. I have no personal experience with Leflunomide in LN. Would it be as effective as MMF in preventing a relapse of LN and wou...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 14 hours ago

Dr Glassock What do you think about using leflunomide instead of MMF for a short period? With steroid And hold benlysta @Richard Glassock -----...

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RE: Cause of Disproportionally High Urea 14 hours ago

I had a similar case. I agree with all above expert explanations. I need help/explanation with use of STATINS in muscular dystrophy cases. Ca...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 15 hours ago

Thanks- He likely has very active immunological disease so discontinuing IS at this point virtually guarantees a clinical relapse . Any opinion on ...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 17 hours ago

Most recent dsDNA Ab was on 11/26. It was >300. Yes, he is on acyclovir.

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RE: ATI, Anuria post kidney transplant 19 hours ago

Remind me if you gave a dose of retuximab and your previous post said you stopped plasma exchange after six doses if that's not correct how many to...

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RE: Measurement of Electrolytes 21 hours ago

Hct is not a measured value in most labs, rather a calculated value, hence not as accurate as the Hgb, which is measured ------------------------...

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RE: Measurement of Electrolytes 21 hours ago

Most laboratories measure total CO2 concentration as part of the standard electrolyte profile. It is technically difficult to measure bicarbonate i...

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RE: Anca vasculitis relapse without circulating antibodies 21 hours ago

Maybe this has been severe crescentic IgA N (or IgAV) all along (with a FP C-ANCA) . Do you have EM on the original Biopsy. Can you post a de-ident...

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RE: Cause of Disproportionally High Urea 21 hours ago

I think that Dr. Rodby''s analysis is "spot on ". The problem is not a "too high" serum urea - it is a "too low" serum creatinine, undoubtedly trac...

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RE: Anca vasculitis relapse without circulating antibodies 21 hours ago

His first US stated his kidneys were normal at the time. But his last US findings were: Right and left kidneys: Parenchyma with normal thickness a...

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RE: Cause of Disproportionally High Urea 21 hours ago

Thanks Dr Rodby. Would you reduce the protein intake since he seems to be in Nitrogen balance. ------------------------------ Awais Nauman HMC...

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RE: Hematuria in 14 years old 21 hours ago

If it is y yo be several weeks before the biopsy results can be obtained , i would seriously consider starting oral steroids --------------------...

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RE: Lupus nephritis with Ramsay Hunt Syndrome 21 hours ago

Is the patient on Acyclovir? The LN is still active (low C3/C4, anti-dsDNA unknown-so stopping IS would be accompanied by a high risk of a serious ...

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RE: Hematuria in 14 years old 22 hours ago

None of the "newer " agents have been tested in IgAV. Rituximab appears to be quite effective (but not RCT) unlike IgAN . From a treatment and prog...

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Lupus nephritis with Ramsay Hunt Syndrome 22 hours ago

Dear all, This is about a 41 yo male diagnosed with extensive lupus presenting with severe pancytopenia, antibDS DNA >300, C3 23, C4 2, Platelet ...

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RE: Cause of Disproportionally High Urea 23 hours ago

His BUN (urea) is not high his creatinine is low from severe sarcopenia, as evidenced by the eGFR OF 11, and cystatin C (the ratio is high from ...

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RE: Anca vasculitis relapse without circulating antibodies 1 day ago

Serial kidney ultrasound findings: size/echogenicity/cortical thickness? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ---...

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Cause of Disproportionally High Urea 1 day ago

70 year old gentleman who is bedbound due to muscular dystrophy, estimated weight 70Kg. In course of multiple hospitalizations had few episodes of ...

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RE: Hematuria in 14 years old 1 day ago

Early morning UPCR 1830 Albumin/ creatinine ration 1240 NO casts in urine and yes actually first attack of macroscopic Hematuria was more t...

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RE: ATI, Anuria post kidney transplant 1 day ago

As previously stated, as many as 20-24 PLEX treatments may be required before declaring failure in patients with recurrent FSGS. In responders, tap...

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RE: Hematuria in 14 years old 1 day ago

Agree with biopsy for the indication of nephrotic-range proteinuria > 40 mg/m2/hr (assuming BSA of ~1.5 m2). Adolescent IgA Vasculitis is different...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

Agree with Dr. Balan. We look into HLA matching in first kidney transplant from a living donor only if more than one living donor is available. If ...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

Agree with Dr Balan, a dialysis patient will be much better served with a transplant from a DR mismatched donor than staying on dialysis. Graft hal...

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RE: Anca vasculitis relapse without circulating antibodies 1 day ago

The original biopsy was pretty bad This may all be just scarring would you consider rebiopsy? ------------------------------ Roger Rodb...

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RE: Hematuria in 14 years old 1 day ago

I would biopsy, the question will be, would you treat this (I am assuming it will be IgAN) at age 14, with one of the newer agents, and if so whi...

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RE: DR MISMATCH in Kidney Allocation 1 day ago

Is the question with regard to the launch of a deceased donor program? If this were a live donor program I don't really see the point of looking fo...

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Anca vasculitis relapse without circulating antibodies 1 day ago

Dear all, I would like to discuss the following case: 46-year-old male with a history of hypertension (since 2002), pre-diabetes, dyslipidemia, a...

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DR MISMATCH in Kidney Allocation 1 day ago

Hi everyone I need your insight as regard the importance of DR mismatch in kidney allocation system, do we still be concerned about the presence of...

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RE: ATI, Anuria post kidney transplant 1 day ago

Our patient is currently on plasma exchange with significant reduction in Proteinuria Last UACR 1300 mg Will measure UPCR and UACR simultaneousl...

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RE: Hematuria in 14 years old 1 day ago

I would do a kidney biopsy. The likely diagnosis is IgA Vasculitis . ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (9...

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Hematuria in 14 years old 1 day ago

14 years old male patient ( with normal birth weight) free medical history presented with history of episode macroscopic Hematuria 2 months ag...

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RE: Measurement of Electrolytes 1 day ago

Thanks ------------------------------ Brian Cronin MD, FASN Hypertension Nephrology Associates, P.C. Huntingdon Valley PA (215) 947-4533 --------...

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RE: Measurement of Electrolytes 1 day ago

Hi, In my experience the difference (particularly in sodium) often is clinically important, this past week I observed a sodium of 123 on the bloo...

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RE: Measurement of Electrolytes 2 days ago

If I ran the same specimen three times with the same machine I suspect we would see 3 different values. Are these differences we see between diff...

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RE: Measurement of Electrolytes 2 days ago

Perhaps this bias is simply the result of the 2 analytic platforms being poorly calibrated to each other. Assuming good calibration, a common cause...

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RE: Measurement of Electrolytes 2 days ago

I think we need both methods of measurement as BGAs are helpful in critical care setting for rapid decisions and treatment of life-threatening elec...

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RE: Measurement of Electrolytes 2 days ago

This phenomenon is well described - electrolyte values from blood gas specimens can be determined rapidly but caution should be used in interpretin...

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Measurement of Electrolytes 2 days ago

My anecdotal observation at the hospital I work is that the sodium runs lower and potassium higher on blood gas (whole blood) measurements than che...

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RE: Clinical Practice Questions 3 days ago

Dr. Venkat. Many thanks. Very clear answer. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...

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