RE: Transplant Case 3 hours ago

Sorry my bad. I thought it was large bowel due to a careless reading of the post. In that case a CT guided lymph node biopsy would be best. ----...

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RE: Transplant Case 4 hours ago

Dr. Balan tissue is needed for PTLD diagnosis but in this case the CT scan shows small bowel involvement.. would you still perform random biopsy in...

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RE: Recurrent ascites in ESRD pt 4 hours ago

Very interesting discussion. I have a patient currently with severe recurrent ascites requiring frequent LVPs where cardiac source has been ruled o...

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RE: Transplant Case 5 hours ago

I think your original suggestion of colonoscopy is great. Everything depends on the tissue diagnosis. If we are able to get a biopsy then the other...

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RE: Transplant Case 6 hours ago

Agree with everything said and we usually involve oncology to help guide PET scan use and treatment. Get Outlook for iOS

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RE: 52 year old male with class V LN 13 hours ago

Thank you all. I will provide a table of recent results which Will make things a bit more clearer ------------------------------ M Kaisar Neph...

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RE: 52 year old male with class V LN 14 hours ago

Mycophenolate sodium 720 mg three times daily (2160 mg/d) is pretty much a maximum dose. I would not push it any further., especially with declinin...

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RE: 52 year old male with class V LN 14 hours ago

Could you please post the deidentified report of the most recent kidney biopsy - this should help with the decisions about treatment modalities . I...

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RE: 52 year old male with class V LN 14 hours ago

With these doses , the patient is receiving Mycophenolate sodium not Mycophenolate mofetil. ------------------------------ Richard Glassock MD, ...

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RE: 52 year old male with class V LN 14 hours ago

I would not consider Rituximab again... Unless biopsy shows high Acuity scores and serology shows high activity . Would probably consider MMF + CN...

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RE: Qb and myocardia stunning 16 hours ago

I too do not know whither there us any good data. No doubt the extracorporeal blood flow in the dialysis circuit is not affected unless the flow ex...

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RE: Recurrent ascites in ESRD pt 17 hours ago

Dr Glassock. The word uremic is too broadly used. Some substance retained in the state of ESRD which has an effect in a particular target system is...

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RE: Recurrent ascites in ESRD pt 17 hours ago

I agree tou Fr Rodby. How do measure adequate dialysis. After more than 49 years of Kt/V I am convinced that the latter does not do justice to "wha...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 18 hours ago

When I had the ARR determines I was off ARB for a week but took the rest of the medical, of course mt BP did go up -----------------------------...

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RE: Recurrent ascites in ESRD pt 20 hours ago

Odd because a "uremic" factor should be acting systemically, yet the serositis is localized exclusively to the peritoneal membrane in cases of "dia...

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RE: 52 year old male with class V LN 21 hours ago

Dr. Kaisar: I am confused about the trends of urine protein, urine albumin and serum albumin levels. If the UPr and UAlb are unchanged but the seru...

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RE: Recurrent ascites in ESRD pt 22 hours ago

Im not sure what you mean by odd, but to me, if I am correct that this is uremia, it just tells us how unhealthy you still are despite being consid...

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RE: 52 year old male with class V LN 23 hours ago

His current dose is 720mg TDS which was his dose pre-reduction to twice a day. On the.TDS dose the urine protein level was 8.3 g though the serum a...

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RE: Recurrent ascites in ESRD pt 23 hours ago

So the terminology is all wrong - it is "Uremic Ascites" in a patient with uremia treated with HD (and cured by Kidney Transplant) - all rather odd...

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RE: Recurrent ascites in ESRD pt 23 hours ago

The only thing I have seen work is transplant I will be curious as HDF gets more common if we see it less ------------------------------ Roge...

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RE: Recurrent ascites in ESRD pt 23 hours ago

Dr. Rodby very intriguing hypothesis Any personal experience of improvement with HD intensification , MCO membranes or PBUT removal? --------...

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RE: Recurrent ascites in ESRD pt 1 day ago

"when you say nephrogenic-what would the mechanism be (assuming that if pts has been on dialysis for some time residual kidney function is nil or q...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 1 day ago

I agree- but measuring ARR while a patient is receiving an ARB is usually not recommended. ------------------------------ Richard Glassock MD, F...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 1 day ago

The low (assuming it's below the lnl) renin concentration with ARB really points towards primary hyperaldosteronism. ---------------------------...

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RE: Transplant Case 1 day ago

Agree with Dr. Glassock biopsy/tissue diagnosis is needed. She is 7 years out from transplant. Early post-transplant lymphomas are more commonly EB...

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RE: Transplant Case 1 day ago

GI involved PTLD seems likely. Is the patient EB+ or -.?Can you get a CT guided biopsy of LN to see if it is CD20+ or not? Reduced IS is always the...

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RE: 52 year old male with class V LN 1 day ago

What is his current MMF , hydroxychloroquine and steroid dosage? What his current eGFR? Serum Sickness should not occur with OBI- the arthritis is ...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 1 day ago

Cannot interpret ARR while receiving an ARB. ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------...

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RE: 52 year old male with class V LN 1 day ago

Thank you Professor Aledan I have just received his latest labs. The UACR is down to 400+ from a peak of 900+. Interim level was around 600 2 wee...

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RE: 52 year old male with class V LN 1 day ago

Thank you Professor Glassock. He had OBI after Rtx and developed serum sickness type reaction. I have just received his latest labs. The UACR is do...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 1 day ago

@Emilio Venturelli What we measure in our lab is direct renin concentrations in ng/l and she was on ARB on board. --------------------------------...

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Transplant Case 1 day ago

Dear Colleagues, I would appreciate input/MDT for this case 38 Female DCD en bloc transplant 2018 Historical anti DP on dual agent( Tac and Aza...

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RE: Recurrent ascites in ESRD pt 1 day ago

I suppose that it is worth remembering that Eleanor Roosevelt. , the former First Lady of the USA , died of unrecognized Miliary Tuberculosis. -...

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RE: Recurrent ascites in ESRD pt 1 day ago

1 case in 500ver 40 years of practice and it was early in my care. The patient had a positive PPD and evidence of "healed" lesions on his chest x-r...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery 1 day ago

I am intrigued by the concept of aldosterone being a vascular toxin. At the age of 40 I WAS noticed to be hypertensive. Thiazides precipitate hypok...

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RE: Recurrent ascites in ESRD pt 1 day ago

Tuberculous peritonitis as a cause of refractory ascites in Hemodialysis patients Must have a very geography specific association. After several de...

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RE: Anticoagulation in Nephrotic Syndrome 1 day ago

Sorry for the mis-citation. The Chapter on Hypercoagulability in Nephrotic Syndrome in the latest version of UpToDate is also an excellent resource...

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RE: Qb and myocardia stunning 1 day ago

Interesting question. A quick search of the literature revealed no good answer, because this issue is understudied. But Blood flow during dialysis ...

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Qb and myocardia stunning 1 day ago

Dear colleagues, The most effective strategies to reduce myocardial stunning are minimizing hourly ultrafiltration and avoiding intradialytic hy...

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RE: Case Of AKI And Nephrotic syndrome 1 day ago

This patient needs a kidney biopsy ASAP. Statistically the most likely lesion is de novo FSGS, possibly due to CNI, but as Dr. Rodby states many ca...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 1 day ago

"Tip lesion" FSGS can closely resemble MCD in many respects, including a tendency for periodic remission and relapse. (Sometimes spontaneously ) ...

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RE: Is kinetic eGFR valid for use in oligoanuric patient? 1 day ago

Or even concomitant diseases, e.g concerning the example above metastatic cancer might alter CysC concentration. These critically ill patients with...

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RE: Lupus Case 1 day ago

I agree with Dr. Rodby. I would use EuroLupus CYC regimen, without Belimumab . I would not use aCNI.. i would start with -2-3 pulses of IV MP. 500m...

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RE: Atrasentan experience and first thoughts 1 day ago

Y do agree that we need have netter indices of the cost-benefit values for many diseases, particularly for "old drugs" which suddenly are discovere...

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RE: Lupus Case 1 day ago

Oh great point, belimumab helped only in the MMF group, suggesting it was a tad irresponsible on my part without mentioning this sub analysis: ...

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RE: Managing 'Pre-Relapse' in FSGS Tip Variant - Restart Cyclosporine or Monitor 2 days ago

Thank you all for the valuable input on this case. I wanted to provide an update on the patient's course: 77-year-old male, biopsy-proven tip-va...

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RE: Lupus Case 2 days ago

Agree with Dr. Rodby. Either MMF based or CYC based regimen is fine in this form of severe LN Given the crescentic disease CYC is sometimes pre...

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RE: Sarcoidosis Case 2 days ago

Infliximab is excellent for refractory sarcoidosis , not sure needed if resounding to steroids but... yes I meant fungal serologies. I think th...

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RE: Case Of AKI And Nephrotic syndrome 2 days ago

"Thoughts on this case?" 1) Needs a biopsy with the history of hepatic disease too many possibilities. Do you have complements? 2) maybe sh...

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RE: Is kinetic eGFR valid for use in oligoanuric patient? 2 days ago

Dr. Filler -all good points concerning creatinine and Cystatin C in AKI. The problem with Cystatin -C is that its production is linked to inflammat...

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