PPIs and Renal Death 26 minutes ago

Proton Pump Inhibitors and Death due to Renal Disease https://www.medscape.com/viewarticle/922906   Learn more from the #NephTwitter commu...

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RE: Reducing risk of recurrent PLA2Rab -positive MN in the kidney transplant 43 minutes ago

I would wait a month or so before treating and only if antiPLA2R levels are not negative From your reference “Treatment with rituximab may be consi...

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RE: Scleroderma Renal Crisis (SRC) 2 hours ago

@K.K. Venkat , I know that prior to ACEi that SRC was uniformly fatal bc of uncontrollable HTN.  But do you think that if BP can be controlled with...

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RE: Reducing risk of recurrent PLA2Rab -positive MN in the kidney transplant 2 hours ago

this is  a VERY interesting question. No surprise but I would take an aggressive approach. Now that we have PLA2R Ab marker for this disease and it...

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RE: CKD G5 with Proteinuria 2 hours ago

Regarding proteinuria from native kidneys causing diagnostic difficulty post-transplant: it usually disappears within ~ 10 weeks post-transplant. P...

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RE: Scleroderma Renal Crisis (SRC) 2 hours ago

Agree with Dr. Rodby that biopsy is unlikely to help in management. one option to consider: add calcium channel blocker + metoprolol and reduce cap...

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RE: Reducing risk of recurrent PLA2Rab -positive MN in the kidney transplant 3 hours ago

Very interesting-since PLA2R is decreasing would repeat again 1month prior to scheduled transplant and proceed if continues to decrease or becomes ...

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RE: IgA Vasculitis 3 hours ago

Brief anecdote; I just saw a patient in followup having presented with lower extremity leukocytoclastic vasculitis, 4 grams U protein, creatinine ....

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RE: mixed metabolic acidosis 3 hours ago

From a humble private practitioner I see this as; A hyperchloremic and anion gap acidosis due to severe renal failure with deficient renal NH4+ sec...

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RE: Slowly functioning graft and pancytopenia 3 hours ago

SCr improved from 345 to 240 before normalization of platelet count. In TMA, usually it takes some time after hematological recovery before SCr sta...

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Reducing risk of recurrent PLA2Rab -positive MN in the kidney transplant 3 hours ago

Fifty two year old male with PLA2Rab-positive primary MN diagnosed approximately 9 years ago. Treatment included cyclosporine, tacrolimus, cyclopho...

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RE: Membranous like Nephropathy with IgG kappa deposits 5 hours ago

IgG subclass staining was not done.. PLA2R staining was not done but I can ask for it.. and the IgG and kappa became positive 3+ after doing paraff...

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RE: IgA Vasculitis 5 hours ago

I am sure, I just got a similar patient with all crescents, 100%!!! We need RCT to unify and give our IgA patients with vasculitis and skin lesions...

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RE: mixed metabolic acidosis 9 hours ago

Thank you for your replys, Her Albumin is 2.7 gm/dl, which will be equivalent to a normal anion gap of 8.1. so the Delta ratio will be 24-13/15-8. ...

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RE: CKD G5 with Proteinuria 11 hours ago

No delay but attention to the following Two points: 1. The allograft can be exposed to reflux and back pressure due to short and near horizontal u...

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RE: Scleroderma Renal Crisis (SRC) 12 hours ago

Dr. Rodby, thank you for your observations. I agree, hoping serum creatinine will reach the nadir while titrating captopril dose per BP readings. A...

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RE: Fabry Ds And Preganancy 15 hours ago

Hi Manisha: Thank you for bringing this important case. I also don't have direct experience in this. But I think the new available genetic screens ...

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RE: Intradialytic Hypertension Due To Volume Overload Or Transplant RAS 15 hours ago

Hypertension most likely volume related or chronic allograft nephropathy with acute rejection due to stopping TAC - doubt RAS which can only be pro...

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RE: Membranous like Nephropathy with IgG kappa deposits 15 hours ago

Good question. Very rarely an IgG3kappa monoclonal Can have anti-PLA2R activity and produce MN. The treatment is still RTX and if no response them ...

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RE: Slowly functioning graft and pancytopenia 16 hours ago

Improving but would still biopsy if creat improve The content in this comment/discussion is not intended to be medical advice for a particular pati...

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RE: Scleroderma Renal Crisis (SRC) 16 hours ago

There is always concern over an overlap syndrome with eg SLE gn, but with the benign urine you describe and the presentation this sounds enough lik...

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RE: Slowly functioning graft and pancytopenia 17 hours ago

HB is 9.7, LDH 165, creatinine 240 ------------------------------ Ahmad Wagih MBBS KASSER AL EINY HOSPITAL BANHA ------------------------------

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Scleroderma Renal Crisis (SRC) 17 hours ago

52 yrs old caucasian lady with history of diffuse scleroderma/polymyositis for 8 yrs, on cellcept, normotensive and well preserved GFR presented to...

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RE: Question on Preemptive Kidney Transplant 18 hours ago

thank you to everyone, as always learning from all of your answers ------------------------------ Mark Vishnepolsky MD, FASN ----------------------...

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RE: Slowly functioning graft and pancytopenia 18 hours ago

What is current creatinine,LDH, and Hgl? --------------------------------- [Mark] [Lerman] [MD,FASN,FACP,FAST] [Medical Director Kidney Pancreas Tr...

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RE: Membranous like Nephropathy with IgG kappa deposits 19 hours ago

Did kappa monoclonality require unmasking by antigen retrieval? Was PLA2R stain negative? Was IgG subclass staining done? -------------------------...

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RE: Monoclonal gammopathy of renal significance 19 hours ago

I dose rituximab based on body habitus.  If the patient has a large BMI, then I use the 375 mg/m2 x 4 per cycle.  @Roger Rodby knows I like to use ...

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RE: A case of treatment-resistant nephrotic syndrome 19 hours ago

Thanks for pointing that out. --------------------------------- Roger Rodby MD, FASN Professor of Medicine Rush University Medical Center Chicago I...

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RE: Monoclonal gammopathy of renal significance 19 hours ago

No need to wait for the first 1 gram dose if the decision has been made to use rituxan. --------------------------------- Roger Rodby MD, FASN Prof...

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RE: Monoclonal gammopathy of renal significance 20 hours ago

I am going to guess 2 doses and 6 months respectively, and wait for Dr Leung's answer before initiating treatment. ------------------------------ J...

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RE: Membranous like Nephropathy with IgG kappa deposits 20 hours ago

I would treat like PGNMID with RTX first and then ask hematologist to treat for a plasma cell disorder . I would also do a Bine marrow and a CT-PE...

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RE: A case of treatment-resistant nephrotic syndrome 21 hours ago

Both Thymoma and NHL are associated with a variety of auto-immune manifestations (including FANA) and the lesion in the kidney with a NS is MCD/FSG...

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RE: Management of Hypercalcemia in Pregnant Transplant Recipient 21 hours ago

@Liz Lightstone any experience with pth-ectomy or sensipar in pregnancy? --------------------------------- Roger Rodby MD, FASN Professor of Medici...

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RE: Monoclonal gammopathy of renal significance 21 hours ago

How many doses of Rituxan do you give and how long do you wait until you decide the treatment is ineffective? --------------------------------- Rog...

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RE: A case of treatment-resistant nephrotic syndrome 21 hours ago

Lupus podocytopathy is not perfect as pointed out by Dr Glassock, but the Serology and IF seems all a bit much for A lymphoma/Castleman related gn....

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RE: Membranous like Nephropathy with IgG kappa deposits 21 hours ago

Have you screen her for active infection? In this case sexually transmitted like chlamydia or syphilis? Any risk factors? -------------------------...

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RE: Question on Preemptive Kidney Transplant 21 hours ago

Thanks to all who commented especially Mark Vishnepolsky MD, FASN for his post and Dr.Glassock for his many comments on this important and interest...

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RE: Question on Preemptive Kidney Transplant 22 hours ago

Again, the proposition that the outcome of Kidney transplantation is better with pre-emptive Kidney transplantation compared to Post -Dialysis Kidn...

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RE: mixed metabolic acidosis 22 hours ago

Why isn’t this uremic acidosis, plain & simple? If her LBW is 60 kg & target bicarb is 22, her bicarb deficit is 513. Forgetting ongoing indirect l...

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RE: Monoclonal gammopathy of renal significance 22 hours ago

if rituximab is ineffective (which will be in 50% of cases), you will eventually need to get the hematologists involved for the anti-plasma cell th...

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RE: Question on Preemptive Kidney Transplant 23 hours ago

Patients who undergo preemptive live donor kidney transplants have better outcomes than those that do not- however these results may not be due to ...

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RE: CKD G5 with Proteinuria 23 hours ago

As transplantation is the first favourable option for RRT, I think no need for delay which could be associated of unwanted sequalae ---------------...

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RE: Fabry Ds And Preganancy 23 hours ago

Thank you Dr Lightstone. appreciate your input. ------------------------------ [Manisha] [Singh] [MD] [FASN] [Assistant Professor] [University of A...

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RE: Question on Preemptive Kidney Transplant 23 hours ago

Thanks Dr. Venkat for this article - I was vaguely familiar with it. Unfortunately it was carried out with data that is now two decades old and it ...

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RE: mixed metabolic acidosis 1 day ago

The “normal” anion gap will be a lot lower in this patient due to hypoalbuminemia so your Delta AG - Delta HCO3 calculations may not be correct. I ...

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RE: Fabry Ds And Preganancy 1 day ago

Dear Manisha im afraid I have no direct experience but would suggest, given your literature review, that you keep a close eye but the mum will prob...

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RE: Twice-weekly HD in patients with preserved RKF 1 day ago

Based on personal experience with a very large ESRD population, residual renal function is certainly important in that issues of volume management,...

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RE: Monoclonal gammopathy of renal significance 1 day ago

Thanks for the reference and the comments. There were no circulating monoclonal paraproteins found, while the bone marrow biopsy was normal with no...

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RE: Methotraxate 1 day ago

Is your rheumatologist recommending "high dose" methotrexate?  If so, that would definitely pose an issue for a patient with CKD.  The crystal-indu...

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RE: Question on Preemptive Kidney Transplant 1 day ago

The following article from the NEJM is relevant to this discussion. Although retrospective and registry-based, it is an important study because it ...

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