RE: CNIs for tip lesion FSGS 7 hours ago

Thank you for your input.I guess one rationale for monitoring the trough would be ensure that the level does not remain supra-therapeutic for a pro...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 8 hours ago

By the Mayo Clinic assay for ant-MPO antibodies a value of > 8 is very, very high.  At least 8 times greater than the upper limit of normal and pro...

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RE: CNIs for tip lesion FSGS 10 hours ago

None of these studies really address the question-  what is the added value of routine  trough monitoring in TAC ((or CSA) treated FSGS? ----------...

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RE: CNIs for tip lesion FSGS 10 hours ago

Tumlin combined ACTH with tacrolimus and used a dose of 1.0-3.0 mg bid for a trough of 5-10: https://datastudio.google.com/s/nJgyJnDyi6s (reported ...

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RE: Unexplained TMA On Kidney Biopsy 10 hours ago

Can you please post the (deidentified) renal biopsy report? How extensive was the "acute TMA"? If the microthrombi were scanty, it may not be right...

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RE: anti-PLA2R Ab and crossmatch 11 hours ago

As far as I know a positive anti-PLA2R antibody should not produce a positive T or B cell cross match. The antibody systems are entirely different....

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RE: Membranous Nephropathy progressing despite Rituximab 11 hours ago

Sorry about the typo in your name, Dr. Tejas Desai. Dr. Rodby: Besides the lack of a steady downward trend in proteinuria, the other concern in the...

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RE: CNIs for tip lesion FSGS 12 hours ago

Many experienced Nephrologist aim for an initial TAC trough level of 5-10ng/ml but then reduce the dose  to achieve a trough level of 3-7ng/ml afte...

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RE: CNIs for tip lesion FSGS 12 hours ago

Is this for a patient with steroid-resistant Nephrotic Syndrome? What is the level of Renal function?  Practice varies in respect to monitoring blo...

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RE: protocol of timing of performing a CDC crossmatch? 12 hours ago

Dr. Nauman: I have not personally been knowingly confronted by an adverse outcome due to HLA-antibodies caused by an overt or subclinical infection...

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CNIs for tip lesion FSGS 13 hours ago

Hello everyone I wanted to know that for treating tip lesion FSGS with tacrolimus, do we follow a certain trough level? Thank you Syed Ali, MD CNMG...

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anti-PLA2R Ab and crossmatch 14 hours ago

Dear Expert Colleagues, We have a patient with several B and T cell flow Xmatch positive results with autocrossX negative result. Patient has prima...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 15 hours ago

well it may be moot bc the patient already got rituxan and you have 6 months before you have to decide on more, but yes I would taper steroids and ...

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RE: What's Is The Lowest Hb You Could Accept To Do HD 15 hours ago

WE CAN PROCEED FOR DIALYSIS WITH SOME PRECAUTIONS LIKE O2 SUPPLEMENTATION ,SUITABLE MACHINE ADJUSTMENT TO REDUCE DIALYSIS LOAD AND AVOIDANCE OF HYP...

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RE: Unexplained TMA On Kidney Biopsy 16 hours ago

Plavix TMA is rare but a LOT of people take plavix. most of there references call it "TTP" but I think they are using to as a general term for TMA....

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RE: Acute Kidney Injury And Valacyclovir 16 hours ago

Thanks for all the comments: Here is the latest update: Amylase and lipase Normal He takes the valcyte on as needed basis- Had one episode of afib ...

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RE: Unexplained TMA On Kidney Biopsy 16 hours ago

Thank you, Dr Rodby. Plts normal, no significant anemia and Ldh 150-300 range. Actually Plavix was stopped because of anticipated biopsy. Anyway no...

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RE: Unexplained TMA On Kidney Biopsy 16 hours ago

Could now identified FSGS lesion represent ‘healed’ (focal & late stage) AAV with concurrent TMA lesion also AAV-mediated? ------------------------...

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RE: Bone mineral case 17 hours ago

I was involved in the management of a patient with similar degree of long standing hypophosphatemia . We detected two fgf23 releasing soft tissue t...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 17 hours ago

Great points, Roger, thanks. Would you be comfortable if all clinical markers resolved completely,  say at around the one month point (after two do...

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RE: Membranous Nephropathy progressing despite Rituximab 18 hours ago

Good point,  Proteinuria should drop faster, what does this mean? And you could argue to try a different CD 20 drug , Ofatumumab and obinutuzumab, ...

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RE: Unexplained TMA On Kidney Biopsy 18 hours ago

TMA dd is long (see tables attached)! and of many disparate pathophysiologies can make discerning the cause very hard. 80 y/o seems a bit odd for a...

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RE: Cinacalcet-induced hypocalcemia 18 hours ago

To me , more practical and safe approach is to start cinacalcet with oral calcium simultaneously. To my experience, it works to avoid any symtomati...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 18 hours ago

My thoughts on some good questions and points: "Drug induced vasculitis is associated with anca titers incredibly high often in the thousands. The ...

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Unexplained TMA On Kidney Biopsy 18 hours ago

80 y.o.with HTN, A fib (Eliquis), CAD,neuropathy, CKD- baseline creat 1.5-1.8. Pt was tested positive for MPO Ab, with no significant increase in i...

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RE: Membranous Nephropathy progressing despite Rituximab 18 hours ago

It is clear from the graph posted by Dr. Tenas Desai (Ruggenenti, et al.) that proteinuria remission lags considerably behind serum antibody remiss...

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RE: protocol of timing of performing a CDC crossmatch? 20 hours ago

Dr Venkat and Dr Lerman.  Low level Anti-HLA Abs are not infrequently seen in patients who have had no previous history of sensitization and are de...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 20 hours ago

Thank you for this interesting case can I know whey this patient need IS , stopping of doxycycline is not enough --------------------------------- ...

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RE: protocol of timing of performing a CDC crossmatch? 21 hours ago

Our program- a protocol of timing of performing a CDC crossmatch before living donor kidney transplant- Up to one month, if patient had no sensitiz...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 22 hours ago

Drug induced vasculitis is associated with anca titers incredibly high often in the thousands. The mpo here was only greater than 8 . Complement lo...

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RE: Bone mineral case 22 hours ago

Your comment resonates so well with the reason many of us chose nephrology! Think, understand and think, understand ... the intricate pathophysiolo...

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RE: Acute Kidney Injury And Valacyclovir 22 hours ago

Hx of AFIB not on AC begs the possibility of emboli renal disease. CT without contrast would miss it. What did ECG show? If no improvement would do...

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RE: Acute Kidney Injury And Valacyclovir 22 hours ago

Agree with Dr. Rodby.  The incidence of AKI with oral acyclovir/valacyclovir is extremely rare. One study found AKI requiring hospitalization after...

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RE: Acute Kidney Injury And Valacyclovir 22 hours ago

This agent has been reported to cause aki in association with ace inhibitors or nsaid. In your case study you did not state how long the patient ha...

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RE: What's Is The Lowest Hb You Could Accept To Do HD 22 hours ago

We have initiated dialysis with Hgb in high 3 range based on renal function. - Without fistula/graft in place, first used femoral HD temporary cath...

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RE: Bone mineral case 23 hours ago

“I am humbled by how much time and effort you put in to answer my question” one of the reasons I get so involved in Communities is bc how much I le...

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RE: Acute Kidney Injury And Valacyclovir 23 hours ago

12 hours after drug administration is too soon for AIN Acyclovir (similar) nephrotoxicity is usually crystalline as very insoluble in urine, and ca...

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RE: Acute Kidney Injury And Valacyclovir 23 hours ago

If no better over the weekend consider biopsy. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 31...

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RE: What's Is The Lowest Hb You Could Accept To Do HD 23 hours ago

I have dialysed patients with Hb around 5 without problems, without transfusion in that session. However, this is a different issue as one cannot t...

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RE: What's Is The Lowest Hb You Could Accept To Do HD 23 hours ago

I would proceed with dialysis and be liberal with the use of iv Fe and esa. ------------------------------ John Mellas MD Nephrology and Hypertensi...

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RE: Bone mineral case 23 hours ago

I think Dr Rodby has put together all the best possibilities. The elevated PTH is consistent with a diagnosis of x- linked hypophosphatemic rickets...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 23 hours ago

Agree with your assessment approach and other above advice, sure fits the doxycycline drug induced lupus /Vasculitis from doxycycline. Minocycline ...

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RE: Acute Kidney Injury And Valacyclovir 23 hours ago

Sounds like AIN. --------------------------------- Tejas Desai, MD Founder, NOD Analytics Charlotte, NC, USA Web: https://goo.gl/mfziXG Contact: tw...

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RE: Acute Kidney Injury And Valacyclovir 1 day ago

Amylase?  Lipase? Albuminuria vs Proteinuria? Maybe needs a kidney biopsy? ------------------------------ Richard Glassock MD, FASN Emeritus Profes...

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RE: Acute Kidney Injury And Valacyclovir 1 day ago

Valacyclovir could cause AIN also could cause Acute crystal Nephropathy. I would DC the Valacyclovir and treat with aggressive Hydration if no conc...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

Rheumatoid factor was negative. No blood culture. Not sure about cats but will ask. Interesting. ------------------------------ Jay Seltzer MD St. ...

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Acute Kidney Injury And Valacyclovir 1 day ago

I Would like to share this case that I was asked to see tonight: 67 year old, retired physician who was traveling via car, stopped for an overnight...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

Very interesting case, I think doxycycline is the culprit here. Since it could cause AAV, Lupus. And have strong anti histone Ab. Stoping Doxycycli...

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RE: Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

Although uncommon, this seems to be most likely a case of doxycycline- induced anti-MPO vasculitis  with immune complex GN .  I suppose an infectio...

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Drug induced vasculitis vs Lupus Nephritis vs Overlap Syndrome 1 day ago

70 y/o white female admitted with fatigue and worsening renal fxn, and findings of hematuria and proteinuria. PMH included hypothyroidism and rosac...

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