RE: Immune complex medicated proliferative GN and focal cellular crescents with HIV 1 hour ago

Sounds like HIVICK, what is the IF stains finding? Do you rule out hidden infections such as SBE? --------------------------------- Hayder Aledan ...

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RE: Immune complex medicated proliferative GN and focal cellular crescents with HIV 1 hour ago

Sounds like HIVICK. Can you post the deidentified pathology report? What are the CD4/CD8 T cell counts, HIV virions , UPCR , Salb?. HAART, RASi are...

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Immune complex medicated proliferative GN and focal cellular crescents with HIV 1 hour ago

43 y/o non complaint with HIV meds in past, admitted with AKI had biopsy which revealed above. Now Creatinine is 2.4 eGFR 33, Proteinuria/ Creatini...

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RE: Pregnant woman with proteinuria 2 hours ago

I agree- add a CNI and taper steroids in an accelerated fashion. Biopsy after parturition. ------------------------------ Richard Glassock MD, F...

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RE: Pregnant woman with proteinuria 2 hours ago

There isn't enough literature on Ritux in Pregnancy for me to be brave and use it on this situation. I would consider adding CNI. In another 6-8 we...

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Pregnant woman with proteinuria 3 hours ago

Good afternoon all, I have a patient who is a 20 year old woman 26 weeks pregnant (G1P0), who presented to the hospital with 3 grams of protei...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 4 hours ago

The Fe stores appear normal.There is zero urgency to give Fe right now, nor even EPO These are chronic treatments, not acute, and the Covid infec...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 4 hours ago

TSAT 21 here indicates a reasonable level of iron stores and no urgency to give iv iron. I would likely leave him alone with a hemoglobin of 8.8 an...

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RE: chronic cardiorenal case 4 hours ago

In our region of chronically under-dialysed patients, we see this quite commonly. Prior to transplant we intensively dialyse them, sometimes even n...

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RE: chronic cardiorenal case 4 hours ago

Did he have right heart catheterization, PCWP, PA and right heart pressures (before and after you dried him out)? As you know, pulmonary hypertensi...

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RE: chronic cardiorenal case 6 hours ago

Any pericardial thickening or calcification by echocardiography? What is the current BNP and iPTH level? What is the reason he is not listed for ki...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 7 hours ago

You can, if you think that the patient is symptomatic from this level of anemia , in my opinion . ------------------------------ Richard Glassoc...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 7 hours ago

Thank you. Can we give blood transfusion at a haemoglobin of 8.8 in this situation ? ------------------------------ Sadeem Ali MD Bridgeport WV (...

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RE: chronic cardiorenal case 8 hours ago

He did have normal endocolonoscopies. ------------------------------ Dr V Lachman Nephrologist South Africa ------------------------------

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chronic cardiorenal case 8 hours ago

46 yr old male with IgA nephropathy, hypertension, dyslipidemia and Polyarticular gout He had presented in stage4/5 and we did try steroids initia...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 10 hours ago

Thank you for all the input. Will get the genetic studies done. A bit early to say CNI resistant as levels have been below target in the first coup...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 14 hours ago

Why not give a blood transfusion? With so much recent inflammation it seems unlikely that the patient would respond to Epo or Iron anyway. Would su...

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RE: IgA nephropathy recurrence post transplant 19 hours ago

@Daniel Guevara-Pineda: Has SCr returned to baseline in your patient? What is the most recent urine protein/creatinine ratio? What are the recent t...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 23 hours ago

I agree - the lack of any response to steroids and CNI increases the likelihood of a FSGS lesion and reduces, but does no eliminate. the possibilit...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 23 hours ago

Thnaks for the great point. RVT was ruled out by CT scan with contrast (although not angiogram but radiologist said renal vein looked pretty clear ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

RVT might lead to persistent proteinuria...and might mask/attenuate some level of therapeutic response? An off chance...but also maybe an additiona...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

What does the master of Kidney Biopsy and its complications say about this case and Transjugular Kidney Biopsy specifically? Dr. Whittier? -----...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

The risk may depend on current serum albumin? Why is it urgent to remove the fibroids? Any suspicion that she may have a genetic cause? May be ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Interesting suggestions Dr. Luyckx. Just curious, what difference in the approach to treatment of this patient woukd be generated if a search for R...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Thank you all. Lady has no major medical background apart from uterine fibroids and history of nsaids for dysmenorrhea. Hence we thought MCD. But 4...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

Another option is attempting a transjugular vein renal biopsy see attached reference to Safety and Efficacy of Transjugular Renal Biopsy Performed...

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RE: IV Iron and ESA during infection including Covid to Hemodialysis patient 1 day ago

https://pubmed.ncbi.nlm.nih.gov/34767026/. Patient is on Apixaban for Atrial fibrillation and history of stroke ------------------------------ Sa...

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IV Iron and ESA during infection including Covid to Hemodialysis patient 1 day ago

76 age white man with ESRD on hemodialysis 3 days a week for more than 8 months, admitted to the hospital for MSSA bacteremia after procedure on va...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

am presuming you have ruled out a malignancy and/or renal vein thrombosis? Any role for genetics? What is the lady's background? --------------...

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RE: Hypokalemia and hyperparathyroidism 1 day ago

I think Dr Glassock is spot on. Nephrocalcinosis seen in MSK can be mixed up with Nephrocalcinosis seen in Barrters. We have a case of genetically ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 1 day ago

@Sivaramakrishnan Ramanarayanan how long since PE and how long on steroids and CNI? UPC now? might consider Temporary IVC filter prior to holding...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

This rise in serum albumin and the dramatic decline in AntiPLA2R antibody cannot be ignored as a "response" to RTX that predicts later clinical rem...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

The answers to many of your questions can be found in Bobart SJ, et al CJASN 2023; 18; 1283-1293. ------------------------------ Richard Glassock...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

The issue here is that is the goal, certainly remission of proteinuria, nephrotic syndrome, hypoalbuminuria. Can we really expect things to resol...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

how much time its expected for the full effect of Rituximab, then to consider it as failure of therapy? is that applicable for all diseases where...

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RE: Hypokalemia and hyperparathyroidism 1 day ago

Thank you for all your replies. She is 29 year old female. Her serum albumin is 40 gm/L, unfortunately, no urine osmolarity was measured and ...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

True, but this patient is responding clinically . Some patients never respond clinically (with a remission of proteinuria ) despite a full immunolo...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 1 day ago

While decrease in PLA2R-Ab levels may predict remission in MN patients treated with RTX, the full normalization of proteinuria can take more time ....

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 2 days ago

High thrombotic risk warrants minimal anticoagulation interruption. • Prefer UFH bridging if switching from DOACs or warfarin. • Hold anticoagula...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 2 days ago

Agree with Dr Rodby, in Pre-Ritux era, steroid+CNI was the most widely used empiric therapy in this scenario but now it is Ritux. What was Albumin...

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RE: MGN with initially high PLA2R-Ab, 4x rituximab, still no remission 2 days ago

Im not so sure I agree wit this approach, in spite of improving albumin, based in this: "PLA2R-Ab (RE/ml, ULN= 14): 890 (2024) -> 573 (5/2024) ->...

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RE: Could piezo channels guide tubule formation the way they guide root growth in some plant species? 2 days ago

ADDENDUM Observation of Honey Moon Phase [hypertrophic glomerulo-pathy] of diabetic nephropathy. This third observation is probably associated ...

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RE: low IgG and rituximab 2 days ago

Agree with IVIG and Rituximab or preferably obinutuzumab ------------------------------ Roger Rodby MD, FASN Professor of Medicine Rush Unive...

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RE: Anca Negative Vasculitis 2 days ago

How long has the patient been on dialysis - 3 months? What did her urine look like during the AKI pre HD? Does the patient make urine now? ...

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RE: Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 2 days ago

Of course you want a biopsy, but that may be delayed or too difficult. it is always tough in this situation. for a biopsy you would have to stop ...

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Kindey biopsy after acute pulmonary embolism in the context of Nephrotic syndrome 2 days ago

Dear all If a patient presents with massive PE in the context of Nephrotic syndrome, how long to wait before interrupting anticoagulation for kid...

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RE: Anca Negative Vasculitis 2 days ago

If the described biopsy can be interpreted as ANCA vasculitis, then anything could be anything! It sounds like some arterionephrosclerosis with eos...

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RE: Anca Negative Vasculitis 3 days ago

Thanks very much Dr. Zuckerman for your helpful comments. They are right "on point". We need to see the actual photomicrographs. (Deindentifief , o...

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RE: low IgG and rituximab 3 days ago

"Could this HypoG be aggravated through the nephrotic syndrome?" Interesting question which is not easy to answer. The volume of distribution of ...

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RE: Anca Negative Vasculitis 3 days ago

I agree, the biopsy description does not provide convincing findings for a diagnosis of an ANCA negative pauci immune GN. It's hard to know what to...

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