RE: PLA2R positive membranous nephropathy 1 hour ago

I agree with Dr. Rodby and would pick a regimen that does not involve steroids. High dose RTX (to compensate for urine losses of RTX) and kis dose ...

View Discussion

RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 hour ago

Obinutuzumab and MMF might be a nice option given the patient is declining steroids - sort of an updated Rituxilup steroid free regimen. --------...

View Discussion

RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 1 hour ago

I have seen this in DKD and retell in IgA. These patients do poorly on RASi and I agree that CNI are relatively contraindicated. With pure Type V L...

View Discussion

RE: Elevated BUN evaluation 1 hour ago

I agree- a"quintuple whammy"-very rarely observed in the wild. It belongs in the museum of rare disorders. Kind of an extreme version of Hickams di...

View Discussion

RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 2 hours ago

Many thanks Dr Rodby, she was just admitted with AKi (creat up to 2mg/dL, now improving) with active sediments, ascites and anasarca, prompting the...

View Discussion

RE: Elevated BUN evaluation 3 hours ago

Agree with Dr Glassock, too much protein -> urea and very little muscle mass -> low creatinine. the only thing that bothers me (uinsg this numbe...

View Discussion

RE: PLA2R positive membranous nephropathy 3 hours ago

Thank you so much Dr. Rodby. ------------------------------ Pongstorn Pitiranggon MD Pee Dee Nephrology Florence SC (843) 669-6694 --------------...

View Discussion

RE: PLA2R positive membranous nephropathy 3 hours ago

Personally I dont think you need malignancy wu in this patient but mammogram and pap are fine. I would be fine with your plan, the CNI for a ...

View Discussion

RE: Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 3 hours ago

I dont know if there are data on this but I would not use it exactly for your reasons. What does she have now that makes you consider using Voclo...

View Discussion

Use of Calcineurin Inhibitors in the Setting of Severe Arteriolar Hyalinosis 3 hours ago

Dear all, I have a 36y AA lady dx with biopsy proven LN class 3 and 5 (Ext-2 +ve). creat has been 0.8-1mg/dL. seems like she was treated a few y...

View Discussion

PLA2R positive membranous nephropathy 4 hours ago

46 year-old white female with type2 DM and obesity (BMI 31) who presented with progressive lower extremity swelling and weight gain and was found t...

View Discussion

RE: Elevated BUN evaluation 4 hours ago

Most likely a sarcopenic patient (with low creatinine generation), impaired kidney function (50% of normal for her age) on a high protein intake (>...

View Discussion

Elevated BUN evaluation 6 hours ago

I have a 61yo weight 60kg with some edema who was in an accident a month ago and eventually required tracheostomy and PEG. I was contacted for BUN ...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 8 hours ago

Really appreciate your quantitative-qualitative reasoning. I have usually used the Fx E of K in trying to solve K issues in a given patient. ----...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 9 hours ago

Based on Halperin's editorial and commentary on U urea and its affect on U K excretion I ran some simulations using many of his assumptions. It sho...

View Discussion

RE: Diffuse proliferative GN 10 hours ago

I apologize for the delay. He was admitted to another hospital (for volume overload) during which I had asked them to get the TEE while he was inpa...

View Discussion

RE: Diffuse proliferative GN 10 hours ago

He is seeing cardiology today and his daughter (a physician) is going to ask about the TEE and explain my concern about endocarditis and the new fi...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 13 hours ago

Thank you Venkat. During my 18 years ta HFHS, I remember few cases presented of transplant kidneys during the conferences for our Fellows. So I wil...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 14 hours ago

"Relatively widespread tubular vacuolar degeneration was noted." Isometric tubular vacuolization can be caused by CNI nephrotoxicity. ---------...

View Discussion

RE: Calciphylaxis 14 hours ago

I've wondered about the extremely (far too) simple standard story of STS finding Ca deposits in walls and tissues, leeching them out, and being dia...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 14 hours ago

Dr Glassock. Bx showed Relatively widespread tubular vacuolar degeneration was noted. Could this reflect inadequate O2 delivery to tubules bi...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 15 hours ago

Yes, a plot of Serum CR vs time with episodes of hospitalization would be very helpful . We might see a tendency for an upward drift in baseline cr...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 15 hours ago

@Shoko Nawa I am curious. Is quadruple therapy (MMF, Pred, TAC, Sirolimus) your usual immunosuppresive regimen following what appears to be a un...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 15 hours ago

I am confused. He is admitted multiple times. Treated as though he is "dehydrated" [ I assuming this is deemed as volume depletion, and he receives...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

Would agree a repeat contrast study post angioplasty is appropriate to exclude restenosis with stenting of lesion if found to be henodynamically si...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

Thank you for summarizing the discussion. During fluid resuscitation, there were no significant fluctuations in blood pressure, which remained co...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

@Emilio Venturelli There were no signs of that. ------------------------------ Shoko Nawa MD Senior resident Hyogo prefectural Nishinomiya Ho...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

Thank you. At the renal biopsy performed five weeks post-transplant, interstitial inflammatory cell infiltration was predominantly perivascular a...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

Thank you. When an improvement in renal function was achieved, it returned to baseline. ------------------------------ Shoko Nawa MD Senior resid...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 16 hours ago

Thank you for the additional information. The immunosuppressive regimen was initiated with tacrolimus, MMF (mycophenolate mofetil), and prednisol...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 17 hours ago

Thank you for the additional information. The immunosuppressive regimen was initiated with tacrolimus, MMF (mycophenolate mofetil), and prednisol...

View Discussion

RE: Calciphylaxis 1 day ago

I think this a key point about calciphylaxis, we need to more deeply understand the pathophysiology in order to treat it successfully. Nice write ...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Patient with Hypoplastic kidneys due to congenital coarctation of the aorta, underwent a living-donor renal transplant from his mother at age 32. O...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Agree , are we blaming the allograft dysfunction on the main stenotic RA ? How is the flow in the rest of the kidney? Can you share the biopsy repo...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Any signs of atheroembolic disease as an explanation for the second acute graft dysfunction episode? ------------------------------ Emilio Ventu...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

This is the publication from our group referred to by Dr. Rubin: https://www.ajkd.org/article/S0272-6386(88)80107-0/fulltext This is the only cas...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 1 day ago

I had previously used the analogy of discover as being a process of peeling an inion, one later at a time. The assumption is that our conclusions p...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

@Shoko Nawa- did renal function, returned to baseline after the last and most recent episode of AKI with fluids? ------------------------------ [...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 1 day ago

Thank you Dr Balan for bringing up the Halperin retraction. I was just going to post it myself. I dont see why people don't use Fractional excretio...

View Discussion

RE: Calciphylaxis 1 day ago

How does STS work? No one knows, Both invivo and invitro, it does not remove calcium from tissues. Here is a theory that need to be tested. A numbe...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Personally, I have not found (except in a handful of cases) the doppler studies (parvus et tardus morphology, changes in peak velocity flows, etc.)...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

When SCr increases and returns to baseline without any intervention other than volume repletion, the common cause is prerenal azotemia from volume ...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

I think you could repeat the Doppler study and check for a stenotic pattern which may recur and may need stenting. TAC levels are important as ment...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Could you kindly post the allograft biopsy report and if you have a biopsy from the donor would during nephrectomy would be helpful as well any h...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 1 day ago

@Ahmed Emara - One issue that has not been discussed in the case that you reported was, did you do an ECG on your patients? And were there any Chan...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thanjs-this makes familial hypouricemia a very unlikely cause of bouts of AKI. ------------------------------ Richard Glassock MD, FASN Laguna W...

View Discussion

RE: ADPKD ON JYNARQUE 1 day ago

Interestingly we have good data that SGLT2is are an effective treatment for SIADH https://journals.lww.com/jasn/fulltext/2023/02000/treatment_effe...

View Discussion

RE: Abrupt drop and spontaneous recovery of kidney function in KTR 1 day ago

Thank you for the additional information. The patient's baseline uric acid levels were typically in the 4.0-5.0 mg/dL range. However, when creati...

View Discussion

RE: Hyperkalemia Post Kidney Transplant 2 days ago

The effect of calcineurin inhibitors on DCT potassium regulation has been a hot topic. Calcineurin can dephosphorylate NCC directly and by affectin...

View Discussion

RE: Calciphylaxis 2 days ago

The question of whether to recommend switching the patient to in-center hemodialysis is an interesting one. I’ve noticed there has been a movement...

View Discussion