RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 2 hours ago

Thank you for sharing I agree that the risk of thromboembolism is lower in MCD/FSGS as opposed to other GN such as membranous but still it is not ...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 3 hours ago

Less than 10 yrs ago, I had a physically active 56 yo AA male executive with obesity class I, hyperlipidemia and negligible microalbuminuria (less ...

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RE: Persistent NAG Metabolic Acidosis 3 hours ago

Thanks Dr Solemani for the references I think the discussion was in reference to CKD withy or without other factors, not ESKD clearly "horses...

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RE: Persistent NAG Metabolic Acidosis 4 hours ago

By "laughs," I mean that when I bring up baking soda, the team thinks I'm joking. Then, we do the calculations, and they see that I am not joking. ...

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RE: Persistent NAG Metabolic Acidosis 5 hours ago

The post by Dr. Cohney (above) may be in response to the management of hyperkalemia in ESRD patients, to which, I would like to indicate the follow...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 6 hours ago

Thank you, David. It is plausible that the insulin resistance in uremic patients may actually be due to enhanced circulating levels of cardiotonic ...

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RE: Persistent NAG Metabolic Acidosis 6 hours ago

I dont know about laughs But, when I receive calls late on a friday about hyperkalaemia - its a lot easier to tell patients to take baking soda and...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 7 hours ago

SCZ 10gms 3xdaoly x 48 hrs --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancre...

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RE: ANCA vasculitis after mRNA COVID vaccine - any experiences? 9 hours ago

Thank you for sharing the information ------------------------------ Rocio Eleid MD Yuma AZ ------------------------------

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 9 hours ago

Great point Manoocher. Another possibility is that the patient is insulin resistant; history of DM not included in the case description. I think th...

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RE: Persistent NAG Metabolic Acidosis 13 hours ago

The term "multi-factorial" maybe very pertinent to the cause of non-gap acidosis in this patient. No single abnormality can explain the etiolog...

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RE: Persistent NAG Metabolic Acidosis 14 hours ago

Your math is pretty much on the mark. I get laughs (and queries from pharmacy) whenever I recommend baking soda. The molecular weight of sodium...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 18 hours ago

My exact thoughts No matter how low look at it , warfarin is a huge pain Noacs have changed the decision tree a bit This is MCD Tip lesion Albu...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 18 hours ago

Dr. Rodby: Thanks for your recommendations. Since severe nephrotic syndrome/hypoalbuminemia caused by MN has the strongest association with venous ...

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RE: Recalcitrant FSGS case 20 hours ago

Probably not. CYC is generally not effective in steroid-resistant presumed Primary FSGS. ------------------------------ Richard Glassock MD, FASN ...

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RE: A 60 year old kidney donor with diabetes 22 hours ago

Many thanks. Nice to see that most of the community is in favour of accepting this potential donor as long as we control his diabetes and have goo...

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RE: Simultaneous diagnosis of lung carcinoma and MPO-ANCA positive crecentic GN 23 hours ago

Other issues : ? To what extent prognosis of lung cancer & molecular markers determine treatment and ? consideration of PD1 inhibitors Is Lung...

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RE: Recalcitrant FSGS case 23 hours ago

would no one consider Cyclophosphamide monotherapy ------------------------------ Shlomo Cohney FASN, PhD, FRACP, MRCP, MBBS Associate Professor ...

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RE: SGLT2 inhibitors and Urine sodium Osm 1 day ago

Have seen a handful of cases where there was a temporal relationship and esp when patient on ARB (or presumably ACEi) Case last week with patien...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 1 day ago

I noticed that the K+ shift by insulin was not robust in this patient, despite receiving a good dose of insulin. The sub-therapeutic response of K+...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Check my math: 1 TBS Of NaHCO3 is 380 mmol? A teaspoon has 127 mmol? Tells you how much inert filler is in a NaHCO3 tablet -----------------...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 1 day ago

You generally have excellent pt judgement, what do you think? --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush U...

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RE: Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 1 day ago

Personally with serum albumin 2, tip variant , MCD, I might not anticoagulate. If steroids are a big problem I would use a CNI and rituximab. S...

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RE: 78 yO F With Immune MPGN 1 day ago

diagnostic & therapeutic issues dictated by availability expense likelihood of best possible outcome with any of these manoeuvres Quality of...

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RE: A 60 year old kidney donor with diabetes 1 day ago

Clearly very difficult In principle, I would generally feel reasonably comfortable accepting donation from a patient of this age with well con...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

with respect to providing more bicarbonate Baking Soday cheap easy just need to find something for patient to mix with to make it palatable....

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 1 day ago

I am surprised to see so many advocating indefinite maintenance with rituximab (a) cost (b) renal limited (c) vaccination & PJP issues Im very int...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 1 day ago

He does not want to get dialysis more than twice a week and has to restrict his potassium in the diet that he does not like so requesting something...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 1 day ago

This is his latest result:It has been all negative since July, 2020 when cANCA was 11.8 ANTINEUTROPHIL CYTOPLASMIC ATB PROFILE BLOOD/GOLD SERUM ...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 1 day ago

Patient Did not develop immunity after hepatitis B vaccination and is being revaccinated. We are also monitoring his hepatitis B surface antigen an...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 1 day ago

Patient is feeling a lot of benefit by Rituximab and insists on continuing it. He actually wishes to get it more frequently but we are giving it on...

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Tip-variant FSGS with severe nephrotic syndrome: Anticoagulation? Alternative s to steroid therapy? 1 day ago

I wish to obtain recommendations on the following patient. Questions: Given severe nephrotic syndrome and marked hypoalbuminemia, should anticoa...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

I suspect the ileostomy is a big part of this, metabolic acidosis, volume depletion (Decreased distal Na delivery and thus K excretion). as for t...

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RE: 78 yO F With Immune MPGN 1 day ago

Agree Dr Gharib and this concept of “mini”renal vascular has been taught for decades. But stopping ARB will not imply automatically reversal of the...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Cording to the recommendation of endocrine specialist:, "once 25 hydroxy vitamin D is 20 or higher, need to repeat 24 hour urine calcium, , 24-hour...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

You mean distal RTA by d RTA? ------------------------------ Sadeem Ali MD Bridgeport WV (612) 865-9067 ------------------------------

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Thank you. Yes, you are correct . According to ultrasound on 18 April,: Left renal atrophy. Severe hydronephrosis of the right kidney. On 18...

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RE: Persistent NAG Metabolic Acidosis 1 day ago

Urine pH was 5 last checked on 18 May, 2022 and has always been 5 checked seven times from January, 2018 to May, 2022. Urine volume recorded as inp...

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RE: 78 yO F With Immune MPGN 1 day ago

Here is the first (that I was aware of) report of reversible AKI from RAASI from diffuse small.vessel disease acting like bilateral large vessel di...

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RE: 78 yO F With Immune MPGN 1 day ago

I agree with Dr. Gharub. The functional consequences of severe arteriolar hyalinosis (as an equivalence to bilateral RAS ) is under-appreciated Cli...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

Increasing ANCA levels may not reliably predict relapses, but I woukdnt say there is no value in increases https://pubmed.ncbi.nlm.nih.gov/32601...

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RE: increasing rituximab from maintenance dose for Rise of c ANCA in GPA 2 days ago

As KDIGO mentioned ANCA titre should not be use to guide treatment and does not strongly predict relapse. Why should we change the maintenance prot...

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RE: Hypokalemia 2 days ago

Could this be a case of Licorice ingestion ? sorry if this Has been discussed . ------------------------------ Mowaffaq -------------------------...

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RE: A 60 year old kidney donor with diabetes 2 days ago

This is exactly how this father feels. If that was not to his daughter, I would not have even considered this. Once again, I appreciate your thoug...

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RE: A 60 year old kidney donor with diabetes 2 days ago

Of course I am not biased being the father of two adult daughters! But ethics aside, parents are often willing to make "extreme" sacrifices for the...

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RE: Treatment of hyperkalemia with Insulin Glucose in dialysis 2 days ago

I want to highlight the following points: - More relative tolerance of this type of patients to hyperkalemia - Arrhythmogenic effect of B2 agonist....

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RE: A 60 year old kidney donor with diabetes 2 days ago

Thanks. ------------------------------ Mohammed Tawhari MD McMaster university Ancaster ON (905) 920-3799 ------------------------------

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RE: A 60 year old kidney donor with diabetes 2 days ago

The risk of daughter dying in next ten years is almost 100% The risk of father developing CKD over 10-20 years is far less I would do the transpla...

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RE: 78 yO F With Immune MPGN 2 days ago

Severe arteriolar hyalinosis may be considered as functional equavalent of bilateral renal artery stenosis and ACEI/ARB may worsen GFR. So a holida...

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RE: Persistent NAG Metabolic Acidosis 2 days ago

With CKD, a NAGMA, and high normal serum K he may have a dRTA due to prior obstruction. The normal U NH3 may be misleading since during a metabolic...

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