RE: Immunosuppression in Lupus/APLA 31 minutes ago

Regardless of the cause of ckd , a eGFR of 24 ml/min, does not correlat with IFTA of 20% . There is a discrepency here , but even if it was RAS or ...

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RE: Immunosuppression in Lupus/APLA 7 hours ago

What I am suggesting is that the progressive CKD is due to "Ischemic Nephropathy" from major vascular disease, Not progressive "Lupus nephritis"- I...

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RE: Immunosuppression in Lupus/APLA 8 hours ago

Thank you for your inputs. I shall update once EM is available and will also get a repeat Renal A doppler. ------------------------------ Sanjee...

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RE: Immunosuppression in Lupus/APLA 10 hours ago

Only 20 % global sclerosis and 20% IFTA does indicate "advanced CKD". The APLA syndrome likely accounts for L kidneys RAS and loss of kidney functi...

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RE: Immunosuppression in Lupus/APLA 11 hours ago

Extensive subendothelial deposits on EM might indicate need for immunosuppression. Regarding anticoagulation: No recent thromboembolic events, remo...

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RE: Anti GBM with Fibrillary GN 12 hours ago

Yes. Negative for paraprotein. --------------------------------- Narothama Reddy Aeddula MD, FASN Newburgh IN (774) 641-1444 -----------------...

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RE: Bivalirudin for CRRT 12 hours ago

We have some reluctance to go down the citrate path due to complexity with multiple ICUs, nursing turnover, etc. We also use NxStage machines so wo...

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RE: Immunosuppression in Lupus/APLA 14 hours ago

Thanks Dr. Venkat- anything that the EM might show that would change your mind? Would you anti-coagulate ( because of the vascular changes and the ...

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RE: Bivalirudin for CRRT 14 hours ago

Hi Dr. Burns, Leo here. Why not citrate, given that it is the recommended anticoagulation strategy per KDIGO? In our experience, when citrate a...

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RE: Anti GBM with Fibrillary GN 15 hours ago

Many thanks. Very interesting case report. I wonder if this is not IgG-4 related disease. It is definitely not Fibrillary GN --------------------...

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RE: Anti GBM with Fibrillary GN 16 hours ago

Dr Glassock thanks I just read knowing it is rare Dual Anti-Neutrophil Cytoplasmic Antibody and Anti-Glomerular Basement Membrane Antibody-Posit...

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RE: Immunosuppression in Lupus/APLA 17 hours ago

I agree with Dr. Dastoor that the pathological changes in the right kidney are too chronic/inactive to justify immunosuppression. I think Doppler U...

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RE: Anti GBM with Fibrillary GN 18 hours ago

Dr. Safdar - can you provide a citation that supports this contention. Paraproteinemias are very rare caused of Fibrillary GN or anti-GBM disease, ...

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RE: Potential donor with mutation in NR3C2 Gene 18 hours ago

Dr. Balan - thanks forvyour very erudite discussion of the dilemma posed by genetic testing of unrelated (altruistic)? Living organ donors .Are you...

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RE: Potential donor with mutation in NR3C2 Gene 18 hours ago

No personal experience with this problem. Will putting this donor on a strict salt-restricted diet, say 10 mmol/day and testing her ability to rema...

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RE: AKI/ANCA Vasculitis 18 hours ago

Thanks. Are the Pulmonary Disease consults comfortable with using Cyclophosphamide in this case ? Just curious by. ------------------------------...

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RE: AKI/ANCA Vasculitis 19 hours ago

The plan is to start cytoxan. We are reaching out to get it approved (sent friday, hopefully start monday or tuesday). He is back on avacopan as we...

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RE: Potential donor with mutation in NR3C2 Gene 21 hours ago

With a genetic report like this, I would definitely not take up the donor. The risks are theoretical but we do not want this to play out in practic...

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RE: Anti GBM with Fibrillary GN 22 hours ago

Was pt checked for paraprotein even MGUS can cause antiGBM AND Fib GN --------------------------------- Shahzad Safdar MD Mt. Auburn Nephrology,...

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RE: AKI/ANCA Vasculitis 23 hours ago

Many thanks for case August 25 diagnosis of Anca Vascultis Sept 25- rituximab 1g x2, prednisolone , avacopan and pcp and bone protection . U...

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RE: Immunosuppression in Lupus/APLA 1 day ago

Drs. Venkat and Rodby -what would be your preferred management of this case? ------------------------------ Richard Glassock MD, FASN Emeritus P...

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RE: Anti GBM with Fibrillary GN 1 day ago

Immunological relapses of anti-GBM disease, after a complete immunological remission , is quite uncommon but it occur in about 10% or less of cases...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

Thank You Dr. Lerman and Dr. Rubin for your help with this case. I have already requested Plasma Aldosterone and Renin activity and will post when ...

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RE: AKI/ANCA Vasculitis 1 day ago

I don't see any clear need for repeat Kidney biopsy. Did you use combined CYC (IV or PO) + RTX . Do you known ehat happened to anti MPO titers? Did...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

@Katafan Achkar -a second response from AST Hub Thanks for that info. This is a mutation in the intronic segment of chromosome 6 where NR3C2 r...

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RE: Anti GBM with Fibrillary GN 1 day ago

Hello all, Wanted to provide an update and seek advice on the case I shared in March( Anti GBM and Fibrillary GN) The patient completed 24 sessio...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

@Simone Sanna-Cherchi Hi Simone. Please comment on the genetic results belonging to a potential living donor included below. As a geneticist, wou...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

My humble professional point of view, is that Dr. Tedla's opinion is logistically sound but, it lacks scientific data that backs up his elegant ass...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

@Katafan Achkar from 1 response so far on AST Hub If she has no evidence of subtle salt wasting (i.e. she has normal renin and aldosterone lev...

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RE: AKI/ANCA Vasculitis 1 day ago

he is breathing comfortably on room air. He's not on any specific treatments for his lungs. he does follow with a pulmonologist but it appears to b...

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RE: AKI/ANCA Vasculitis 1 day ago

His UA from yesterday had 1+ glucose, 3+ protein and 3+ blood. visually it was yellow. No gross hematuria. microscopical eval showed numerous no...

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RE: Bivalirudin for CRRT 1 day ago

Thank you!! Jeff Berns

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RE: Bivalirudin for CRRT 1 day ago

Dr. Berns, I attached an article from Yadava et al. from earlier this year that is the first study I have seen that directly compares reg...

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RE: Membranous Nephropathy 1 day ago

With ANA+ 1:40, other than holding hydralazine, would you recommend checking anti histone ab or ds dan ab+ in this case? By the time 6 months are...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

Thank you Dr. Lerman, please feel free to post this important question on AST hub. ------------------------------ Katafan Achkar MD, FASN Houston...

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RE: Potential donor with mutation in NR3C2 Gene 1 day ago

"this raises an important question: is it preferable to use broad panel testing-with the potential to uncover unexpected and difficult-to-interpret...

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RE: Immunosuppression in Lupus/APLA 1 day ago

"a doppler in 2024 showed increased peak systolic velocity proximal and mid right renal artery with small kidney" I assume there is a typo here a...

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RE: Generic FSGS 2 days ago

Hello Just as a follow up , all 10 siblings in this family tested positive for Homozygous LAMA5 genetic mutation. Have suggested Atrasentan or Sp...

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RE: Immunosuppression in Lupus/APLA 2 days ago

The left kidney is atrophic . The right kindey showing a lot of fibrosis and not much activity eGfR down to 24 ml/min Not sure how much of kidney ...

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RE: IgA Nephropathy 2 days ago

I agree that steroids and Rituximab would be a good option. Not sure of the role of Iptacopan in IgA vasculitis , would consider if patient fails R...

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RE: Immunosuppression in Lupus/APLA 2 days ago

Thank you. The cause of atrophy of left kidney is not clear but sounds vascular- though a doppler in 2024 showed increased peak systolic velocity...

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RE: AKI/ANCA Vasculitis 2 days ago

Does he have hematuria now? CRP/ESR? Current kidney imaging findings? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ------...

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RE: Bivalirudin for CRRT 2 days ago

Hey Dr. Berns-- Though the tiny trial from U. of Colorado is indeed tiny, I would agree with Dr. Rodby. Bival is an approved anticoagulant. While...

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RE: AKI/ANCA Vasculitis 2 days ago

Interesting / unfortunate case. I am not a GN expert but will just comment that "lack of proven efficacy" is true about avacopan, but the sit...

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RE: PD question - Peritoneal dialysis in bile peritonitis with an indwelling PTGBD and exhausted hemodialysis vascular access 2 days ago

Dear Dr. Alejandro: Regarding the external jugular veins, we did consider this route, but unfortunately the chronic thrombosis of the right interna...

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RE: PD question - Peritoneal dialysis in bile peritonitis with an indwelling PTGBD and exhausted hemodialysis vascular access 2 days ago

I once heard it said that if you have a long enough catheter and an imaginative and good enough surgeon, you can always dialyze someone. IVC cathet...

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RE: PD question - Peritoneal dialysis in bile peritonitis with an indwelling PTGBD and exhausted hemodialysis vascular access 2 days ago

it seems to me now that PD is not a good option with the ongoing drainage and tubing, We have had some luck with femoral tunneled catheters. Per...

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RE: PD question - Peritoneal dialysis in bile peritonitis with an indwelling PTGBD and exhausted hemodialysis vascular access 2 days ago

what about the External Jugular veins? are they patent? With regards to femoral catheters they are most durable when a long catheter (50 cm tip to ...

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RE: Bivalirudin for CRRT 2 days ago

Thanks. Someone from Penn might be in touch. Jeffrey S. Berns, MD Professor of Medicine and Pediatrics Hospital of the University of Pennsylvan...

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RE: Bivalirudin for CRRT 2 days ago

We have used both bivalrudin and argatroban, but very infrequent. Personally, I used argatroban more. Both are small enough molecules with high cle...

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