Management of treatment resistant Primary FSGS- Questions 3 hours ago

What is your current first choice of management regimens for adult patients with a kidney biopsy shoeing a presumed Primary FSGS lesion (genetic st...

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RE: When do you start screening for children of patients with confirmed ADKPKD? 10 hours ago

I fully agree with Dr. Balan, simply ordering genetic tests without fully understanding the consequences of the results, positive or negative, is a...

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RE: When do you start screening for children of patients with confirmed ADKPKD? 14 hours ago

all excellent points. I agree. certainly not something a child can handle anyway. ------------------------------ Roger Rodby MD, FASN Professor of...

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RE: When do you start screening for children of patients with confirmed ADKPKD? 17 hours ago

The real question is what do we gain by establishing a diagnosis. At this age I assume the kidney size and volume would be near normal and therefor...

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RE: celia dises with metabolic acidosis 18 hours ago

This appears to be a combined AG and non AG metabolic acidosis. Not unusual with kidney failure, possibly aggravated by diarrhea. ----------------...

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RE: Community app 18 hours ago

Mark, this is odd, the app works for all the other communities except open. When you open the app it defaults to show you all the posts from the c...

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RE: celia dises with metabolic acidosis 18 hours ago

In our case ph 6.7 , HCO3 8,AG 18. We give trial by bicarbonate but not respond and start to tachypnea from acidosis so she received HD I Agree i...

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RE: celia dises with metabolic acidosis 19 hours ago

Review of this reference shows diarrhea and malabsorption as the main issue on this case. The serum HCO3 was 19.8 and the pH 7.314. Electrolytes we...

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RE: PD With Calciflaxis 19 hours ago

Current therapy for calciphylaxis is of the kitchen sink" variety. Throw everything at your disposal at it and hope something works. We really don'...

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Community app 19 hours ago

Still not working ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Medical Director Kidney Pancreas Transplan...

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RE: PD With Calciflaxis 22 hours ago

My anecdotal experience with hyperbaric oxygen as an adjunct to STS has been real good for would healing. Not sure about any studies though that ha...

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RE: Lupus Nephritis - now w change of class 1 day ago

With proven EXTI/II Lupus MN, I would definitely try RTX, without MMF. She should be on Hydroxychloroquine as well. A sort course of moderate dose ...

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RE: celia dises with metabolic acidosis 1 day ago

Patient received dialysis due to persistent acidosis as he got AKI not respond to iv fluids i found some case report about Celia crisis with HAG MA...

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RE: PD With Calciflaxis 1 day ago

Any experience about hyperbaric o2 ------------------------------ Mohamed Mahmoud MBBS NEPHROLOGIST MOH KUWAIT 00965 51377736 --------------------...

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RE: Lupus Nephritis - now w change of class 1 day ago

Bx in 2021 was EXT2 +ve For now, i have her on the same maintenance regimen -- MMF alone along w lisinopril. Going to see her back in few weeks ...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

IgAV and IgAN are at two very different ends of a spectrum of disease with a common pathogenesis and an unknown etiology. I think they need to be t...

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RE: When do you start screening for children of patients with confirmed ADKPKD? 1 day ago

age related ultrasound cyst number ADPKD diagnosis criteria are available " In children, the diagnosis of ADPKD is typically established by a posi...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

"In other words, are crescents bad news in IgA vasculitis regardless of renal function?" I sure think so. 50% crescents I would not wait until th...

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RE: Membranous Lupus Nephritis management 1 day ago

Do you have linear data on creatinine and proteinuria or there is a data gap? Sample is not great (9 gloms on light and none on EM), which makes sa...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

The patient has nephrotic-range proteinuriawhich can lead to an over-estimation of GFR using a creatinine-based formula. I would bet that the GFR i...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

Drs. Glassock and Rodby: Despite crescentic GN, this patient's SCr is "normal". Will you add rituximab now or watch closely for worsening renal fun...

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RE: When do you start screening for children of patients with confirmed ADKPKD? 1 day ago

Children at risk for ADPKD should have their BP monitored regularly beginning a 5 years of age. There are no specific recommendation concerning an ...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

Dr. Rodby is right on target that RTX is not of any proven efficacy in IgAN- but several observational studies have shown dramatic remissions (80 -...

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When do you start screening for children of patients with confirmed ADKPKD? 1 day ago

Is it age 15 or 20? I'm reading different ages. Another question, I have a 25 year old with 2 subcm csyts on R kidney, 1 subcm cyst on L kidney (...

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RE: celia dises with metabolic acidosis 1 day ago

Agree that an elevated AG not consistent with an RTA. Could you explain the rationale for a dialysis session for a metabolic acidosis? ----------...

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RE: Case of rash with Nephrotic range proteinuria 1 day ago

A bit "apples and oranges" but The interesting thing about rituximab on IgAN (this was in routine IgAN not IgA vasculitis) was that "Alt...

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RE: Cobalt toxicity and mineral bone disease 1 day ago

I have seen a number of patients in medical toxicology clinic for metal and metal hip concerns, including one with end-stage kidney disease. It was...

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RE: Our concept of 'secondary membranous' nephropathy in question. 1 day ago

IgG4+, PLA2R ab - and Cancer, suggests a THSD7A subtype of MN. Can you arrange for THSD7A staining of the kidney biopsy and the excused Cancer. Inc...

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RE: celia dises with metabolic acidosis 1 day ago

Looks like HAGMA secondary to kidney failure to me. ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geffen Schoo...

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RE: Our concept of 'secondary membranous' nephropathy in question. 2 days ago

Thanks Justin. My understanding was that IgG4 is generally seen in cases of primary membranous GN and IgG1 in both primary or secondary. There were...

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celia dises with metabolic acidosis 2 days ago

49 y ,no DM,no HTN admirted by chronic diarrhea for about 6 month ur 18,cr 508, bicarbonate , AG 18, Ph 6.8 ,mg 0.43,k 2.4 ,AG 18,po4 1.1. Cca 1.7...

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RE: Cobalt toxicity and mineral bone disease 2 days ago

The toxic effect of Cobalt on bone is generally believed to primarily affect the osteoblast, so a low serum bone alkaline phosphatase should be pre...

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RE: Case of rash with Nephrotic range proteinuria 2 days ago

This is not IgA N, it is IgA Vasculitis and I think the observational data, so far, point to greater efficacy for RTX than CYC, but there are no RC...

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RE: Case of rash with Nephrotic range proteinuria 2 days ago

RItuximab is hardly the standard of care for IgAN. If you cannot get it I would go with oral cyclophosphamide and mid dose (1/2 mg/kg/d) steroids f...

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RE: Case of rash with Nephrotic range proteinuria 2 days ago

THANK YOU ALL FOR YOUR VALUABLE INPUT. I HOPE INSURANCE APPROVES IT. REGARDS Sudeendra ------------------------------ Sudeendra Gupta MD AL AIN --...

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Cobalt toxicity and mineral bone disease 2 days ago

I could use the collective's opinions and guidance on how to approach this case: 74y AAF lupus pt, on PD for the past 4 years. Had a total hip re...

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RE: Case of rash with Nephrotic range proteinuria 2 days ago

A few of the references. ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago IL...

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RE: PD With Calciflaxis 2 days ago

I agree that we don't have good data for any type of imaging, thus, it does rely on clinical diagnosis ------------------------------ Stuart Sprag...

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RE: Lupus Nephritis - now w change of class 2 days ago

I am not yet convinced that “multi-targeted therapy” (MMF + CNI+ steroids) is indicated in pure Class V Lupus Membranous Nephropathy- where is the ...

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RE: Lupus Nephritis - now w change of class 2 days ago

in view of normal complements, normal creatinine and biopsy findings, the predominant lesion seems to be Class V. What about serum albumin level? ...

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RE: PD With Calciflaxis 2 days ago

I have seen seen a few small reports (in biopsy confirmed CUA) suggesting a sensitivity of around 85% and specificity of around 95% of bone scintig...

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RE: Case of rash with Nephrotic range proteinuria 2 days ago

There are anecdotal reports of successful use of rituximab in IgAN presenting with IgA vasculitis especially when the patients have nephrotic syndr...

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RE: PD With Calciflaxis 2 days ago

From UpToDate Although modalities such as radiography and computed tomography (CT) have been shown to detect tissue calcifications in patients wi...

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RE: PD With Calciflaxis 2 days ago

As far as I understand it is not very sensitive. A better imaging technique would be mammography if the area which could detect vascular micro calc...

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RE: PD With Calciflaxis 2 days ago

How sensitive is a bone Scan for the detection of Calciphylaxis?. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Davi...

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RE: Our concept of 'secondary membranous' nephropathy in question. 2 days ago

Can you stain for other IgG subtypes? While IgG4 is classical dominant in primary membranous, it is very frequently positive in secondary as well. ...

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RE: PD With Calciflaxis 3 days ago

Sodium Thiosulphate in PD patients In our practice we administer intraperitoneally .Please see attached ------------------------------ Dwarakana...

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RE: PD With Calciflaxis 3 days ago

Bone scan --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH KUWAIT 00965 51377736 ----------------------------...

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RE: Our concept of 'secondary membranous' nephropathy in question. 3 days ago

Sincere thanks for your thoughts and analysis. We have previously sought PLAR2 staining on biopsies so I think this may be feasible. Other autoanti...

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RE: Case of rash with Nephrotic range proteinuria 3 days ago

Based on fairly convincing observational data (no RCT) , I would give RTX to this patient with a well established diagnosis of IgA Vasculitis. ---...

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