RE: Severe Acute Tubular Injury With Severe Nephrotic Syndrome And Presumptive MCD diagnosis 6 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? 8 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? 8 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 10 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 12 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 13 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 13 hours 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 14 hours 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? 14 hours 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 16 hours 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 16 hours 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 17 hours 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? 18 hours 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? 18 hours 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? 20 hours 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? 1 day 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? 1 day 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 1 day 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 1 day 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 1 day 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? 2 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? 2 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? 2 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 2 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? 3 days ago

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 3 days ago

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

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Thoughts on immunosuppresion for canine MPGN? 3 days ago

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 3 days ago

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 3 days ago

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 3 days ago

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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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:15 AM

Could you please post the deidentified report of the most recent kidney biopsy - this should help with the decisions about treatment modalities . I...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:04 AM

With these doses , the patient is receiving Mycophenolate sodium not Mycophenolate mofetil. ------------------------------ Richard Glassock MD, ...

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RE: 52 year old male with class V LN Wednesday, September 10 @ 12:04 AM

I would not consider Rituximab again... Unless biopsy shows high Acuity scores and serology shows high activity . Would probably consider MMF + CN...

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RE: Qb and myocardia stunning Tuesday, September 9 @ 10:00 PM

I too do not know whither there us any good data. No doubt the extracorporeal blood flow in the dialysis circuit is not affected unless the flow ex...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 9:05 PM

Dr Glassock. The word uremic is too broadly used. Some substance retained in the state of ESRD which has an effect in a particular target system is...

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RE: Recurrent ascites in ESRD pt Tuesday, September 9 @ 8:50 PM

I agree tou Fr Rodby. How do measure adequate dialysis. After more than 49 years of Kt/V I am convinced that the latter does not do justice to "wha...

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RE: Primary Aldosteronism With Hamaturia And Proteinuria For Possible Surgery Tuesday, September 9 @ 8:15 PM

When I had the ARR determines I was off ARB for a week but took the rest of the medical, of course mt BP did go up -----------------------------...

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