RE: C3 Inhibitor - Pegcetacoplan for C3G and RPGN 2 hours ago

Pegacetocoplan is not approved by the FDA in the USA (yet) . I would use Iptacopan (which is approved for C3G in the USA in this case, zI have no p...

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RE: IgA nephropathy 2 hours ago

Which KDIGO guidelines.? The last ones Published were in 2021. A DRAFT version was circulated in a limited way in 2024, but the final version has n...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 5 hours ago

Thank you for your thoughtful feedback and for sharing your clinical experience—it’s greatly appreciated. You are absolutely right—the case presen...

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RE: IgA nephropathy 6 hours ago

Hello Reviewing this patient , it seems she has normal eGFR and uPCR 1.5 and eGFR 3 ml/min/year or uPCR > 1.5 g/g despite foundational therap...

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C3 Inhibitor - Pegcetacoplan for C3G and RPGN 7 hours ago

52 year old male diagnosed with C3G in May 2024. Initial eGFR was 30 ml/min and 2.5 grams of proteinuria. Biopsy showed around 25-30% TI fibrosis a...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 7 hours ago

I have taken care of many such individua's with DM and poorly controlled metabolic issues. I have no personal experience with STS (being retired fr...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 7 hours ago

Na thiosulfate is probably more like a placebo Best options include High volume HDF , daily x 7-10 days , WITH , 250 ml of 5% albumin during...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 7 hours ago

As I said earlier, this doesn't sound feel look like CUA, but is STS such a bad idea? Dr. Hirsch is the king pragmatist, And while I don't think...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 8 hours ago

I agree that doing a trial of N=1 is plausible but you really need to do off-on-off-on to demonstrate efficacy. I did this years ago studying the e...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 8 hours ago

The pictures surely look like ischemic diabetic disease, still, STS might be reasonable. Mostly, because you can't be 100% sure there is no UCA com...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 9 hours ago

I agree that does not look like calciphylaxis. A picture is worth 10,000 words. ------------------------------ Anatole Besarab MD ABesarab Consu...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 9 hours ago

So the warfarin was short term or was he long-term because of lack of arterio-venous options? ------------------------------ Anatole Besarab MD ...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 9 hours ago

Agree with Dr Hirsch. So young and so much calcified vascular disease. On warfarin for ? what indication which needs to be stopped and switched to ...

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RE: Suspected Calciphylaxis in Young ESRD Patient — Start Treatment Without Biopsy? 10 hours ago

We believe a positive bone scan may support a diagnosis of calciphylaxis, and in our report of the first case of calciphylaxis treated with STS we ...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 11 hours ago

Appears more like like ischemic diabetic arteriopathy, as mentioned above. Amputation appears appropriate. In such a patient I would be reluctant...

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RE: Iptacopan -now or later 12 hours ago

Hello, You are fortunate to have it approved , considering the cost , and in an ideal world where cost would not be an issue , i would consider I...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 13 hours ago

As Dr Glassock said these lesion seem to be ischemic rather than Calciphylaxis which is usually proximal. Aggressive treatment of infection, nutrit...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 15 hours ago

With such a severe process and such a poor predicted outcome i think you would be justified in making such an attempt, but with a high degree of un...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 17 hours ago

This is Ll lesion --------------------------------- Mohamed Mahmoud MBBS NEPHROLOGIST MOH Egypt 00965 51377736 -------------------------------...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 17 hours ago

Thank prof Glassock Iso if we give trial of STS in this patient will be wrong ? --------------------------------- Mohamed Mahmoud MBBS NEPHROLOG...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 19 hours ago

Thanks. This looks more like ischemic diabetic arteriopathy than calciphylaxis to me. ------------------------------ Richard Glassock MD, FASN La...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 19 hours ago

He was on warfarin for thrombosis related to tunneled line and now off I posted prof Glassock hand lesion for opinions -------------------------...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 23 hours ago

Why is he on warfarin ? I do not believe that Warfarin is indicated in severe diabetic arteriopathy in ESRD. Aspirin or anti-platelet agents maybe....

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 1 day ago

He has amputation of one limb and planning for other Has radiological finding diffuse calcification On 31 yrs male type --------------------...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 1 day ago

Why is the patient on Warfarin. Could you post photos of the lesions, without any patient identification. From your description this may well be is...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 1 day ago

"lower limb ischemia requiring amputation" , and on warfarin, is a lot of complicating info UCA, is typically preceded by a very tender indurated...

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RE: Iptacopan -now or later 1 day ago

These studies make a circulating monoclonal Ig that inhibits the action of CfH on C3b.. usually a lambda LC. Less likely . But A mixing experiment ...

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RE: Iptacopan -now or later 1 day ago

Immunoelectrophoresis is ok (apart from the IgE..) IgG 4 classes are WNL Immunofixation is ok FLC ratio 1.26 No clue for monoclonalinity o...

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RE: Iptacopan -now or later 1 day ago

I agree with Dr. Balan- good candidate for Iptacopan, but a MGRS must be excluded. ------------------------------ Richard Glassock MD, FASN Lagun...

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RE: Suspected Calciphylaxis in Young ESRD Patient - Start Treatment Without Biopsy? 1 day ago

IMO, this is a life-threatening but often treatable disease, you simply can not afford to miss it, that overwhelms concern over treating needlessly...

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RE: Iptacopan -now or later 1 day ago

In an older individual with C3GN it is important to rule out monoclonal disorders. We see them in younger and younger patients these days. If a tho...

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RE: Rituximab for Minimal Change GN - For how long ? 1 day ago

In reading this thread, we have lost track of why his serum HCO3 is 17-19 mEq/L and his previous "noncompliance" RTX may for a while solve the ...

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RE: Rituximab for Minimal Change GN - For how long ? 1 day ago

Dr. Buhary, giving RTX on regular basis lead to higher dose exposure so my practice is to follow up for any relapse on regular basis and treat rela...

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Suspected Calciphylaxis in Young ESRD Patient — Start Treatment Without Biopsy? 1 day ago

I have a 31-year-old male with Type 1 DM and ESRD on HD for 2 years who has developed painful, black necrotic skin lesions in both legs. He also ha...

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RE: Rituximab for Minimal Change GN - For how long ? 1 day ago

as per riterm , mt ritux is a good idea. I don't routinely give for more than 18 months unless a high risk situation (frequent relapse, gfr <30, co...

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Iptacopan -now or later 1 day ago

I have a 49 year old man with c3 GN .. doing pretty well on candesaeran , forxiga and cellcept. Wanted to avoid prednisone ACR down to 70...

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RE: Anuric ATN Without Any Obvious Cause 2 days ago

Thanks Did paste Bx result before No other obvious vascular disease or calcification mentions on CT Abdomen CK was not done No muscle symptoms ...

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RE: Anuric ATN Without Any Obvious Cause 2 days ago

Please provide a CPK level. ------------------------------ John Mellas MD Nephrology and Hypertension Specialists St Louis MO 3145372356 --------...

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RE: Anuric ATN Without Any Obvious Cause 2 days ago

Thank you for the interesting case. Could this be ischemic ATN such as cholesterol embolism . recent procedures ? -----------------------------...

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RE: Rituximab for Minimal Change GN - For how long ? 2 days ago

Dr Hyder, Wouldnt the pt end up with higher cumulative Ritux dose with your PRN menu ? Whst was your experience? ------------------------------...

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RE: Rituximab for Minimal Change GN - For how long ? 2 days ago

Genetic testing takes around 4 months tk come back I am told ! ------------------------------ Dr Mohamed Buhary MBBS, FRCP, FASN Consultant Nephr...

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RE: Rituximab for Minimal Change GN - For how long ? 2 days ago

Dr Rodgby, I observe you often advocate for PCP prophylaxis while being on Rituximab for understandable reasons. Ritux effect lasts for around 6 ...

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RE: Renal transplant with pan resistant Kelbsiella colonization 2 days ago

I am yet to see a bug, even resistant to gentamicin with disk diffusion sensitivity assay, survive bladder irrigation with gentamicin 0.5 mg/ml QID...

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RE: IgA nephropathy 2 days ago

@Richard Glassock. Yes, you are correct in your assumption. We do not know where the cells (clones) that makes the IgA are located. Sometime the to...

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RE: Mpo Vasculitis Case 2 days ago

thanks ana was negative awaiting repeat bloods i have attached full biopsy report. awating repeat bloods . i also noticed that albumin was low and ...

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RE: Is this Immune complex GN or something else? 2 days ago

Thank you Dr. Zuckerman for your expertise and quick response. Yes, Dr. Glassock I am already tapering the steroids and have added MMF for him. Rea...

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RE: Is this Immune complex GN or something else? 2 days ago

You may want to consider adding MMF while tapering steroids as there is a lot of inflammatory activity and continuing high dose prednisone is risky...

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RE: Is this Immune complex GN or something else? 2 days ago

My take on these images, assuming they are representative of the rest of the biopsy, is that they show at least one glomerulus involved by an activ...

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RE: C1q Nephropathy - diagnosis? treatment suggestions 2 days ago

Thank you for your input. Tried to test for G1 and G2, but our local lab does not have this analysis (!), but sending a new sample to Bergen wher...

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RE: Renal transplant with pan resistant Kelbsiella colonization 2 days ago

Please see article attached. It there was no rprior UTIs prior to Nephrectomy, agree he wa colonized in hospital. With the epidemic of multi=resist...

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