RE: lupus membranous nephropathy treatment 1 hour ago

I don't think you should be concerned with over-Immunosuppression by substituting OBI for RTX. I would give OBI once the UPCR comes back over 1.5-2...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 1 hour ago

If the cream does not contain ammoniated mercury and was used for some purpose other than skin lightening I do not believe that this is sufficient ...

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RE: lupus membranous nephropathy treatment 1 hour ago

Thank you Dr Rodby, I appreciate the advice. And the same question I asked Dr Glassock- what will be a good timing? after all she got 1+ partia...

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RE: lupus membranous nephropathy treatment 1 hour ago

Thank you Dr Glassock ( as always). My main concern us the pt got already one dose and a partial second dose so I'm not sure when will be a good ...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 3 hours ago

What kind of cream is that? Any skin whitening cream exposure? Can you send for NELL-1 antibody staining on the biopsy? Sounds like mercury indu...

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RE: lupus membranous nephropathy treatment 4 hours ago

A longer version of my response might also be- while OBI has never (yet) been tested for safety and efficacy in pure Class V LN it seems to be ve...

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?incomplete dRTA, heterozygous SLC4A1 arg to tryptophan mutation, recurrent calcium phosphate stones (95% hydroxapatite) and nephrocalcinosis 10 hours ago

Hello I would appreciate some ideas on how to further approach and help this patient. 31 yo F, stones since the age of 16, passes 9-10 s...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 14 hours ago

Thanks for the input 1. Am trying to get her to bring the cream to us , initially assumed it was like a skin Whitening cream that many use , but s...

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RE: Role of Complement Blocker in Infectious GN ?? 15 hours ago

Yes we have access to C3NeF, will order it next week. --------------------------------- Dr. Hormaz Dastoor. MD, FASN Nephrology Consultant - Seha...

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RE: Role of Complement Blocker in Infectious GN ?? 18 hours ago

Dr. Dastoor. By chance, do you have access to assays of C3NeF. Such studies would be very interesting in this case,(see Noris and Remuzzi,JASN 2020...

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RE: lupus membranous nephropathy treatment 19 hours ago

"What about trying OBI?" Dr Glassock's shortest reply ever. I will shorten it Obi? I doubt it will ever get tested against Rituximab, but it ...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 19 hours ago

The story of cream and Hg or lipoic acid suggests NELL1 MGN , but that is often segmental and definelty not fun house etc AND the EM show resorbi...

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RE: lupus membranous nephropathy treatment 19 hours ago

What about trying OBI? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ------------------------------

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RE: Role of Complement Blocker in Infectious GN ?? 19 hours ago

The "spontaneous" improvement of GFR and C3 is most consistent with an IRGN, specifically ASPGN. I would observe him for further improvement with t...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 20 hours ago

Dr Dastoor have you checked the composition of the cream? Lipoic acid appears to be common in skin care products and it is associated with NELL1 ...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 20 hours ago

What is the tissue stains for PLA2R , NELL1 , EXTI/II and THSD7A.? More jlikely to to be ANA negative ClassV LN in the presence of mesangial deposi...

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RE: Is this Lupus MN or Idiopathic Membranous Nephropathy 23 hours ago

Seems compatible with Mercury Induced Membranous. 10.2215/CJN.07571009 ------------------------------ Awais Nauman HMC Doha ---------------------...

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Is this Lupus MN or Idiopathic Membranous Nephropathy 23 hours ago

I have been discussing a case with a colleague , who has a 32 year old female . She took some OTC cream for her skin , and few weeks later noted a ...

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RE: Role of Complement Blocker in Infectious GN ?? 1 day ago

hello again. This patients current status is a follows: He is off dialysis Serum creatinine is 160 umol/l ( 1.8 mg/dl)- baseline normal renal...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 1 day ago

High Serum Bicarbonate, High urine Spot chloride makes me to suspect Barrter's phenotype. Points against are unilaterality and normal urinary calci...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 1 day ago

MSK is in the differential. It can be a unilateral disease. Because IVPs are seldom ordered, MSK is diagnosed less frequently. It would be interest...

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lupus membranous nephropathy treatment 1 day ago

Hello I was treating a 39 y/o female diagnosed with lupus membranous nephropathy with low dose prednisone ( 5 mg daily) , Tacrolimus and Rituxim...

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25 y/o female type 1 dm with dibetic nephropathy with 12 gm proteinuria 1 day ago

Patient is 25 y/o black female with Type 1 DM and biopsy proven DM nephropathy, serum creatinine 2.5,mg/dL , eGFR 32 ml/min, has 12 gm of proteinur...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 1 day ago

Thanks Drs. Yau and Asplin. Very helpful comments .Does a spontaneous serum HCO3 (off all exogenous alkali , such as K Citrate) make an "incomplete...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 1 day ago

Like everyone else, I'm interested in what kind of stones he has. His urine chems certainly make one assume he has Ca stones (oxalate or phosphate)...

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RE: Hypokalemia , what is happening! 1 day ago

Roger, I agree with repeat measurements, particularly for stone formers. Even when urine is collected properly, there can be considerable variabili...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 1 day ago

Hi, Do you have any stone analyses on file? And is he making new stones based on imaging or just has persistent old stones seen on imaging? It ...

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RE: Hyperaldosteronism conundrum 1 day ago

What was the serum creatinine and cystatin-C? The unsuppressed renin may be due to long effect of the hypertension which may cause secondary kidne...

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RE: AI in Nephrology Conference April 23-24 2 days ago

Time is approaching University of California at San Diego, in collaboration with University of Alabama and Mount Sinai School of Medicine, is p...

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RE: Hyperaldosteronism conundrum 2 days ago

Thanks- i was interested in UACR to examine the CKM risk, which is fairly low in this patient , despite the coronary calcium score. -----------...

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RE: Hyperaldosteronism conundrum 2 days ago

Dr Glassock, urine protein cr ratio on treatment has been around 0.1 mg/mg 24 hr protein during the same test was only 100 mg . No prior stroke...

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RE: Hyperaldosteronism conundrum 2 days ago

Yes Dr Hirsch , I noted that as well, guidelines are more aggressive at present due to MACE . ------------------------------ Dhivya Sundaramurth...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 2 days ago

High alkali diet explains high bicarb, low sulphate but hypocitratruia is still perpelxing. Did this patient had a CT at any time? I wonder if US...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 2 days ago

The disparate 24 hour collections makes it difficult to use both for interpretation purposes although I do think it's reasonable to state that the ...

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RE: Hyperaldosteronism conundrum 2 days ago

Worth considering in a 56 year old: the latest Endocrine guidelines--https://pubmed.ncbi.nlm.nih.gov/40658480/--call for ALL patients with HTN to b...

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RE: Hyperaldosteronism conundrum 2 days ago

Just curious, what is the patients UACR? ------------------------------ Richard Glassock MD, FASN Laguna Woods CA (949) 388-8885 ---------------...

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RE: Hyperaldosteronism conundrum 2 days ago

Thanks Dr Chandran, will discuss with her again soon. If she chooses aggressive path, then would proceed to adrenal vein sampling. --------------...

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RE: Hyperaldosteronism conundrum 2 days ago

Thanks Dr Rodby, I agree . Had discussed about conservative vs aggressive approach with the pt prior to work up . I will discuss with her again. Sh...

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RE: Hyperaldosteronism conundrum 2 days ago

Thanks Dr Gharib for your pragmatic input. I appreciate it . ------------------------------ Dhivya Sundaramurthy MD, MBBS Des Moines IA (989) 964...

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RE: Hyperaldosteronism conundrum 2 days ago

Dr Glassock , we donot have the PET scan here in our hospital but I will explore at Mayo. Thanks for your suggestion. --------------------------...

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RE: Hyperaldosteronism conundrum 2 days ago

Divya: As Roger said, nice logical post. Your patient had significant disability from long history of hypertension from a treatable course and ther...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 2 days ago

UNH4+ very low UpH high BUT how does someone have an incomplete D-RTA with a HCO3 of 30? (assuming he was really off the KCItrate)? I can go...

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RE: Hyperaldosteronism conundrum 2 days ago

Nice post and nice responses! If you think you would remove this adenoma if adrenal aldo lateralized, then consider adrenal vein sampling. If p...

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RE: Hyperaldosteronism conundrum 2 days ago

-Should I do saline suppression test however worried about HTN and hypokalemia w/o amiloride? Mostly no need. The clinical scenario and aldostero...

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RE: Hyperaldosteronism conundrum 2 days ago

Do you have access to Adrenal Aldosterone Synthase imaging (? Mayo Clinic ). See Arstad E, et al NEJM, 2025) ------------------------------ Richa...

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Hyperaldosteronism conundrum 2 days ago

56 yr old female with h/o HTN ,hypokalemia since 40yrs, on amiloride, losartan, kcl 40meq per day > 10 yrs, normal gfr referred for HTN and hypokal...

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RE: Complement Profile Interpretation in IgA Nephropathy 2 days ago

This comment is a bit of an aside relative to the main point of Dr. Dastoor's original post but I think it is worthwhile pointing out that the 2025...

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RE: Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 2 days ago

The etiology of the stones could be 2 fold ... Hypocitraturia causing Ca oxalate stones , in which case I would still give K citrate or alkaline ur...

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Kidney stones in a 19 year old with alkaline urine, high urine PH, how to treat? 3 days ago

Hello everyone, I have a 19 year old male referred to me for kidney stones. He came from Pediatric Nephrology with a diagnosis of "Incomplete Dis...

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RE: Hypokalemia , what is happening! 3 days ago

@John Asplin your graph is amazing, it must contains the same population NYC! It also is an example of something (I cannot remember the termin...

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