IS pneumonia 1 day ago

Gentleman age 39 status post kidney transplant cadaveric in November, 2016,with walking pneumonia,on mycophenolate and tacrolimus, any suggestions ...

View Discussion

RE: tunneled catheter removal 1 day ago

​I remove about 2 permcaths per week for 21 years. I have taken a brand new catheter (outside of the patient) and pulled on both sides as hard as I...

View Discussion

RE: When is the optimal time for AVF placement? 1 day ago

Remote ischemic conditioning plays little role in prevention of post cardiac surgery Aki based on meta-analysis and a few small RCT. Sent from my i...

View Discussion

RE: When is the optimal time for AVF placement? 1 day ago

Does remote ischemic remodelling has any role? --------------------------------- Bajinder Reen MD Brampton ON (905) 453-0821 ----------------------...

View Discussion

RE: When is the optimal time for AVF placement? 1 day ago

Timing of AVF placement is, and will continue to be, a dilemma, especially in elderly population which currently represent the major proportion of ...

View Discussion

Renal Pathology Video Episodes 1 day ago

I’m Tim Yau, and I’m a clinical nephrologist and medical educator at Washington University in St. Louis.  In 2015, I created the Wash U Nephrology ...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

Based on a meta-analysis of available publushed trials there is no clear evidence of superior efficacy for induction of remission in Class III +V L...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

I am not sure that this protocol is applicable to your patient and longer term FU failed to show any superiority to the comparator. See Ayoub and R...

View Discussion

RE: Rituximab 1 day ago

There is a presumption of equivalence based on verified composition. But to my knowledge, none of the Rituxan biosimilars have undergone rigorous R...

View Discussion

Rituximab 1 day ago

I have been asked if there is any difference in efficacy among the different rituximab and biosimilars available and whether they can be used inter...

View Discussion

RE: diuretics and measurement of urinary sodium 1 day ago

This is an important point, often misunderstood, diuretics bring you to a lower total body sodium and try to keep you there. Otherwise you woukd sh...

View Discussion

RE: IgA Nephropathy with Proteinuria 1 day ago

If steroids are to hVe an effect it may take months to appreciate so I'd complete the course, unless this infection dictates otherwise. -----------...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

Tac may be faster than cyclophosphamide as it works directly on the podicytes. I'm not sure if this translates into improved long term prognosis. I...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

Thank you Dr. Glassock. Yes I am going to discuss anticoagulation with him- wanted to do kidney biopsy first. In regards to tacro+mmf I was referen...

View Discussion

Follow up from Kidney Week 2019 1 day ago

Hi fellow Kidney Educators! I hope you all of have recovered well from Kidney Week! We saw some amazing presentations at Kidney Week from both the ...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

This patient might need prophylactic anti-coagulation, if no contra-indications exist, as the risk of a VTE is fairly high. Sent from my iPad

View Discussion

RE: Lupus membranous GN treatment 1 day ago

Creatinine 0.8 alb < 1  upc 6.7 gram ------------------------------ Sumeyye Calp Inal MD Attending Physician (Nephrology) Salem VA Medical Center S...

View Discussion

RE: Dialysis helping gout ? 1 day ago

I agree, with an eGFR under 30ml/min/1.73m2 Indapamide is not very natriuretic, although this is not well studied, IMO.  More aggressive xanthine o...

View Discussion

RE: Lupus membranous GN treatment 1 day ago

This lesion might be categorized as Class III + Class V LN. I don’t think that good evidence is available to suggest that any one of the 3 apprsoch...

View Discussion

Lupus membranous GN treatment 1 day ago

​Dear community members, I would appreciate input from you all in regards to the treatment of Lupus membranous. I have a 40 yo AA male who presente...

View Discussion

RE: Dialysis helping gout ? 1 day ago

I doubt indapamide would have much diuretic effect at this given eGFR --------------------------------- Amar Mahdi MBChB University Hospital Birmin...

View Discussion

RE: IgA Nephropathy with Proteinuria 1 day ago

UPDATE: ​Started patient on Prednisone. Repeat labs after 2 1/2 weeks of prednisone therapy. BUN 48 Cr 1.92 K 5.1 Na 136 Bicarb 24 UA Protein 2+, b...

View Discussion

RE: diuretics and measurement of urinary sodium 2 days ago

Patients receiving diuretics usually eventually come into sodium balance, albeit with a slight- moderately reduced ECFV, depending on the initial r...

View Discussion

RE: Rituximab Dose In MCD 2 days ago

I am facing the same challenge. Insurance has denied 1st request, going for next step which is appealing then it will be Peer to peer review. Thank...

View Discussion

diuretics and measurement of urinary sodium 2 days ago

​I have a general question about urinary sodium measurement in someone on chronic diuretics. Specifically, this has come up in patients with calciu...

View Discussion

RE: Proteinuria 2 days ago

Dr.Leung,  You had mentioned that you have treated patients with PGNMID with no detectable clone and negative bone marrow with 8 weeks of Rituximab...

View Discussion

RE: Dialysis helping gout ? 2 days ago

Lowering Uric acid could be beneficial.  Rapid lowering with xanthine oxidase inhibitors can ppt gout flare.  If this is "uncontrolled gout" and yo...

View Discussion

RE: Dialysis helping gout ? 2 days ago

IMO, uric acid > 10 plus active gout means not enough allopurinol. The dose should be titrated against the uric acid level, even in CKD. ----------...

View Discussion

RE: tunneled catheter removal 2 days ago

I've been asked to weigh in, but have little to add to the discussion above.  If the catheter does not pull out with steady moderate force, I favor...

View Discussion

RE: Dialysis helping gout ? 2 days ago

Indapamide is a diuretic that is said to produce less hyperuricemia. Sent from my iPad

View Discussion

RE: When is the optimal time for AVF placement? 2 days ago

When the first article to show this was published, there was a discussion on this. One of the discussants felt that this could be just regression t...

View Discussion

RE: When is the optimal time for AVF placement? 2 days ago

I agree with Bob. It is quite possible that the slowing of CKD progression after AVF placement was caused by the patients realizing that dialysis w...

View Discussion

RE: risk of transmission of Thsd7A ab to fetus 2 days ago

thank you, this is encouraging! Will let you know how this goes for this lady. ------------------------------ Mark Nader MD Kidney Care Consultants...

View Discussion

RE: Rituximab Dose In MCD 2 days ago

We have been able to obtain rituximab for most patients in this circumstance (although sometimes requires appeals, peer to peer review, etc). Ther...

View Discussion

RE: Dialysis helping gout ? 2 days ago

Orthopedic did not find the painful joint "tap able " and the pain has also improved but uric acid is more than 10 and he is admitted with cardiore...

View Discussion

RE: tunneled catheter removal 2 days ago

I agree as previously suggested that the main point of adherence is at the cuff , however thick subcutaneous fibrin sheath can wrap tightly against...

View Discussion

RE: tunneled catheter removal 2 days ago

Although the subcutaneous cuff is the intended site of fibrosis/ anchoring site, in this case, it appears that a catheter fragment fibrosed into in...

View Discussion

RE: tunneled catheter removal 2 days ago

Chiming in again -  The only point of adherence of the catheter is the cuff. Beyond that to the tip, yes, the sheath encases the catheter but does ...

View Discussion

RE: tunneled catheter removal 2 days ago

Great discussion everyone, we usually dissect around the cuff if it is close to the exit site, with some traction, it comes out.  If not, we may d...

View Discussion

RE: renal biopsy in CML patient with acute kidney disease 2 days ago

Yes CML. Already off cefepime completed course and discharged home .  Today his urine analysis found negative blood, 30 protein, 2 white cells, few...

View Discussion

RE: tunneled catheter removal 2 days ago

Athough I have not personally come across this problem,   there are reports of "Stuck" or difficult to remove HD catheters in the literature. Ebad,...

View Discussion

RE: risk of transmission of Thsd7A ab to fetus 2 days ago

For your info, we had a case of PLA2R1-associated MN in a French mother and I was just told that she delivered recently, with a healthy baby and mo...

View Discussion

RE: tunneled catheter removal 2 days ago

As l posted the ref last week Was once in that situation, catheter was removed by endoluminal dilation by IR Bajinder Reen Sent from my iPhone Spel...

View Discussion

RE: tunneled catheter removal 2 days ago

The method of endoluminal angioplasty works quite well in this situation. There only needs to be minimal expansion of the catheter for it be freed ...

View Discussion

RE: tunneled catheter removal 2 days ago

To answer the initial three questions:  1) Where is the adherent tissue? - subcutaneous tissue - mostly around the cuff    2) What is it adhering t...

View Discussion

When is the optimal time for AVF placement? 2 days ago

ASN In The Loop on Nov 26, 2019 reported that "AVF Creation May Slow Kidney Function Decline in Predialysis Patients". It stated "The BMC Nephrolog...

View Discussion

RE: Rituximab Dose In MCD 2 days ago

The more rapid B cell return with larger patients is an anecdotal observation, but planning to look at this in our cohort and see if there is a sig...

View Discussion

RE: tunneled catheter removal 3 days ago

I agree with Dr. Martin. I've used this technique too and it is effective. Highly recommend sending patients with resistant tunneled catheters to t...

View Discussion

RE: Sphygmocor central Bp monitor 3 days ago

Thank you Dr. Glassock ! Agree , it would be great to see long term outcome data . What are your thoughts on outcome data with respect to a primari...

View Discussion

RE: Sphygmocor central Bp monitor 3 days ago

Thank you Dr. Glassock . I appreciate your feedback ! Sent from my iPhone

View Discussion