RE: heart transplant candidate with membranous nephropathy 2 hours ago

Can you please post the deidentified kidney biopsy report? If this patient is being considered for heart transplantation, important to know how muc...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 3 hours ago

That is a good point. Thank you! ------------------------------ Jonathan Zuckerman MD, PhD UCLA Los Angeles CA (310) 794-1485 ------------------...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 3 hours ago

very thoughtful an complete analysis-- but I want to point out that a small number of cases that meet classical definition for fibrillary GN ( ie I...

View Discussion

RE: heart transplant candidate with membranous nephropathy 7 hours ago

Is the patient a candidate for Rituximab (or Obinutuzumab )therapy.? If so, I would treat with either one, Has the biopsy been sent for LD/MS analy...

View Discussion

heart transplant candidate with membranous nephropathy 9 hours ago

Subject: Consultation Request – Complex Case of Membranous Nephropathy in Heart Transplant Candidate I am seeking expert input on a challenging c...

View Discussion

RE: High 125 vitamin D With No Hypercalcemia Or Hypercalciuria, But Kidney Stone 9 hours ago

I agree with getting genetic testing rather than 24 OH metabolites. Because of the ratio, even a small error in measurement of 24 OH metabolites ca...

View Discussion

RE: High 125 vitamin D With No Hypercalcemia Or Hypercalciuria, But Kidney Stone 10 hours ago

Thanks Dr Glassock Will do I am surprised though no Hyperphosphatemia Hypercalcemia or hypercalciuria Not sure if lov lab can do 24,25 vit D Will s...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 12 hours ago

Given the high risk APOL-1 genotype, I am biased to think this is a genetic FSGS/APOL-1 nephropathy. The deposits seem somewhat underwhelming based...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 12 hours ago

Thank you so much for the details. ------------------------------ Anatole Besarab MD ABesarab Consulting Scottsdale AZ (734) 417-4793 ----------...

View Discussion

RE: Refratory nephrotic syndrome? 12 hours ago

The bacteriemia resolved very quikly and it this in the context of a colonoscopy. Next monday it will have 6 weeks post rtx. We started tacrolimus ...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 18 hours ago

Yes I agree , Iptacopan eGFR data is still awaited. But interestingly on stopping Iptacopan after 9 months , the majority will have recurrence of p...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 22 hours ago

The EM findings might be compatible with a MYH9 related disorder. Not all such patients have megathrombopemua. What was the platelet count? Any May...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

Agree The albumin loss is 2.13 g/g Cr Agree with staering RAAS therapy to decrease the exretion. Dr Glassock, anything else that should be do...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

Thanks for the clarification. The significant albuminuria and proteinuria with normal serum albumin and minimal podocyte effacement are not compati...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

Apologies, I found the error in my original post. The lab reported the spot urine micro albumin as > 1140 ug/mL Urine creatinine was 53 mg/dL ...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

I agree with Dr. Besarab. The urinary albumin excretion value posted in this thread is not compatible with cubulin deficiency. Please repeat the te...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

The problem or me is the inconsistency of the irone albumin to the dipstick False-positive results can occur with alkaline urine (pH more than 7....

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

Could this be a CUBulin problem; with VitB 12 deficiency (although not always low in infancy) = Imerslund Grasbeck Syndrome. In these cases ACei...

View Discussion

RE: High 125 vitamin D With No Hypercalcemia Or Hypercalciuria, But Kidney Stone 1 day ago

I think this is likely to be 24 hydroxylase deficiency. A ratio of 25 OH D to 24,25 DiOH D greater than 80 will give you the answer. -----------...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 1 day ago

Thanks Dr. Zuckerman for your erudite and well considered analysis of this case. Very helpful indeed . What diagnosis would you assign to this path...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 1 day ago

For the text provided; it's difficult to get a sense for the degree of C1q deposition. No intensity is provided and segmental deposition can be see...

View Discussion

High 125 vitamin D With No Hypercalcemia Or Hypercalciuria, But Kidney Stone 1 day ago

Please kindly help thanks 46 year-old female with history of kidney stones found incidentally on ultrasound in 2022 when she had abdominal pain N...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 1 day ago

Confusing data 3+ proteinuria confirmed upon multiple rechecks and first morning specimen. I prume by modern dispsticks which is specific for alb...

View Discussion

RE: IgAN vs postinfectious 1 day ago

went down a rabbit hole scrolling thru the ASN thread and came across this, any updates on this patient how they're doing? ----------------...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 1 day ago

We do not have any long term data on eGFR slope with ERA( Atrasentan ) but do have such data with DEARA.(Sparsentan). No long term eGFR data isyet ...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 1 day ago

Yes I agree with you... immunological driven disease ( hematuria , proteinuria , rapidly decreasing eGFR, M1 E1 C1-2) lesions probably will benefit...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 1 day ago

Current therapy is candesasrtan, dapagliflozin and rosuvastatin. Not started any immunosuppresion yet. ------------------------------ Bartlomiej ...

View Discussion

RE: Resistant hypertension 2 days ago

I think you are correct and in many younger individuals with little to no decrease in Kidney function with essential HTN. A hyperdynamic state is t...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 2 days ago

I think we could use a little help from our Renal Pathology colleagues. Drs. Fogo, Nast, Zuckerman? ------------------------------ Richard Glasso...

View Discussion

RE: Resistant hypertension 2 days ago

I would never disagree with Guyton unless I had clinical data. I believe there is data that shows that hyperdynamic state can cause HTN m...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 2 days ago

Thanks for the additional information. I still am not sure how to categorize this lesion. The evidence points to a secondary form ofcFSGS, modified...

View Discussion

RE: Proteinuria of unclear etiology in a pediatric patient. 2 days ago

With normal serum albumin and a very low UACR/ UPCR this looks like mainly tubular proteinuria. Do you have a Urine Protein Electrophoresis, serum ...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 2 days ago

Why does there need to be a decision between just two drugs. Many drugs are available to treat IgAN. Steroids and MNMF may be best for some patient...

View Discussion

Tablo machines 2 days ago

We have been having problems with positive water cultures in our tabllo machines that have been used for a good number of years as the main machine...

View Discussion

Proteinuria in IgA nephropathy- practice patterns 2 days ago

Error..apologies

View Discussion

RE: X linked Alport syndrome In Female 2 days ago

I completely agree with Dr. Glassock that the study by Yamaguchi M, et al. raises a red flag, but because is done in mice, it provides no evidence ...

View Discussion

Proteinuria of unclear etiology in a pediatric patient. 2 days ago

Greetings, I have a pediatric nephrology case I would appreciate some adult nephrology perspective on. 3 year old female presented with incid...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 2 days ago

From Uptodate - " The eGFR two-year chronic slope (from weeks 6 to 110) was -2.7 mL/min/1.73 m2/year with sparsentan and -3.8 mL/min/1.73 m2/year w...

View Discussion

RE: IgAN- ET1a Vs Complement Blockers In High Risk patients 2 days ago

Neither studies of ERA (Atrasentan ) or Complement Factor B inhibitors have reported (published) any results with GFR endpoints in IgAN . See the l...

View Discussion

RE: C1q Nephropathy - diagnosis? treatment suggestions 2 days ago

Genetic testing shows G1/G2 haplotype. The APOL1 G1 haplotype is c1024A>G, p.(Ser342Gly) and c.1152T>G, p. (Ile384Met) in cis (rs73885319 and rs609...

View Discussion

IgAN- ET1a Vs Complement Blockers In High Risk patients 2 days ago

For patients with High Risk IgAN, we have new FDA approved drugs . The question hence arises , for these high risk group , what should we use 1....

View Discussion

RE: X linked Alport syndrome In Female 2 days ago

The results of Yanaguchi et al study (referenced by Dr. Campese ) are very intriguing ( and potentially very worry provoking) but exclusively carri...

View Discussion

RE: Resistant hypertension 3 days ago

The search strategyin the ref cited comparing hydralazine to placebo did not yield any randomized controlled trials for inclusion in this review. T...

View Discussion

RE: X linked Alport syndrome In Female 3 days ago

The article by Gross et al in KI (thanks to Agnes for pointing this out), included only 20 patients in the randomized arm, and it failed to demonst...

View Discussion

RE: Resistant hypertension 3 days ago

My question to the group is what is the evidence that hydralazine is a better BP med than CCB? Has the safety, tolerability, efficacy been studie...

View Discussion

RE: X linked Alport syndrome In Female 3 days ago

Agree completely with Dr. Glassock's points- hopeful apparent benefit for "progression"- but hit is not based on long-term follow-up ------------...

View Discussion

RE: X linked Alport syndrome In Female 3 days ago

Many Thanks Dr. Fogo for pointing out this important Phase 3 RCT of Ramipril in Alport's. "Progression" in this study was based on change in albumi...

View Discussion

RE: X linked Alport syndrome In Female 3 days ago

The phase 3 trial in children with Alport- Early-PROTECT- did give ACEI (ramipril) early- with lesser proteinuria and appeared to decrease progress...

View Discussion

RE: X linked Alport syndrome In Female 3 days ago

Dr. Campese is absolutely correct that the evidence concerning a long term beneficial effects of RAS inhibition in Alport Syndrome is not based on ...

View Discussion

RE: MPGN/Lupus/DKD - biopsy. 3 days ago

I would wager a bet that the proteinuria response is probably due to Foundational CKD therapy. Having said that only a repeat biopsy would conclusi...

View Discussion