Do we need genetic testing in C3G (outside Cypriot ancestry)? 51 minutes ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

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RE: Iron replacement strategy in dialysis 53 minutes ago

I tend to agree with Dr. Rodby's position and would like to pose the question regarding the trade-off between higher ferritin tolerance vs. need fo...

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RE: A case of Acute Kidney Injury. 59 minutes ago

Did the kidney biopsy show extensive RBC in the tubules- if not, it will be hard to invoke "anticoagulant nephropathy " as the cause of the AKI- i ...

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RE: A case of Acute Kidney Injury. 1 hour ago

He is on Apixaban. Immunofloresence showed mild IgA deposits. Once again not enough to explain his AKI. No ATN. Given RBCs with no evidence...

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RE: AA Amyloidosis of unknown origin? Idiopathic? Other ? 6 hours ago

Thank you for tour valuable input. WR Zaher ------------------------------ Zaher Armaly MD Nazareth Hospital -EMMS Nazareth 97246028829 ----...

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RE: A case of Acute Kidney Injury. 9 hours ago

He has AF (presumably on a DOAC or warfarin), and an episode of gross hematuria, which is a classic setup. Look for RBC casts, tubular obstruction ...

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RE: A case of Acute Kidney Injury. 11 hours ago

Agree that non-diabetic nodular glomerulosclerosis cannot explain the AKI. It only accounts for the proteinuria. As I had speculated earlier, anoth...

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RE: A case of Acute Kidney Injury. 14 hours ago

That's true. But how to explain such quick deterioration in GFR. ------------------------------ [Saifullah] [Kazi] [MD] [Consultant Nephrologist...

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RE: A case of Acute Kidney Injury. 15 hours ago

Cigarette smoker? Non-diabetic nodular glomerulosclerosis more common in smokers. ------------------------------ K.K. Venkat MD Troy MI (248) 42...

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RE: A case of Acute Kidney Injury. 15 hours ago

Yes diffuse foot process effacement. I don't have AUCR. Worth a check I guess? no dysmorphic RBC or casts. ------------------------------ [Saif...

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RE: A case of Acute Kidney Injury. 16 hours ago

Thanks. Very helpful. The UPEP is not likely be normal with 3gms of proteinuria. . Do you have a uACR and uPCR?. The thickened GBM and nodular Glom...

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RE: A case of Acute Kidney Injury. 16 hours ago

Free light chains normal, SPEP and UPEP are negative, including cryo. no h/o diabetes EM- open capillary loops, thickened basement membrane, p...

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RE: A case of Acute Kidney Injury. 17 hours ago

The repeat kidney biopsy pretty much makes Vasculitis or Glomerulonephritis as a cause of AKI extremely unlikely, but the episodic hematuria remain...

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RE: A case of Acute Kidney Injury. 17 hours ago

Unfortunate that no past urinalyses are available. Proteinuria and microscopic hematuria due to another cause might have antedated the superimposit...

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Do we need genetic testing in C3G (outside Cypriot ancestry)? 18 hours ago

In my opinion — no. Would like the community's input on this. Unlike aHUS, genotype doesn't drive diagnosis, treatment, monitoring, stopping decisi...

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RE: A case of Acute Kidney Injury. 19 hours ago

I would echo the statements of the Dear Professor . During my fellowship several decades ago , I was taught that in case of subacute renal failure...

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RE: A case of Acute Kidney Injury. 20 hours ago

Do you have EM on the second biopsy? What is the full extent and nature of "nodular sclerosis "?. Is the patient diabetic? Do you have serum free l...

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RE: AA Amyloidosis of unknown origin? Idiopathic? Other ? 20 hours ago

I would postulate that this patient (and perhaps his sister ) have inherited a high -Amyloid risk variant of the NOD2 gene associated with Crohn-s....

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RE: Iron replacement strategy in dialysis 21 hours ago

The Pivotal Trial has serious limitations and should not be used to establish "Guidelines". 1) it was open-labeled. 2) it showed an ARR of only...

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RE: Iron replacement strategy in dialysis 21 hours ago

Teleologically, the iron level is controlled at the entry gate, which speaks of overload harm. In dialysis patients, we bypass that gate with IV ir...

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A case of Acute Kidney Injury. 22 hours ago

76-year-old male who with medical history for long standing hypertension, Atrial fibrillation who had a mechanical fall with tibia fracture needing...

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AA Amyloidosis of unknown origin? Idiopathic? Other ? 1 day ago

Dear All Good day, A 32-year-old male, Parents of Arab origin from the Galilee. In 2014, he began experiencing abdominal and diarrheal symptoms...

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RE: Resistant Rejection 1 day ago

Look at prograf level variablity index. Also, how does patient seem, mentally and psychologically? we have had a couple of patients flat out gi...

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RE: Iron replacement strategy in dialysis 1 day ago

I agree - guidelines are not infallible and are often (too often) touted as "evidence based" when they really are not, since the evidence is freque...

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RE: Iron replacement strategy in dialysis 1 day ago

Dr Cook, I hardly am pretending to know much about this topic, so I asked open evidence… I am generally NOT a fan of guidelines , my former c...

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RE: Iron replacement strategy in dialysis 1 day ago

The KDIGO recommendations are based on the PIVOTAL trial, which shows that a proactive approach targeting high TSAT and ferritin levels is more eff...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thank you fir this citation. I was not aware of it. It is a single research letter report from 6 years ago. . Was the finding ever independently co...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

another way that might help is to stain globally sclerosed glomerulus for IgA, if positive, IgA related GN is probably less likely. See: Kidney Int...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

These values make me more worried about an infection-related IgA dominant GN. Have you performed a TEE for cardiac valve vegetations? Do you have K...

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RE: Resistant Rejection 2 days ago

A though case. I think second dose of rituximab or tocilizumab is unlikely going to work in this case. We have some experience with daratumumab in ...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Rheumatoid factor was 88 IU/mL and 77 IU/mL, two days apart (Lab reference range: 0-14 IU/mL). C3 complement was 52 mg/dL (reference: 82-167) and C...

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RE: Iron replacement strategy in dialysis 2 days ago

Thanks Dr Rodby, I really appreciate and respect your posts in general. Even though I've never met you, I consider you one of my better educat...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 2 days ago

RItuximab in true steroid resistant Prinaryv FSGS with Nephrotic Syndrome , results in a complete or partial remission in about 20% of patients . T...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thanks. What were the levels of RF and C3/C4. If the RF is very high, you may want to start with a low dose of RTX to avoid a passive serum sicknes...

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RE: PLEX in Crescentic IgA Nephropathy 2 days ago

Thank you all for the great inputs! Here are the answers to all the questions that were asked. Creatinine data - Baseline around 1 mg/dL...

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RE: Iron replacement strategy in dialysis 2 days ago

im still not sure of the risk if clinically evident end organ damage from top From Open Evidence - "How often is iron overload by ferritin lev...

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RE: Nephrotic Range Proteinuria And Unremarkable Renal Biopsy 3 days ago

Dr. Dastoor very interesting It's quite unusual for me to see response with Rituximab in (true) steroid resistant patients Do you, or other pe...

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RE: Resistant Rejection 3 days ago

If DSA is negative, the MVI element, provided recurrent GN and Hep C infection etc is ruled out, maybe it could be due to NK Cells and warrant CD38...

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RE: Resistant Rejection 3 days ago

What are tacrolimus trough levels during this period. The August biopsy showed intimal fibrosis and prominent arteriolar hyalinosis which is not pr...

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RE: Iron replacement strategy in dialysis 3 days ago

Ferritin >500 μg/L is a red flag, especially if it's rising without clear inflammation. But the real signal is transferrin saturation (TSAT): once ...

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RE: Iron replacement strategy in dialysis 3 days ago

You're right, that's probably an unrealistic target goal. But I wonder if our ferritin protocols are too generous and I also wonder if some of the ...

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RE: Iron replacement strategy in dialysis 3 days ago

Not meaning to sound flippant but good luck keeping the ferritin 1-300. May I ask where this data comes from? Is it observational ? My guess is i...

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RE: Resistant Rejection 3 days ago

Dr Pineda is spot on about further tissue staining for markers of PTLD. Dr Aleydan I want to clarify what does "Late Active" signify in histopatho...

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RE: Iron replacement strategy in dialysis Saturday, September 26 @ 8:29 AM

Based on my personal experience a slightly higher ferritin target may be necessary and acceptable. Then the question becomes one of overruling th...

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RE: PLEX in Crescentic IgA Nephropathy Saturday, September 26 @ 5:50 AM

I do not think that this patient would qualify for the suggestion made by KDIGO CPG to treat with a combination of CYC + Steroids. I agree that the...

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RE: PLEX in Crescentic IgA Nephropathy Saturday, September 26 @ 4:06 AM

In this patient with crescentic IgA nephropathy/IgA vasculitis nephritis, routine PLEX is not recommended, as evidence for benefit in IgAV-associat...

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RE: PLEX in Crescentic IgA Nephropathy Saturday, September 26 @ 12:31 AM

Dr. Gharib- you raise some important issues. We do need to know the results of C3/C4 serum levels, Rheumatidc Factor levels, Cryoglobulin Assays an...

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RE: PLEX in Crescentic IgA Nephropathy Friday, September 25 @ 6:55 PM

It seems that the major contribution of very low GFR (serum creatinine 4 mg/dl) comes from ATI from RBC casts as suggested by Dr. Rodby especially ...

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RE: PLEX in Crescentic IgA Nephropathy Friday, September 25 @ 6:49 PM

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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RE: PLEX in Crescentic IgA Nephropathy Friday, September 25 @ 6:49 PM

------------------------------ Mohamed Gharib MBBS Ain shams university Cairo 01000322177 ------------------------------

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