Any Role For PLEX In Severe ANCA Vasculitis? 2 minutes ago

UpToDate suggests that PLEX does have a role in ANCA vasculitis severe enough to require dialysis , PEXIVAS didn’t see evidence that PLEX will decr...

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RE: covid 19 beyond chloroquine 6 hours ago

Revised number of deaths in NY today is 95, much more believable but still a decrease and hopefully a good sign. They were posting 14 for most of t...

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RE: CVVHD retrofitted as an ECMO 6 hours ago

We should all keep therapeutic maneuvers as simple as possible particularly in this complex clinical setting. I am attaching an excellent review (b...

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RE: CVVHD retrofitted as an ECMO 8 hours ago

Will preface what follows with an admission that I have no experience with ECMO/artificial lung. So if I’m mistaken, correct me. I think there’s a ...

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RE: CVVHD retrofitted as an ECMO 8 hours ago

Personally, I think that trying to adapt CRRT equipment to an ECMO purpose is a losing proposition for all involved . There must be a better answer...

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RE: CVVHD retrofitted as an ECMO 9 hours ago

I think that is using ecmo lines for crrt not the other way. I appreciate think ng outside the box but using 3 crrt machines even if you coukd wouk...

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RE: CVVHD retrofitted as an ECMO 9 hours ago

Here are some interesting tidbits of converting CRRT to ECMO from the #NephTwitter community https://datastudio.google.com/s/kdBrXxCk9Ho ​ ------...

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RE: CVVHD retrofitted as an ECMO 10 hours ago

Sequence and parallel crrt as mini ecmo would not help but perhaps two separate crrt running at same time (ie teo separate hd lines ..one in each f...

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RE: covid 19 beyond chloroquine 13 hours ago

The numbers coming out of New York today indicate something dramatic is happening there, unless the deaths are just not being updated properly. 114...

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RE: covid 19 beyond chloroquine 13 hours ago

Regarding risk in HD patients, there is one non-peer reviewed report from China. 37 cases among 230 HD patients and most were mild and none require...

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RE: AKI in COVID 19 and CRRT 13 hours ago

Tocilizumab is indicated for those with septic shock from SARS-CoV2 infection.  There are references here, as well as to the paper from China where...

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RE: AKI in COVID 19 and CRRT 13 hours ago

Has anyone measured I L6 levels? Going way outside the box would there be any indication to try tocilzumab ------------------------------ Jeffr...

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RE: AKI in COVID 19 and CRRT 14 hours ago

I can understand the consensus about “early start” of CRRT or IHD for volume control in patients with COVID-19, but we should also acknowledge that...

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RE: RAAS and covid19 14 hours ago

There was a good discussion last week on the topic.  You could try the link below but you could also search COVID-19 and ACEi/ARB usage. ​https://c...

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RE: AKI in COVID 19 and CRRT 14 hours ago

After talking with numerous physicians around the country it seems like we can establish that the following may be true. Start the CRRT early t...

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RE: Covid-19 and CKD 16 hours ago

Thanks.   Very helpful. ------------------------------ Richard Sterns MD Professor of Medicine, Emeritus University of Rochester School of Medicine...

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RE: Unexplained AIN 18 hours ago

The reason to determine whether this is from a drug exposure vs autoimmune is the maintenance.  If it is an exposure, no maintenance is necessary b...

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RE: Medically Creating Anuria 18 hours ago

Thanks-just curious why is wife refusing to do intermittent catherization? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] [Past...

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RE: Covid-19 and CKD 19 hours ago

>  There is a shortage of ventilators to care for patients infected with Covid-19 and this may require the terrifying prospect of rationing resourc...

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RE: covid 19 beyond chloroquine 19 hours ago

We have implemented similar practice in our intensive care unit , One attending who does the exam, every other consultant can do it as you describe...

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CVVHD retrofitted as an ECMO 20 hours ago

I was struck by the discussion re use of cvvhd as an ECMO device and its limitations due to blood flow by a magnitude of 10 ( 400 vs 4000 ml/min) I...

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RE: Vascular access 20 hours ago

Under ordinary times, the scheduling of AVFs and AVGs are essential, and removal of CVC s highest priority when no longer in use. However, as pract...

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RE: Covid-19 and CKD 21 hours ago

Maybe this can help; from (https://doi.org/10.1016/j.kint.2020.03.001): There are 7184 patients on hemodialysis (HD) in 61 treatment centers in Wuh...

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Covid-19 and CKD 22 hours ago

There is a shortage of ventilators to care for patients infected with Covid-19 and this may require the terrifying prospect of rationing resources....

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RE: Medically Creating Anuria 23 hours ago

The circumstances under which this 85 yr old was initiated on dialysis was post a complicated CABG and valvular heart disease about 18 months ago. ...

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RE: Medically Creating Anuria 1 day ago

Thank you for sharing this interesting case. 85 year old hemodialysis dependent patient., I wonder how much urine output he is  making ?, whether s...

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RE: COVID -19 and positive MPO 1 day ago

Can I piggy back onto this case?  I have a young lady (50's) with acute renal failure, Cr up to 3 (from baseline of ~ 0.8 over 1 year ago), 3 grams...

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RE: Unexplained AIN 1 day ago

Pjp prophylaxis is supposed to be used at prednisone of 20 mg/d or more, I have not been that cautious but on the doses you are using, I would. As ...

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RE: Unexplained AIN 1 day ago

I was only thinking of MMF for steroid-sparing purposes. If she has IgG4 related disease, which seems possible- then I would use RTX, as she will r...

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RE: Unexplained AIN 1 day ago

Thanks Dr. Rodby. I agree--so far on steroids with a slow taper as noted above. Given no other IS at this time, would you add PJP prophylaxis with ...

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RE: Unexplained AIN 1 day ago

Hi Dr. Leung, No obvious concern for uveitis based on history and routine exam. I did check ACE level, it was 11 (lower limit of reference range). ...

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RE: Unexplained AIN 1 day ago

Thank you so much for the feedback Dr. Glassock. I have asked the pathologist again for specific IgG4 staining. No CT chest or abdomen done--should...

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RE: Vascular access 1 day ago

Thank you for the joint statement on the issue of vascular access surgeries. Hopefully this will help our patients get the procedures they need in ...

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RAAS and covid19 1 day ago

I am interested in learning from the community on two issues:  1) In patients in normal health, would suppressing RAAS by volume expansion decrease...

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RE: Unexplained AIN 1 day ago

Good point. If there are lots of Plasmablasts (CD20+) that are also positive for IgG4, I would taper steroids quickly and give RTX. Sent from my iPad

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RE: Unexplained AIN 1 day ago

While mildly elevated serum IgG4 can be seen in many conditions, markedly elevated serum IgG4 (>5 g/L) is approximately 90% specific for IgG4-RD. T...

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RE: Unexplained AIN 1 day ago

Any eye findings or history?  The uveitis can occur months in advance or even afterward.  Did you check an ACE level?  Renal limited sarcoidosis co...

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RE: Vascular access 1 day ago

At SSMVAC in STl, MO it is an outpatient department of the hospital. We have continued treating patients with malfunctioning AV Access. We have con...

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covid 19 beyond chloroquine 1 day ago

Just wanted to make some comments about covid 19 and also ask some questions which I have not been able to find the answers to. I work in Southern ...

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

i think we are adding the 02 modifier and have an indicator that the note was done as telemed - my billing department is doing this ---------------...

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RE: AKI in COVID 19 and CRRT 1 day ago

Thank you very much, Dr. Rodby and Dr.Gura for explaining significant points I was not aware of. The US machine was invented by Britts during WW2 b...

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RE: Vascular access 1 day ago

The limiting factor appears to be the shortage of PPE. ------------------------------ Michael Allon MD University of Alabama at Birmingham Birmingh...

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RE: Vascular access 1 day ago

At our hospitals we are working very closely with our vascular surgeons who in turn navigate these new restrictions on elective surgeries with the ...

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RE: AKI in COVID 19 and CRRT 1 day ago

I agree with Dr. Rodby. It would be lovely to turn a CRRT machine into an ECMO but the differences seem, for now, insurmountable. The main challeng...

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RE: Hydroxycloroquine 1 day ago

Thanks for the info! This is the way to go. -- Dr. Antonio R. Vilches Fellow del American College of Physicians- FACP Fellow de la American Society...

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RE: Hydroxycloroquine 1 day ago

Here is an ongoing RCT from Minnesota using a slightly different (higher) dose of hydroxychloroquine c/w the study from France. According to the PI...

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RE: AKI in COVID 19 and CRRT 1 day ago

In my country we have more than 1000 reported positive cases for COVID-19. But we have not yet seen kidney failure in ICU patients in my city. Howe...

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RE: HOME DIALYSIS FACE-TO-FACE ENCOUNTERS 1 day ago

ASN supports telephonic waivers and has made the recommendation in multiple phone conversations with CMS and HHS as part of the society's COVID-19 ...

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

So, if one is doing all 4 visits via telemedicine and submitting 90960, it negates the fact that comp was done under telemedicine? Are you submitti...

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RE: In Center and PD dialysis visits via telemedicine 1 day ago

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes LIST OF MEDICARE TELEHEALTH SERVICES  CY 2020 ...

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