RE: SLE Patient With HLH 15 minutes ago

Anti-phospholipid antibody screen, lupus anticoagulant? ------------------------------ K.K. Venkat MD Troy MI (248) 420 7798 ---------------------...

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RE: SLE Patient With HLH 25 minutes ago

ADMATS. 13. Negative, blood film few schistocyte , neutophilic toxic granulation, thrombocytopenia , lemphopenia. Platelets 10. 10^9. WBC 6 10^9. H...

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RE: SLE Patient With HLH 53 minutes ago

SLE and HLH can uncommonly co-exist and might be associated with a TMA. The paucity of Ig or C3 makes a diagnosis if Lupus Nephritis unlikely. Do y...

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SLE Patient With HLH 4 hours ago

27 y female known to be SLE admitted. by diffuse pulmonary hemorrhage(DFH). Cr 234 ,ur 10, 7 ,Albu 18 She received cyclo,PEx, HD. Also she MV Bi...

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RE: Rapid decline in renal function in a patient with AA amyloidosis 11 hours ago

Sorry about the typos. Meant to say: ............................... prior results for these? SCr changing actively vs stable elevation? ---------...

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RE: salt wasting 12 hours ago

In my opinion CSW does not exist and the Verbalis article is quite well written and convincing. Putting that aside, the varied U [Na] differences ...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 14 hours ago

Well, at least we have a diagnosis- severe Lupus Nephritis, almost certainly DPLN + superimposed Crescentic Disease and auto-Immune hemolytic anemi...

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RE: Renal biopsy in Jehovah witness with low Hb/AKI 14 hours ago

Started HD as volume overloaded, dyspnea, not much UO despite Lasix. No heparin with HD. Anti-DS DNA  Positive 1: 160 Anti- Smith Ab Positive > ...

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RE: Rapid correction of hypernatremia 15 hours ago

Her Na was 164 on chemistries and 145.8 on ABG. No documented IVF given in that 1.5 hour duration. I appreciate the replies. Thank You. ---------...

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RE: salt wasting 15 hours ago

lol appreciate the advice from everyone. I thought it was siadh, but when brought up, I questioned the diagnosis- but it always good to make sure n...

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RE: salt wasting 15 hours ago

Challenging dogma is the only good way to get at the truth. I too am proud to wear the CSW Atheist frock, when it comes to defrocking this perpetua...

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RE: Rapid correction of hypernatremia 15 hours ago

You might be right about an error in Plasma sodium concentrations although such errors are quite uncommon. The use of “formulas” to decide how rapi...

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RE: Rapid correction of hypernatremia 15 hours ago

The conventional wisdom  of avoiding over correction of Hyper Na is less popular these days see attached. at least for adults.  At 23.7 Kg her tota...

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RE: salt wasting 15 hours ago

Lol Earlier today I had typed that CSW was a controversial subject that many do not believe even exists, it is just SIADH, but I didn't want to ope...

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RE: salt wasting 15 hours ago

See Verbalis JG, CJASN 2020; 15: 1666-1668 Sterns, RH, JASN 2008; 19: 194-196 --------------------------------- Richard Glassock MD, FASN Emeri...

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RE: Rapid decline in renal function in a patient with AA amyloidosis 16 hours ago

Current UPr/Cr, UAlb/Cr and urine sediment in contrast to prior results fir these? Current SCr vs prior SCr? SCr changing actively was stable eleva...

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RE: salt wasting 16 hours ago

Does an entity of “cerebral salt wasting” really exist? I doubt it. --------------------------------- Richard Glassock MD, FASN Emeritus Professo...

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Rapid correction of hypernatremia 17 hours ago

33 years old female w/ PMH of w/ hx of Cerebral palsy, G tube presented with dyspnea. Pt is non-verbal. CXR and CT scan demonstrated left Pneumotho...

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RE: Rapid decline in renal function in a patient with AA amyloidosis 18 hours ago

Good idea.  Tociluzumab can be effective in AA Amyloidosis due to RA.  If you can re-start it, I think I would do it.  Any suspicion of COVID 19? ...

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RE: Mangement of obesity related glomerulonephritis and membranous? 18 hours ago

Disregard.  Improperly posted ------------------------------ Richard Glassock MD, FASN Emeritus Professor David Geffen School of Medicine at UCLA ...

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RE: Mangement of obesity related glomerulonephritis and membranous? 18 hours ago

This supports a contention that MN is the major issue here, not ORG. ------------------------------ Richard Glassock MD, FASN Emeritus Professor D...

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RE: Mangement of obesity related glomerulonephritis and membranous? 18 hours ago

Amazed that needle biopsy was successful and I assume uncomplicated with BMI 60. --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,...

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RE: Mangement of obesity related glomerulonephritis and membranous? 18 hours ago

Thanks Dr. Glassock. FPE was 80% ------------------------------ Amy A. Yau, MD Clinical Assistant Professor of Medicine Division of Nephrology, Un...

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RE: Rapid decline in renal function in a patient with AA amyloidosis 18 hours ago

Can you restart the toclizumab?  Though not sure what the duration of treatment would be.  Is there any hope of getting the Crohn's disease under c...

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RE: Mangement of obesity related glomerulonephritis and membranous? 18 hours ago

Many seem to recommend ritux for PLA2r-negative membranous: More info on PLA2r-negative membranous: https://datastudio.google.com/s/o4Alflbs27Q ...

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RE: Rapid decline in renal function in a patient with AA amyloidosis 19 hours ago

This suggests development of Crescentic GN in a patient with severe AA Amyloidosis. What is the urine sediment findings? What is the ANCA and anti-...

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RE: Mangement of obesity related glomerulonephritis and membranous? 19 hours ago

Addendum-It would be of interest to know the degree of FP effacement in the KB. --------------------------------- Richard Glassock MD, FASN Emeri...

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RE: Mangement of obesity related glomerulonephritis and membranous? 19 hours ago

My guess is that the main disease operative in this patient is Primary MN (non-PLA2R type). Obesity likely underlies the glomerular enlargement and...

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Mangement of obesity related glomerulonephritis and membranous? 20 hours ago

​​Hello all, My friend has a 45 year old female with morbid obesity (BMI 60), HTN, asthma referred for elevated Cr from 0.7 mg/dL (April 2021) to ...

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Rapid decline in renal function in a patient with AA amyloidosis 22 hours ago

Hello everyone  I want to present the case of 73 y old female with previous history of Crohn disease diagnosed to have nephrotic syndrome 2 y ago a...

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RE: salt wasting 1 day ago

Hi  thank you for great explanation..  agree siadh have variable sodium depending on salt load - i did look that up. but wanted to confirm..med att...

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RE: salt wasting 1 day ago

Nice discussion Sheldon. If SIADH is bad enough, when you volume load the UNa can be greater than PNa and your PNa drops bc you are desalination y...

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RE: salt wasting 1 day ago

> That is characteristic of the steady state of SIADH: Na homeostasis with U Na potentially ranging from very low to very high depending on Na int...

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salt wasting 1 day ago

have pt with labs consistent with siadh , low uric acid high urine osm, una plus uk also more then serum sodium—- sodium stabilized after 2 percent...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

Let us know what the muscle biopsy shows. If is is myonecrosis without inflammation, I think you will have to work the patient up for an inherited ...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 1 day ago

I don't think that you can rule out Apol1 on this basis. Apol1 high risk genotypes are associated with a wide phenotypic spectrum, from so-called H...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 1 day ago

APOL1-associated FSGS will behave more like primary FSGS. With sub-nephrotic proteinuria, stage-3 CKD and SAlb of 3.6 to          4.1 g/dl, this pa...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

Regarding low SAlb: If there is an hyperimmune response to the vaccine, low SAlb could be the result of systemic inflammatory state - negative acut...

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RE: Membranous Nephropathy 1 day ago

What do you mean by HBV Immune. Many patients with + HB core antibody positive can harbor potential replicative HB virus in the liver.. please watc...

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RE: Membranous Nephropathy 1 day ago

Thank you every one ! Will treat and  post the follow up  results here ! ------------------------------ Devaraj Munikrishnappa MD Houston Kidney S...

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RE: Membranous Nephropathy 1 day ago

same  here ! ------------------------------ Devaraj Munikrishnappa MD Houston Kidney Specialists Center Houston, TX 713 598 3040 ---------------...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

Sorry for late reply, busy inpatient service.  I will send another post with lab values requested.   Unsure why albumin low other than pt nit eatin...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

I agree not to rush into PLEX.  Interesting and plausible theory of immune antibody mediated myositis.  Do all the above mentioned testing. It is...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

" I would approach this as follows: 1. the patient has excellent U/O  2. his renal function is still normal   3. he is otherwise healthy. Why not c...

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RE: Micronutrients Use In AKI 1 day ago

Thank you sir --------------------------------- Ahmed Emara MD, PhD Cairo, Egypt +201006721401 ---------------------------------

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RE: Pheresis for vaccine associated rhabdo 1 day ago

A skeptic might say that this is a treatment rarely done in this situation and not really known to work (case reports only), for a disease  (Covid ...

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RE: Pheresis for vaccine associated rhabdo 1 day ago

Although PLEX is an interesting idea here, I would approach this as follows: 1. the patient has excellent U/O  2. his renal function is still norma...

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RE: Renal biopsy for strong family history , subnephrotic albuminuria, bland Urine , normal albumin, stable creatinine 1 day ago

If the son has FSGS diagnosed by biopsy and the mother is also of recent African Ancestry, I would put your patient's chance of having APOL1-associ...

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RE: Dual Pathology or Pauci-immune lupus nephritis? 2 days ago

Good pursuit of testing anomalies showing the unreliability of  ANCA screening by IIF.  However,  this finding does not change things much-  it is ...

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RE: Dual Pathology or Pauci-immune lupus nephritis? 2 days ago

We repeated the test before treatment. the repeated test was sent to central lab - an institute of medical research unit in Malaysia. the initia...

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