RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 54 minutes ago

Dr. Glassock, yes she has edema and hyperlipidemia (LDL 350 mg/dl and TC 450 mg/dl), the biopsy was done right after 3 pulse steroid therapy. Dr. ...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 2 hours ago

Dr. Hughson thanks I was aware of the use of paraffin embedded tissue for EM as a "rescue" technique to look for electron dense deposits. Can it...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 5 hours ago

MCD is now suspect. Was any edema or hyperlipidemia found at presentation? The UPCR and UACR may be wrong due to AKI. Was the biopsy done after or ...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 7 hours ago

Dr Hyder We will need a new biopsy for EM. One core in formalin is fine. There was no "dusting" on the glomeruli. There was no podocytopathy b...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 7 hours ago

Dr Hyder We can do the EM, if there are enough glomeruli in the block. It will take about a week. I'll talk to Dr Alaa tomorrow. It is not done r...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 8 hours ago

I published a study on proteinuria occurring in transplanted kidneys. Seeing that even LR kidneys had proteinuria , I wondered whether proteinuria ...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 9 hours ago

Thanks all for your insightful comments. We have the opportunity to have access to do ELISA anti-nephrin antibodies and I agree it is still not st...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 16 hours ago

Also If standard US was done I would perform a Doppler US to rule out renal vein thrombosis. ------------------------------ Emilio Venturelli MD...

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RE: Thoughts on immunosuppresion for canine MPGN? 18 hours ago

I have an average of 6 dogs, and whenever they have a terminal illness , I prefer to euthanize them. Having said that I am amazed by the advances i...

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RE: Thoughts on immunosuppresion for canine MPGN? 18 hours ago

If you were to proceed to treat this as a lupus case, you can try MMF again or if there is GI introlerance try mycophenolic acid. Apparently MPA ha...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 20 hours ago

Dr. Aledan, please clarify: 1. Was BP markedly elevated (SS-A/SS-B positive)? 2. Type of "pathological casts" in urine (mentioned under history in ...

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RE: Lupus Case 22 hours ago

I never use UACR in LN. After a Euro -Lupus CYC regimen, with a rapid PEXIVAS styled steroid taper, I would maintain on MMF (or RTX if ANCA +.). Ju...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 23 hours ago

How is anti-Nephrin antibody "pending"? We do not have an FDA approved assay in the USA. Research assays cannot be used for patient care. I suspect...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

Anti-nephrin antibodies but no Ems? that is a new one but you have to deal with what you have. IS this SS with MCD or a podocytopahty like we ...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

Too bad no EM. Thus case is most likely MCD superimposed on Sjogren Syndrome . Multiple case reporters have described this association. I would thi...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Primary (presumed auto-immune) IC-MPGN is exceptional uncommon in adult Humans-I have no ideas how common it is in dogs, but standard IF for LC mon...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

This is of course assuming that the GFR impairment is due to severe podocyte foot process effacement and acute tubular injury and not other process...

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RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

Very nice case Dr Aledan. this is my personal opinion it's unfortunate that the EM is not available. I think MCD is possible and we sometimes se...

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Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 1 day ago

A 48 years old female patient with a history of hypertension (7-8 years duration ) and poorly controlled. Presented with decreased urine output and...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Assuming this is not a CMGRS (canine monoclonal gammopathy of renal significance) - on the list only bc of the MPGN pathology Assuming this is n...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Thanks, Dr. Torralba. Detection of anti-ds and anti-Smith antibodies have been described in dogs, but they are not commercially available tests to ...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

Jd: A question for you. I have been interested in uremic toxins for years as a clinician. I know cats get renal failure not infrequently. Would you...

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RE: Thoughts on immunosuppresion for canine MPGN? 1 day ago

ANA or RF would not give you much specificity. Would it be possible to run anti-dsDNA, anti-Smith instead? ------------------------------ Karina...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Since dogs do have and express all four IgG heavy chain subclasses, it is probably best to test for heVy chain rather than LC monotypism, if one is...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Thanks so much for sharing your thoughts. We can definitely run an SPEP and immunofixation to look for any gammopathy that could be present. We...

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RE: Lupus Case 2 days ago

I agree , a sister facility has used CarT for malignancies and 2 cases of lupus . Awaiting to see their results . But I think it has drawbacks , in...

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RE: Lupus Case 2 days ago

Just an opinion but I don't think that CAR-T cell therapy is quite ready for prime time in a case of LN like this. . The potential for AE related t...

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RE: Lupus Case 2 days ago

Any thoughts on CarT - CD19/BCMA or TCE therapies ( teclistamab) if it's available at your facility. --------------------------------- Dr. Horma...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Exactly correct. This I s why PGNMID needs to be considered as a cause of a MPGN lesion in this dog with monotypic LC glomerular deposits and a "M ...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

for MPGN I always refer back to this figure from 2013 NEJM review that starts with isolated C3 staining or not The IF in this case puts it to...

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RE: Thoughts on immunosuppresion for canine MPGN? 2 days ago

Understood. Under these circumstances it will be extremely difficult to establish a " diagnosis" of PGNMID in a dog, in humans PGNMID is usually ...

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RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Bortezomib has been reported in 2 case reports for treating multiple myeloma in our world- one in a cat and another in a dog. The dog was also trea...

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RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Thanks . Understood. This is a problem. In dogs, one cannot exclude a PGNMID by using anti-human LC specific antibody reagents . I suspect that Las...

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RE: Thoughts on immunosuppresion for canine MPGN? 3 days ago

Thanks for your thoughts, Dr. Glassock. For clarification, the ratio of lambda to kappa light chains in dogs is almost entirely lambda. Kappa sta...

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RE: 9/11 and Nephrology 3 days ago

David, Like you I have flashback as well. Thank you for for the reminder and what it led to . ------------------------------ Anatole Besarab MD A...

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RE: Thoughts on immunosuppresion for canine MPGN? Thursday, September 11 @ 4:00 PM

What is LLC? If it is Lambda Light Chain then you need to consider Proliferative GN with monoclonal IgG deposits ------------------------------ ...

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RE: 9/11 and Nephrology Thursday, September 11 @ 1:00 PM

An amazing combination of hilarious, insightful, imaginative, and fascinating. Thanks for sharing! ------------------------------ Sheldon Hirsch ...

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Thoughts on immunosuppresion for canine MPGN? Thursday, September 11 @ 11:11 AM

Hi everyone, I'd love to get some thoughts on potential drug options for a patient of ours. This is a 3 and 1/2 year old French Bulldog who ha...

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9/11 and Nephrology Thursday, September 11 @ 10:14 AM

As I always have flashbacks on 9/11, I thought I would share with you a report and an essay on the nephrologic aspects of that day in New York City...

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RE: Transplant Case Thursday, September 11 @ 10:06 AM

A biopsy is needed. A late PTLPD is usually EBV negative and behaves more like a lymphoma that early PTLPD that often goes away when immunosuppresi...

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RE: Lupus Case Thursday, September 11 @ 9:04 AM

I agree with you Dr. Dastoor. But the BLISS trial may have included too few patients with this severe crescentic GN to draw any firm conclusion abo...

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RE: Lupus Case Thursday, September 11 @ 3:31 AM

I would take the contrarian view. Your patient has severe renal and extra renal involvement , and would benefit more from a Belimumab based regimen...

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RE: Lupus Case Wednesday, September 10 @ 7:21 PM

Thanks everyone after 6 pulses of cyclophosphamide Then start mmf ? Thanks --------------------------------- Muhammad Soobadar MBChB UK -----...

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RE: Transplant Case Wednesday, September 10 @ 10:41 AM

Sorry my bad. I thought it was large bowel due to a careless reading of the post. In that case a CT guided lymph node biopsy would be best. ----...

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RE: Transplant Case Wednesday, September 10 @ 10:35 AM

Dr. Balan tissue is needed for PTLD diagnosis but in this case the CT scan shows small bowel involvement.. would you still perform random biopsy in...

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RE: Recurrent ascites in ESRD pt Wednesday, September 10 @ 10:03 AM

Very interesting discussion. I have a patient currently with severe recurrent ascites requiring frequent LVPs where cardiac source has been ruled o...

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RE: Transplant Case Wednesday, September 10 @ 9:09 AM

I think your original suggestion of colonoscopy is great. Everything depends on the tissue diagnosis. If we are able to get a biopsy then the other...

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RE: Transplant Case Wednesday, September 10 @ 8:34 AM

Agree with everything said and we usually involve oncology to help guide PET scan use and treatment. Get Outlook for iOS

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:42 AM

Thank you all. I will provide a table of recent results which Will make things a bit more clearer ------------------------------ M Kaisar Neph...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:33 AM

Mycophenolate sodium 720 mg three times daily (2160 mg/d) is pretty much a maximum dose. I would not push it any further., especially with declinin...

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