RE: Biopsy dilemma in setting of severe refractory ITP 2 hours ago

Cryoglobulins just ordered. RF to be repeated. Details of prior RF no known since initial evaluation at other hospital. Hep C negative previously. ...

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RE: EPS 5 hours ago

Thank you. I was curious because the ISPD does not provide a specific dose or regimen for tamoxifen in EPS. As the authors of the UpToDate card sta...

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RE: EPS 7 hours ago

Dr. Rubin up-to-date mentions a dose of 10 mg three times a day for at least three months which is why I decided on that dose and the duration. s...

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RE: EPS 7 hours ago

@Salil Mangi I am curious, how did you come up with 3 months? The suggested initial dose is 20 mg for 6-12 months with adjustments according to c...

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RE: Reference values for blood anion gap 7 hours ago

While we re-read the classical jewel attached, let's see what the main source says! @Michael Emmett ------------------------------ Mari...

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RE: EPS 7 hours ago

Thank you, Drs Glassock,Rubin,Bargman and Rodby for your input. I am going to put the patient on Tamoxifen for 3 months and hope that it helps. s...

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RE: Reference values for blood anion gap 7 hours ago

I have looked into this nd the best answer I could find was also this: From UPTODate "Historically, the normal range for the AG has been 12±...

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RE: Hypercalcemia in a Critically Ill Patient with MAC Infection 8 hours ago

Did he have any evidence of rhabdomyolysis as a cause of his dialysis-dependent AKI, such as elevated CPK, severe hypocalcemia and severe hyperphos...

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Reference values for blood anion gap 8 hours ago

Hello, I seek guidance on what has changed, if anything, with the reference range for blood anion gap. On recent LabCorp reports, I see the refer...

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Encourage fellows to volunteer as case report reviewers for Kidney Week 2026! 9 hours ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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Volunteer by April 29 to serve as a case report reviewer for Kidney Week 2026! 9 hours ago

ASN invites ASN Fellows-in-Training members to serve as reviewers for case reports submitted by trainees for Kidney Week 2026. The reviewing/gradin...

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RE: EPS 10 hours ago

let's face it, EPS is devastating and tamoxifen is pretty benign so I would absolutely use it... The reports of using sodium thiosulfate (referre...

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RE: hemodialysis 11 hours ago

12.5-25 G mannitol IV given through hd port before start of HD.We used to do it not infrequently back in the day at UVA to prevent disequilibrium s...

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RE: Hypercalcemia in a Critically Ill Patient with MAC Infection 11 hours ago

These findings are more suggestive of immobilization hypercalcemia , but the absence of 1,25 dihydroxy vitamin D suppression is a bit atypical. Do ...

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RE: EPS 11 hours ago

Thanks Dr. Bargman. Very helpful advice. My enthusiasm for steroids and Tamoxifen was misguided, probably because of my paucity of "hands-on ";expe...

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Hypercalcemia in a Critically Ill Patient with MAC Infection 12 hours ago

We would appreciate insights from colleagues regarding the following challenging case of hypercalcemia in an ICU patient. Case Summary: A 76-year-...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 14 hours ago

@Azam Mughni In addition to ECMO and as previously suggested, your patient may have a superinfection (PJP, fungus) and requires, if not already d...

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RE: EPS 14 hours ago

Thank you Dr. Bargman for your customary valuable input. The unpredictable role of Tamoxifen in ESP reminds me of the one of Thyosulfate in calciph...

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RE: EPS 15 hours ago

I agree with Dr. Rubin that it sounds like she is in the fibrosing phase of EPS and there is little indication for corticosteroids (unlike in the i...

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RE: Biopsy dilemma in setting of severe refractory ITP 16 hours ago

Dr Fein For cryo do we know cryocrit Are cryo class 1,2 or 3 What is Rheumatoid Factor and HepC status It seems pt already received Rituximab T...

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RE: EPS 17 hours ago

Dr. Rubin is quite correct in his suggestion for avoiding high dose steroids in the management of the late, predominantly non-inflammatory fibrosin...

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RE: EPS 1 day ago

If not done already, I will have IR place a percutaneous cholecystostomy ASAP. Personally I would avoid steroids at this stage (he is well beyond t...

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RE: EPS 1 day ago

With this history , clinical findings and imaging this is very likely EPS progressing in the absence of PD. This is not an uncommon occurrence. I w...

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EPS 1 day ago

I have a 60 year-old Latin American female with a history of hypertension and ESRD for which she was on peritoneal dialysis for six years. The peri...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

A relatively large observational cohort study of solid organ transplant with severe COVID showed no beneficial effects on outcome using Tocilizumab...

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RE: Another lithium patient 1 day ago

I was not suggesting that you should biopsy him but my intention was to add to the differential diagnosis of the glomerular component of his protei...

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RE: Another lithium patient 1 day ago

Thank you for that. He does not have nephrotic syndrome at this point. UPCR fairly stable on empagloflozin and valsartan. He is very resistant , fo...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

I did see it mentioned as a safer option. I have no experience with the procedure but could ask our IR team. On Wed, Mar 25, 2026 at 8:51 PM Debora...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

I really appreciate your comments and wisdom

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

Thanks prof glassock and prof sprague --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

Dr. Whittier- what are your current views on transjugular kidney biopsy in patients with severe Thrombopenia contraindicating percutaneous or open ...

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RE: hemodialysis 1 day ago

@ prof rodby cool stuff. Thanks --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

If serology is negative and biopsy would potentially change management any thought about transjugular kidney biopsy ? ---------------------------...

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RE: hemodialysis 1 day ago

Thanks for update What is mannitol prime? Can you explain this regime to me? Kind regards --------------------------------- Muhammad Soobadar M...

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RE: hemodialysis 1 day ago

Hi, we had palliative->wants to continue. To be honest I find this academically stimulating. I am hoping we can find a happy dialysis regimen for...

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RE: hemodialysis 1 day ago

Dr Junejo Is your Pt able to consent? Does he/she really want dialysis support? Given overall pathology supportive care may be a good choice. If I ...

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RE: hemodialysis 1 day ago

could also look for carotid disease. while not exactly the same symptoms, https://pmc.ncbi.nlm.nih.gov/articles/PMC12103909/#:~:text=This%20w...

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RE: Severe COVID in Renal Transplant Patient - Tocilizumab? 1 day ago

I'm sorry to hear about this case from Transplant perspective. We have seen an increase number of invasive fungal infections and PJP in patients on...

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RE: hemodialysis 1 day ago

Update: mannitol prime 12.5 g,BFR 200->250.No UF, Na145->140 no heparin.EEG and tele ongoing. Running smoothly so far. -----------------------...

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RE: Lupus Nephritis 1 day ago

From Dr Glassock: "See this "Position Paper" by De Vriese, Fervenza and Sethi (KI 2025;107:198-211. ) It is very convincing, to me at least, t...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

I had to leave for an emergency in Dialysis so not with her chart now. I'm in the habit doing both ACR and UPCR to determine whether MGUS/ myeloma ...

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RE: Biopsy dilemma in setting of severe refractory ITP 1 day ago

What a treatment nightmare for this patient. I have this pet peeve of mine, calling something ITP in the setting of other autoimmune disease (I s...

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RE: Another lithium patient 1 day ago

Lithium is listed in the literature as a cause of MCG and FSGS (see the references listed below from UpToDate). So that is why the ratio of ACR/PCR...

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RE: Another lithium patient 1 day ago

valsartan and Empa always a good idea. ACR 1.4 with PCR 2.0 is 70% albuminuria so this seems more like glomerular proteinuria (Li should be 20-3...

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RE: Another lithium patient 1 day ago

Only reason I raise IGAN as far less likely is that anyone with proteinuria could have and not there are so many treatment options if found. So he ...

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RE: Osteoporosis v Renal Osteodystrophy in Renal Transplant Recipient 1 day ago

As per Professor Glassock, Cinacalcet should not be used to lower PTH when using Denosumab. Denosumab MOA lowers calcium by decreasing bone resorpt...

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Biopsy dilemma in setting of severe refractory ITP 1 day ago

A 73 yo female with remote breast CA, RA, Sjogrens, MGUS (BMB several years ago), MDS and very severe refractory ITP. Splenectomy at Memorial many ...

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RE: Another lithium patient 1 day ago

Not sure why IgAN comes up but Diabetic nephropathy is certainly more common than Li nephropathy, Still this patient DID have a long history of Li ...

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Another lithium patient 1 day ago

I have a 70 yo male with poorly controlled DM, on lithium for >20 years. In the past he has reports been institutionalized and "falling apart' when...

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RE: A Young Patient with IgA Nephropathy, Portal Hypertension, and Refractory Anemia: One Disease or Many? 1 day ago

Dear Dr. Glassock and Dr. Ud Din, Thank you again for your insightful suggestions. Hemoglobin electrophoresis was not repeated during the current...

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