RE: Treatment of progressing Fabrys 44 minutes ago

Dr. Lerman, the following reference from the AI response is relevant to your question:: https://pmc.ncbi.nlm.nih.gov/articles/PMC10232004/ it a...

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RE: Treatment of progressing Fabrys 53 minutes ago

Could absence of glomerular hypertrophy & proteinuria reflect converse of Brenner hypothesis (given height-correlated nephron over-endowment assumi...

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RE: Treatment of progressing Fabrys 1 hour ago

Dr. Venkat did your AI suggest any additional treatment? ------------------------------ [Mark] [Lerman] [MD,FASN,FACP,FAST] AST KPCOP EC [Past Me...

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RE: Treatment of progressing Fabrys 1 hour ago

Dr. Venkat- many thanks. Hard to postulate progressive podocyte injury in absence of proteinuria (albuminuria ). Coukd be a delayed response to pri...

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RE: Treatment of progressing Fabrys 1 hour ago

Thanks for posting this case. I did a Google AI search with the following question: "Findings on serial kidney biopsies in Fabry's patients on cont...

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RE: Treatment of progressing Fabrys 3 hours ago

Thanks for the quick reply. It might help to examine the sclerotic glomeruli more carefully. If they are of a solidified character they are not par...

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RE: C5 blocker in IgA and other controversial recommendations 3 hours ago

Dr. Dastoor- thanks for your detailed response- very helpful. Here are somexcomments. 1) you might find a better response to oral systemic ster...

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RE: Treatment of progressing Fabrys 4 hours ago

Antidrug antibodies have been considered, not yet done the sclerosed glomeruli are described as atrophic, no hypertrophy described IF: IgG and Ig...

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RE: Treatment of progressing Fabrys 5 hours ago

What di the IF show? Does the patient have any anti-drug antibodies? At what age was therapy started? Please give the serum creatinine values ay z...

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Treatment of progressing Fabrys 6 hours ago

I would be grateful for some suggestions. We have a patient with Fabrys who has been on Fabrizyme for around 10 years, on the maximal dose. We...

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RE: GLP -1 RA question 13 hours ago

Thanks prof glsssock --------------------------------- Muhammad Soobadar MBChB UK ---------------------------------

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RE: nephrotic syndrome 13 hours ago

Thanks for case Why is there increased bleeding risk ( related to biopsy ) with using VEGF inhibitor? I know there might be data that patients ...

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RE: C5 blocker in IgA and other controversial recommendations 15 hours ago

thanks for the question.. we have 5 patients lined up for Ravulizumab . They all have had one or two cycles of oral steroids based on low dose TE...

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RE: C5 blocker in IgA and other controversial recommendations 17 hours ago

Thanks- very clear. Why did you use Ravulizumab first in the case you posted.? Was there some clinical or morphological feature that drove you make...

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RE: salt losing nephropathy 18 hours ago

Thanks dr. Mellas for the clarification. --------------------------------- Dr. Hormaz Dastoor. MD, MSc, FASN Divisional Head of Nephrology Sheik...

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RE: C5 blocker in IgA and other controversial recommendations 18 hours ago

Thank u for your comments . I use the same criteria as recommended in Uptodate . We identify 4 high risk factors - 1. Hematuria 2. Proteinuria mor...

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RE: GLP -1 RA question 20 hours ago

The easy answer to your Question is YES , in my opinion. But the severity of Diabetic Retinopathy should not be used as an argument against better ...

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RE: C5 blocker in IgA and other controversial recommendations 21 hours ago

Dr. Dastoor- thank you for your comments and for opening a dialogue about when to use potent (and sometimes very expensive ) immunosupprressive/ an...

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RE: GLP -1 RA question 21 hours ago

Thanks prof lerman and prof glassock Found interesting article https://pmc.ncbi.nlm.nih.gov/articles/PMC6587545/ If someone has proliferative d...

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C5 blocker in IgA and other controversial recommendations 1 day ago

3 days ago , the UAE , was the first country to officially approve Ravulizumab for IgA nephropathy , and we injected our first patient with the med...

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RE: Unexplained Renal Failure or Not 1 day ago

Very interesting theoretical question. Would repetitive episodes of low grade rhabdomyolysis and myoglobinuria predispose to heme-Fe -related tubul...

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RE: Unexplained Renal Failure or Not 1 day ago

No unlikely from AI • Persistent mild CK elevation and trivial myoglobinuria (26 vs [More]

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RE: Unexplained Renal Failure or Not 1 day ago

agree but he does have persistent mildly elevated CK without exercise and elevated uric acid so metabolic -muscle workup as I also suggested Number...

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RE: Unexplained Renal Failure or Not 1 day ago

Would this persistent low level rhabdomyolysis and myoglobinuria damage his kidney in the long run ?? --------------------------------- Dr. Horma...

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RE: Unexplained Renal Failure or Not 2 days ago

not an issue DR. GLASSOCK you are amazing -thanks for all you and Dr. Rodby do by creating this forum !!! ------------------------------ [Mark] [...

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RE: Unexplained Renal Failure or Not 2 days ago

We agree 100%. Sorry I missed your point in a prior post. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen Scho...

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RE: Unexplained Renal Failure or Not 2 days ago

"He does not have CKD- as he does not meet any of the criteria used for making this "diagnosis". -almost exactly what I said Number 5 above. Dr. ...

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RE: Unexplained Renal Failure or Not 2 days ago

He does not have CKD- as he does not meet any of the criteria used for making this "diagnosis". ------------------------------ Richard Glassock M...

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RE: Unexplained Renal Failure or Not 2 days ago

In the general population the eGFR Cystatin C is no more accurate the eGFR creatinine in estimating the level of measured GFR. The combination of t...

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RE: Unexplained Renal Failure or Not 2 days ago

I think one major issue is exercising at 50 degree C. You don't need a muscle disorder to produce AKI at that level. It may be better for him to ex...

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RE: Unexplained Renal Failure or Not 2 days ago

I dont think he has chronic kidney disease. His cystatin C is normal with normal eGFR of 125 ml/min. Despite the fact that he is on ARBs with diure...

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RE: Unexplained Renal Failure or Not 2 days ago

Or do genetic screening for the mutant PYGM allele. ------------------------------ Richard Glassock MD, FASN Emeritus Professor Geffen School of ...

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RE: Unexplained Renal Failure or Not 2 days ago

You might want to consider a muscle biopsy for glycogen deposits (McArdle disease) in light of exercise induced rhabdomyolysis. -----------------...

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RE: Unexplained Renal Failure or Not 2 days ago

I agree with Dr Rodby on all four points. I suspect--based on Cystatin C vs Cr-based eGFR discrepancy--that his musculature is more than "average b...

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RE: Unexplained Renal Failure or Not 2 days ago

1) i suspect he does not have ckd 2) i would not do a renal biopsy 3) i would work him up for metabolic muscle disease such as McArdles, and si...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 2 days ago

Thank you for your reply. I think its only chronic kidney disease with no active disease warranting risking the patient with immunosuppression. J...

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RE: Unexplained Renal Failure or Not 2 days ago

He has a high risk metabolic profile with high BMI, high uric acid , Impaired glucose tolerance , high lipids .. seen and started on oral orforglip...

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RE: Unexplained Renal Failure or Not 2 days ago

I'm interested to know about his other metabolic risk factors, such as his BMI, waist circumference, lipid profile, triglyceride levels, HbA1c, and...

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RE: Unexplained Renal Failure or Not 3 days ago

Would not label as CKD as criteria is not made post discharge ARB can elevate serum creatinine and lower eGFRcr but not eGFRcys more importan...

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RE: Management Challenges in a Patient with C3 Glomerulonephritis 3 days ago

Hi, Dr. Jebur, thanks for the discussion. Below are the answers for your questions: The patient is 1.829m tall. In 11/20217, renal US showed:...

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RE: Unexplained Renal Failure or Not 3 days ago

I have scheduled him for a measured GFR estimation. 24 hour urine collection has not been requested and not done as yet . Peak creatinine during ...

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RE: Unexplained Renal Failure or Not 3 days ago

What is the 24 hour creatinine excretion compared to estimates based on Age, sex, weight, height?. Ethnicity. I would do a measured GFR. I have lil...

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RE: Unexplained Renal Failure or Not 3 days ago

Peak SCr levels during 2 episodes of rhabdomyolysis? May consider an accurate 24hr urine collection for measured creatinine clearance or radioisoto...

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RE: salt losing nephropathy 3 days ago

In a steady state with euvolemia and negligible insensible losses of Na and H2O; 2000 ml .45% NS = 154 meq Na in, 1000 ml H2O in, 154 meq Na out, 1...

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RE: salt losing nephropathy 3 days ago

In a situation of euvolemia and a steady state with negligible insensible losses of Na and H20. 2000 ml .45% NS = 154 meq Na in, 1000 ml free wat...

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RE: salt losing nephropathy 3 days ago

@John Mellas i didn't understand point number 2. Is it possible you could elaborate with some numbers ...thank you ------------------------------...

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RE: salt losing nephropathy 3 days ago

2 points; 1 If the kidney function is improving a salt wasting state is not likely and reflects infused and retained solute. 2 The urine Na exc...

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Unexplained Renal Failure or Not 3 days ago

This is a case of a 42 year old male , who is the legal counsel of our hospital. He comes from London , but is of mixed Afro Caribean origin from...

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RE: Denovo Idiopathic MPGN of Renal Allograft 3 days ago

Dr. Sarwat- thanks for posting the native and allograft biopsy reports. As I was concerned given using Tac monotherapy alone- particularly in a pat...

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RE: salt losing nephropathy 3 days ago

Your patient is experiencing polyuria from an osmotic diuresis (NaCl induced). I suspect that thus is more related to the infusion therapy than to ...

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